Acute and chronic vertebral compression fractures

An 83 year old woman with back pain. [...]

C3 burst fracture

A 77 year-old woman seen in the emergency room, following trauma, with cervical pain but no neurologic deficit. [...]

Val M. Runge, MD – ASNR 2015 – Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease – The Essentials with MR and CT

This educational exhibit was presented at the ASNR 2015 meeting, with imaging performed on a 3 T Siemens Skyra MR system. The full reference for the exhibit is given below. Runge V, Smoker W, Valavanis A. Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease – The Essentials with MR and CT. ASNR 53rd Annual Meeting, […] [...]

Oligodendroglioma (WHO grade II)

A 30 year old man referred to Neurosurgery for a mass lesion (of the brain) revealed by imaging at an outside hospital. [...]

Medulloblastoma (posterior fossa PNET)

A 7 year-old boy who presents with nausea and vomiting. [...]

Val M. Runge, MD – ASNR 2015 – Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI

This educational exhibit was presented at the ASNR 2015 meeting, with imaging performed on a 3 T Siemens Skyra MR system. The full reference for the exhibit is given below. Runge V, Richter J, Beck T, Piccirelli M, Valavanis A. Simultaneous Multi-Slice (Slice Accelerated) Diffusion EPI. ASNR 53rd Annual Meeting, April 25-30, 2015, Chicago, Illinois […] [...]

Disk space infection (L2-3)

A 70 year-old woman with chronic kidney disease, on IV antibiotics for osteomyelitis. [...]

Metastasis (breast carcinoma)

A 64 year-old woman with a history of breast cancer, presenting with weakness [...]

Pituitary microadenoma (prolactinoma, treated)

A 31 year-old woman with long-standing infertility, who prior to treatment presented with galactorrhea, now on cabergoline. [...]

Pituitary macroadenoma, with invasion of the left cavernous sinus

A 58 year old woman presenting with a visual field defect (bitemporal hemianopsia) [...]

Parenchymal hemorrhage, late subacute

A 68 year-old woman several weeks following a stroke. [...]

Periventricular leukomalacia

A 3 year-old girl, product of in vitro fertilization (with a normal twin), delivered by c-section at 30 weeks. She is mildly developmentally delayed, with spastic diplegic/triplegic cerebral palsy. [...]

Metastases (renal cell, lumbar)

A 56 year-old man with back pain [...]

Cavernous malformation

A 60 year-old woman with myelopathic symptoms, status/post cervical decompression, with follow-up cervical MR revealing a lesion in the pons. [...]

Toxoplasmosis

A 30 year-old woman with HIV [...]

ACOM aneurysm

A flow void is noted in the region of the anterior communicating artery (ACOM) on an axial T2-weighted image, with signal intensity corresponding to arterial flow on an axial source image from a 3D TOF MRA. CE MRA images further confirm the aneurysm, with the right A1 segment of the ACA noted to be very […] [...]

ACA aneurysm

Note the prominent pulsation artifact in the first image (a FSE T1-weighted scan at 3 T), seen propagating in the left-right dimension. On the post-contrast image (a short TE GRE scan), the aneurysm is well depicted, other than partial volume effects (due to the 4 mm slice thickness). This 2D scan is relatively immune to […] [...]

Ankylosing spondylitis, chronic disease

There is marked irregularity and sclerosis of the sacroiliac joints bilaterally. Fatty changes are noted as well, in the sacrum, bordering the joint. There is little edema within the bone adjacent to the sacroiliac joints. All are findings consistent with long standing disease. Part of the on-line supplement to Neuroradiology – The Essentials with MR […] [...]

Ankylosing spondylitis, hip disease

One-third of individuals with AS develop hip and shoulder involvement. Bilateral disease, with joint effusions and synovial enhancement are characteristic. Additional less common findings include subchondral bone marrow edema, erosive destruction, and fatty accumulation. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – […] [...]

Ankylosing spondylitis, sacroiliac joint disease

In this patient with long standing disease, joint space irregularity and adjacent fatty changes predominate. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Ankylosing spondylitis, with bony ankylosis of the sacroiliac joints

In this 44-year-old patient, coronal images of the pelvis reveal fusion of the sacroiliac joints bilaterally. Sagittal images of the lumbar spine show vertebral body squaring and a bamboo like appearance due to diffuse ankylosis (and syndesmophytes). There is vertebral body fusion at multiple levels, with loss of disk space height and abnormal signal intensity […] [...]

Anterior and posterior fusion defects of C1

Note the well corticated margins and absence of a discrete fracture line. Such fusion defects are congenital in nature, and are primarily incidental findings. Incomplete posterior fusion can be seen in normal children up to the age of 10, with bony fusion typically occurring by age 5. Clefts of the posterior arch occur in 5% […] [...]

Cervical cord hemangioblastoma

Cervical cord hemangioblastoma, in a patient with von Hippel Lindau syndrome. A small enhancing intramedullary lesion is noted at C4, with mild accompanying vasogenic edema. 75% of spinal cord hemangioblastomas are sporadic, 25% occur in association with von Hippel Lindau syndrome. Spinal cord hemangioblastomas most commonly occur posteriorly within the cord, as in this patient. […] [...]

Chondrosarcoma of the cervical spine

The left lamina of C2 is involved by a focal mass lesion, which is slightly expansile in nature. A somewhat characteristic feature of the histologic diagnosis, reflecting hyaline cartilage, is the marked hyperintensity on the T2-weighted scan. There is moderate enhancement post-contrast, which as with the other findings (with the exception of the appearance on […] [...]

Chronic dens fracture

A type II odontoid fracture is present, with non-union (pseudoarthosis). (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

DISH (diffuse idiopathic skeletal hyperostosis) in the cervical spine

In DISH (also known as Forestier disease) there is calcification and ossification of ligaments and entheses (the connective tissue between bone and a tendon or ligament) involving the vertebral column. Ossification of the anterior longitudinal ligament is common (and often marked), and may occur in conjunction with ossification of the posterior longitudinal ligament (OPLL). Both […] [...]

Epidural hematoma, spine, illustrating image composition

Composed sagittal T2-weighted, T1-weighted, and post-contrast T1-weighted images are presented. Each image is an automatically generated composition of two high-resolution independent cervicothoracic and thoracolumbar image acquisitions. The patient was on aspirin and Plavix, and presented with urinary retention and poor anal sphincter tone, consistent with a lesion compressing the conus medullaris. A predominantly deoxyhemoglobin epidural […] [...]

Hydatid cysts of the sacrum, ileum and L5

In the spine, with hydatid disease, there is typically slow resorption of trabeculae, without bony expansion, with a conglomeration of daughter cysts. This accounts for the multilocular appearance on MR, with high signal intensity on T2-weighted sequences. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement […] [...]

Hyperflexion injury with a clay-shoveler fracture

CT depicts an avulsion fracture of the spinous process of C6. MR reveals additional important findings, including the extensive posterior paraspinal muscular injury (edema), disruption of the interspinous ligament, compression fractures (marrow edema) involving multiple contiguous cervical and thoracic vertebral bodies, and extensive prevertebral edema as well as fluid (hemorrhage). Note that the cord appears […] [...]

Ivory vertebra, metastatic prostate carcinoma

The ivory vertebra describes a dense sclerotic vertebral body on plain film or CT, with the correlate on MR being very low signal intensity on both T1- and T2-weighted sequences. L2 and S2 are involved in this fashion in the presented case, with additional metastatic lesions noted posteriorly in L1 and L3, together with mild […] [...]

Klippel-Feil

There is vertebral nonsegmentation at two levels, one involving a hemivertebra, together with a prominent scoliosis of the cervical spine. Also present is an anterior fusion defect of C1. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and […] [...]

Lipoma, tethered cord, hydromyelia, block vertebrae

The cord extends at least to the S1 level, with dilatation of the central canal within that portion visualized (hydromyelia). A small lipoma is noted within the bony spinal canal posteriorly at the S1 level. The axial scan at this level reveals the cord near its termination/posterior tethering, with the lipoma immediately contiguous bilaterally. Fusion […] [...]

AVM (within the third ventricle)

A 21 year-old man, presenting with syncope [...]

Meningioma (WHO grade I, meningotheliomatous in type), cervical spine

A large, homogeneously enhancing, intradural extramedullary mass lesion is noted anteriorly within the thecal sac at the C2 level. There is prominent deformity and compression of the cord, long standing in nature, without evidence of edema or gliosis. Note the characteristic flat margin of the lesion along the dura. Part of the on-line supplement to […] [...]

Multiple myeloma

Back pain in a 58 year old woman [...]

Migrated disk fragment

There is mild loss of disk space height (and thus substance) at L5-S1. A left paracentral disk herniation is noted, at this level, together with superior migration. Note the slight hyperintensity of the superiorly migrated portion of the disk on the T2-weighted scan, consistent with a free fragment (which is also suggested by the extent […] [...]

Synovial cyst

Back pain in a 58 year old woman [...]

Multiple sclerosis, cervical and thoracic cord lesions

An enhancing cervical cord lesion is noted on sagittal and axial images, located at the C2 level, with an additional thoracic lesion (which did not enhance) depicted on a lower axial T2-weighted section. Neither lesion respects gray-white matter boundaries, as seen on the axial T2-weighted scans, a common finding for MR lesions of the cord. […] [...]

Tethered cord

Back pain in a 58 year old woman [...]

Hepatic Hemangioma

A 55 year old woman with an incidental finding on an MRI of the thoracic spine. [...]

Neurofibromatosis type 1

Dural ectasia and a lateral meningocele are present. Also noted are scalloped vertebrae and scoliosis. All are characteristic findings. (Case provided courtesy of Reto Sutter, MD, Leitender Arzt, Radiologie, Uniklinik Balgrist, Zürich) Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015) [...]

Acute cerebellar hemorrhage

Acute cerebellar hemorrhage, hypertensive. A large acute parenchymal hemorrhage is seen in the left cerebellar hemisphere, on sagittal, axial, and coronal reformatted images from a non-contrast CT exam. Note the vasogenic edema circumferential to this hematoma. Hemorrhage is also seen in the fourth ventricle on the axial image, with interstitial edema and ventricular enlargement noted […] [...]

Germinoma

A 22 year-old woman presents with a suprasellar mass on CT [...]

Acute infarction of the caudate head and lentiform nucleus

Both structures are supplied by the lateral lenticulostriate arteries, which originate from the MCA. The caudate nucleus is also supplied by the medial lenticulostriate arteries, which arise from the ACA. The recurrent artery of Heubner, which supplies the anteromedial caudate nucleus and the anteroinferior internal capsule, is the largest of the medial lenticulostriate arteries, and […] [...]

Oligoastrocytoma (WHO grade 2)

A 23 year old man presenting with a mass lesion on CT [...]

Acute lacunar infarction, posterior limb of the internal capsule

The patient was hypertensive, and presented for CT (which was negative) with acute hypoesthesia involving the left side of the body. The MR was obtained 15 hours later, and reveals a small acute lacunar infarct in the internal capsule on the right. Due to the ability to detect cytotoxic edema, with diffusion weighted imaging, MR […] [...]

Posterior reversible encephalopathy syndrome (PRES), also known as acute hypertensive encephalopathy

A 25 year-old woman on chemotherapy, with hypertension and visual symptoms [...]

Acute medial medullary infarct

Abnormal hyperintensity is noted in the right medial medulla on both T2- and diffusion-weighted scans, which corresponds to vasogenic and cytotoxic edema, respectively. The medial medulla is most often described as being supplied by the anterior spinal artery. The medial medullary syndrome, also known as Dejerine syndrome, is caused by infarction of this region. It […] [...]

Paget disease of the lumbar spine and pelvis

Both the L1 and L2 vertebral bodies (together with their respective posterior elements) are involved, with the vertebral bodies expanded in the antero-posterior dimension and L2 a characteristic “picture frame” vertebra. There is involvement as well of the pelvis together with the sacral vertebral bodies. Coarse and thickened trabeculae are particularly evident in the iliac […] [...]

Carotid artery pseudoaneurysm

Trauma [...]

Acute parenchymal hemorrhage, due to an underlying AVM

Acute parenchymal hemorrhage, due to an underlying AVM. A large acute parenchymal hematoma is noted in the right frontal lobe. Post-contrast, there is tubular like enhancement within and immediately posterior to the hemorrhage, most consistent with acute extravasation of blood. The coronal thick MIP from the CTA study reveals a small nidus of arterial enhancement […] [...]

Septo-optic dysplasia

A five year-old boy with hydrocephalus and pituitary dysfunction [...]

Left temporal lobe arteriovenous malformation (AVM)

A 31 year old woman [...]

Cholesterol granuloma

A large expansile lesion is noted in the right petrous apex, hyperintense on both T1- and T2-weighted scans, without diffusion restriction or internal contrast enhancement. The imaging findings are characteristic, with one exception – that a peripheral hemosiderin rim is not present. The lesion was resected through a transnasal, transclival route. Part of the on-line […] [...]

Glioblastoma Multiforme (left parietal)

A 57 year old man presents with a mass lesion on CT, with MR performed for differential diagnosis and better delineation of the lesion. [...]

Acute subarachnoid hemorrhage from a small ACOM aneurysm

The images presented include an axial unenhanced CT, a coronal MIP from the CTA, and a 3D magnified view of the aneurysm from the CTA, obtained using volume rendering technique (VRT). The latter shows the distal internal carotid artery, the two anterior cerebral arteries, and the small multi-lobulated aneurysm originating from the ACOM, near its […] [...]

Posterior cerebral artery infarct (early subacute)

A 79 year old man presents with symptoms of a cerebrovascular accident [...]

Lumbar vertebral metastases

A 61 year old man with small cell carcinoma of the lung [...]

Acute superior cerebellar artery (SCA) infarction

Acute superior cerebellar artery (SCA) infarction, with an accompanying small unilateral pontine infarct. Hypodensity is seen on CT in a portion of the SCA territory, with hyperintensity on axial T2-weighted MR (and sagittal FLAIR), both due to vasogenic edema. The presence of restricted diffusion is confirmed on the ADC map, reconstructed from the diffusion scans. […] [...]

Acute subdural and parenchymal hemorrhage, from an underlying AVM

Acute subdural and parenchymal hemorrhage, from an underlying AVM, in a patient with fibromuscular dysplasia (FMD). Intracranial aneurysms are a well known associated finding in FMD, with the occurrence of intracranial arteriovenous malformations less common. On axial CT, both the acute subdural and parenchymal hematomas are well demonstrated, together with midline shift and compression of […] [...]

Multiple sclerosis (cervical spinal cord)

A 28 year old woman [...]

Left MCA trifurcation aneurysm

A 45 year old man with end-stage renal disease and a history of polycystic kidney disease [...]

Cholesterol granuloma, orbit

More common sites for a cholesterol granuloma include the petrous apex, middle ear and mastoid antrum. The lesion, when in the orbit, presents as an extraconal mass, in the superior-temporal quadrant. Differential diagnosis includes the lacrimal gland tumors. Although post-contrast T1-weighted scans are presented, the lesion was hyperintense pre-contrast (and specifically demonstrated only peripheral enhancement). […] [...]

Left middle cranial fossa arachnoid cyst

An incidental finding in a 46 year old man being evaluated for possible recent cerebral infarction (the brain MR was otherwise normal) [...]

Anaplastic astrocytoma (WHO grade III), CT and MR

A focal, mildly hyperdense, lesion is noted on CT in the right centrum semiovale, with restricted diffusion and no abnormal contrast enhancement. rCBV is mildly elevated. The hyperdensity on CT is unusual, with the diffusion restriction (confirmed on the ADC map, not shown) correctly suggesting a higher-grade lesion, with the lesion appearing on other scans […] [...]

Glioblastoma (WHO grade 4 astrocytoma), recurrent

A 55 year old man, with a previous partial tumor resection [...]

Anaplastic ependymoma (WHO grade III), in an 18 month old infant

There is a large enhancing extra-axial mass lying within the 4th ventricle and extending into the foramen of Luschka on the left. Heterogeneity of the lesion with cystic and necrotic areas is characteristic, along with the previously described findings. Most patients are one to five years in age, and present – as this child – […] [...]

Aortic Arch Arteritis

A 45 year old male with headache and mild chest pain for several months. [...]

Aneurysm, cavernous carotid artery

A small mass lesion is noted within the left cavernous sinus on both CT and MR (axial imaging), with CT revealing enhancement therein. MRA confirms this to be an aneurysm, with the DSA provided for comparison (from an initial balloon test occlusion study). This 12 mm aneurysm of the cavernous segment of the internal carotid […] [...]

B cell lymphoma

A hyperintense periventricular mass lesion with accompanying vasogenic edema is noted in the right occipital lobe. The mass is hyperintense on DWI, with disruption of the blood-brain barrier (enhancement) demonstrated post-contrast. The mass had restricted diffusion (reflected by the high SI on DWI), which is compatible with primary CNS lymphoma, a diagnosis confirmed at surgery. […] [...]