Pictorial Essay. Primary Lymphoma of the Central Nervous System: Typical and Atypical CT and MR Imaging Appearances
|
|
- Clyde Reynolds
- 6 years ago
- Views:
Transcription
1 Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved Primary Lymphoma of the entral Nervous System: Typical and typical T and MR Imaging ppearances P rimary central nervous system (NS) lymphoma refers to isolated involvement of the craniospinal axis in the absence of primary tumor elsewhere in the body. Once considered a rare occurrence, primary lymphomatous disease of the NS is now encountered frequently, in both immunocompetent and immunocompromised patients. HIV infection and IDS are the leading risk factors [1]. y definition, diagnosis of primary NS lymphoma in a patient with HIV is an independent criterion for IDS. ongenital causes of immunodeficiency (e.g., Wiskott-ldrich syndrome, Ig deficiency, and X-linked lymphoproliferative syndrome) and acquired causes, including an immunosuppressive regimen after organ transplantation, are also associated with greater risk for primary lymphoma of the NS. Recent epidemiologic data show an increased incidence of primary NS lymphoma in low-risk immunocompetent patients as well [1, 2]. This pictorial essay illustrates various imaging appearances of primary NS lymphoma and should aid in its early recognition. Namik Erdag 1,2, Rajeev M. horade 1, Ronald. lberico 1,3, Naveed Yousuf 1,4, Mahesh R. Patel 1,5 Received July 13, 2000; accepted after revision October 19, Presented in part at the annual meeting of the merican Roentgen Ray Society, San Francisco,. pril May Department of Radiology, eth Israel Deaconess Medical enter, Harvard Medical School, 330 rookline ve., oston, M Pictorial Essay linical spects Primary NS lymphoma may arise from different parts of the brain, with deep hemispheric periventricular white matter being the most common; corpus callosum, cerebellum, orbits, and cranial nerves may also harbor the tumor. fter the diagnosis is made, an examination is done that includes MR imaging of the craniospinal tract; cerebrospinal fluid and bone marrow examinations; and screening for primary tumor in the eye, chest, and abdomen [1]. The presenting symptoms in primary NS lymphoma vary depending on the location of the masses and the immune status of the patient. Primary NS lymphoma in immunocompetent patients tends to present with a large solitary hemispheric mass. HIV-positive patients often present with an acute change in mental status and an encephalopathy-like picture, likely related to combined effects from other concomitant infections and the side effects of antiretroviral drugs. The traditional method of administering 2 weeks of empiric antitoxoplasmosis treatment to distinguish between primary NS lymphoma and toxoplasmosis, the most common cause of solitary or multiple brain masses in an HIV patient, is not warranted in patients with negative serology findings for Toxoplasma organisms [2]. ecause of the rapid course of primary lymphoma, a delay in whole brain irradiation and chemotherapy markedly decreases the effectiveness of the treatment and survival. Therefore, early diagnosis is critical. Histology of the primary NS lymphoma almost always reveals intermediate- to high-grade extranodal non-hodgkin s lymphoma of -cell origin [1, 2]. Systemic lymphoma, on the other hand, may also present with neurologic symptoms in one third of patients sometime during the course of the disease [2]. Imaging studies are often helpful to distinguish primary NS lymphoma from systemic lymphoma; the latter typically invades dural and leptomeningeal coverings of the brain. high-attenuation lesion on T and a periventricular T2 low-signal-intensity mass with ependymal seeding on MR imaging favor the diagnosis of primary lymphoma [3]. T, MR imaging, and 201 Tl scintigraphy remain the mainstay in diagnostic imaging workup of primary NS lymphoma [3, 4]. Imaging Features Typical ppearance in Immunocompetent Patients In patients with normal immunity, lymphoma classically presents as a solitary ho- 2 Present address: Department of Radiology, righam and Women s Hospital, 75 Francis St., oston, M ddress correspondence to N. Erdag. 3 Present address: Department of Radiology, Roswell Park ancer Institute, Elm and arlton Sts., uffalo, NY Present address: loomington Radiology, S.., 200 S. Towanda ve., Normal, IL Present address: Valley Radiology, 3031 Tisch Way, Ste. 01, Plaza South, San Jose, JR 2001;176: X/01/ merican Roentgen Ray Society JR:176, May
2 Erdag et al. Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved Fig year-old woman with left-sided weakness. Note typical appearance of hemispheric primary central nervous system lymphoma in immunocompetent adult., xial unenhanced T scan shows typical hyperdense mass (arrows) in right parietal lobe surrounded by low-density zone, consistent with vasogenic edema., xial contrast-enhanced T scan shows homogeneous enhancement (arrows) of lesion near midline., xial T2-weighted MR image shows heterogeneous mass (black arrows) of predominantly low signal intensity. Note central linear T2 hyperintensity (arrowhead ), likely representing necrosis. lso note surrounding vasogenic edema (white arrows). D, xial gadolinium-enhanced T1-weighted MR image shows marked contrast enhancement of lesion (arrows). Note mass effect on adjacent right lateral ventricle. D mogeneously enhancing mass [5 7] (Fig. 1). Unenhanced T typically shows a high-density (70%) lesion in a central hemispheric location, which often reaches or crosses the midline (Fig. 2). Highly packed abnormal cells are thought to be responsible for the increased attenuation. Hemorrhage within the tumor is rarely seen, although it is more common in lymphoma associated with IDS (Fig. 3). Internal calcification is unusual in NS lymphomas unless the patient has undergone prior chemotherapy or radiation treatment. In most patients, MR imaging reveals intermediate- to low-signal-intensity tumor on T1-weighted images and either isointense or hypointense signal relative to the gray matter on T2-weighted images (Fig. 1). lassic findings of a space-occupying 1320 JR:176, May 2001
3 T and MR Imaging of entral Nervous System Lymphoma Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved Fig year-old immunocompetent woman who presented with confusion and change in mental status. Note primary lymphoma that crosses midline through corpus callosum. High-grade gliomas and radiation necrosis may have similar appearance., xial unenhanced T scan shows lobulated mass (arrows) of high attenuation extending across splenium of corpus callosum., xial proton density weighted MR image reveals mass (arrows) isointense to gray matter in same location as in. ilateral parietooccipital generalized edema caused by lesion is typical for transcallosal tumors. Note white matter edema in frontal lobes resulting from chemotherapy., xial gadolinium-enhanced T1-weighted MR image shows marked homogeneous enhancement (arrows) of callosal tumor with extension to left occipital lobe. lesion, including mass effect and surrounding vasogenic edema, are seen on imaging studies [3]. fter the infusion of paramagnetic contrast material, intense homogeneous enhancement (74%) of a solitary mass is the hallmark of primary NS lymphoma in immunocompetent patients (Fig. 1D). Typical ppearance in HIV Patients In more than half (55%) the patients, a cerebral mass is detected in a supratentorial parenchymal location with frequent involvement of the corpus callosum, basal ganglia, and other deep cerebral nuclei (Fig. 4). ontrast enhancement is variable, commonly of an inhomogeneous or bizarre pattern. Solitary ringlike enhancement is more likely seen in this group [8] (Fig. 5). When necrosis develops in the tumor (64%), the periphery still maintains an isointense signal and the center becomes hyperintense. Multiple lesions may be seen in as many as 50% of patients (Fig. 6). Extension along the Virchow-Robin spaces is a well-known feature of primary lymphoma. Periventricular lesions frequently invade the ventricular surface, causing ependymal seeding (38%) (Fig. 7). However, meningeal enhancement is surprisingly not frequent. typical NS Lymphomas lthough lymphomas are usually hyperdense, they may also show isodensity or JR:176, May
4 Erdag et al. Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved 3 Fig year-old immunocompetent man with acute onset of headache. Other primary or secondary hemorrhagic and necrotic brain neoplasms may appear similar to this primary central nervous system lymphoma associated with spontaneous bleeding. xial unenhanced T scan shows large necrotic mass in left frontal lobe with posterior hemorrhagic component (arrow). Fig year-old woman with HIV who presented with seizure. Sagittal gadolinium-enhanced T1-weighted MR image shows irregularly enhancing mass (arrows) in rostrum and genu of corpus callosum. Primary lymphoma frequently invades corpus callosum and periventricular cerebral parenchyma. Fig year-old man with HIV who presented with disorientation and confusion. Note HIV-associated primary brain lymphoma mimicking toxoplasmosis. erebral toxoplasmosis may show identical appearance, except that toxoplasmosis usually will not have hypointense center on T2-weighted images., xial T2-weighted MR image shows nodular well-defined right frontal subcortical lesion (arrows) with central hypointense core (arrowhead )., xial gadolinium-enhanced T1-weighted MR image shows solitary ringlike enhancement of mass and peripheral low-signalintensity halo (arrows). 4 even hypodensity on T. In the setting of a periventricular low-density lesion, lymphoma may easily be misdiagnosed as chronic small vessel ischemia or encephalomalacia (Fig. 7). Diffusely infiltrative lymphomas may not exhibit parenchymal enhancement at all (Fig. 8). In addition, unenhancing periventricular lymphomas may respect deep anatomic boundaries. We have 1322 JR:176, May 2001
5 T and MR Imaging of entral Nervous System Lymphoma Fig year-old man with HIV who presented with acute change in mental status. oronal gadolinium-enhanced T1-weighted MR image shows two enhancing parietal masses (straight and curved arrows) associated with vasogenic edema (arrowheads). Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved Fig year-old man with HIV who presented with lower extremity weakness. Note atypical lymphoma in immunocompromised patient presented as nonenhancing low-density lesion in right basal ganglia on T, initially thought to be a lacunar infarct., xial contrast-enhanced T scan shows barely discernible ill-defined area (arrow ) of low attenuation in right globus pallidus., xial proton density weighted MR image obtained 3 months after shows hyperintense lesion (arrows) with irregular borders at same location., oronal gadolinium-enhanced T1- weighted MR image obtained at same time as again reveals interval growth and enhancement of pallidal mass (arrows). Subtle enhancement (arrowhead ) is also seen in ependymal surface. iopsy revealed primary lymphoma. D, oronal gadolinium-enhanced MR image obtained 3 months after shows multiple large ependymal seeding lesions (arrows) and enlargement of ventricular system. D JR:176, May
6 Erdag et al. Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved Fig year-old man with HIV who presented with acute onset of confusion. xial gradient-echo MR image shows large heterogeneous mass (straight arrows) in left basal ganglia and region of susceptibility-induced signal loss (curved arrow ), representing a hemorrhagic focus. Physiologic calcification in left globus pallidus indicated by arrowhead is displaced posteromedially. Fig year-old woman with normal immune status who presented with right-sided weakness and difficulty finding words. High-grade glioma may appear similar to this diffusely infiltrative pattern of primary brain lymphoma., xial T2-weighted MR image shows ill-defined T2 hyperintensity (arrows) surrounding left internal capsule and adjacent left temporal lobe., xial gadolinium-enhanced MR image reveals barely discernible parenchymal enhancement in corresponding region., xial contrast-enhanced T scan obtained 4 months later shows marked expansion of left basal ganglia and thalamus caused by infiltrating neoplasm, with loss of normal anatomic boundaries (arrows). observed a primary NS lymphoma of the left temporal lobe with significant vasogenic edema sparing the basal ganglia, a feature previously described in herpes encephalitis and, more recently, in progressive multifocal leukoencephalopathy [9]. The tumor sometimes may show mild hyperintensity on T1-weighted images. Dense cellularity and high nucleus-to-cytoplasm ratio of the tumor accounts for the isointense or slightly hypointense signal seen on T2- weighted sequences. Hemorrhage in the tumor also results in low signal intensity on gradient-echo images because of magnetic susceptibility [3, 5] (Fig. 9) JR:176, May 2001
7 T and MR Imaging of entral Nervous System Lymphoma Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved typical Locations rare primary lymphoma of the pineal gland appears similar to a primary neoplasm of pineal origin (Fig. 10). ranial nerves, brainstem, cavernous sinus, or tuber cinereum may have lymphomatous involvement (Figs ). In general, primary NS lymphoma in unusual locations is more common in patients with IDS. onclusion Fig year-old woman with normal immune status who presented with intermittent headache., xial T2-weighted MR image shows well-circumscribed mass (arrows), isointense to gray matter, in pineal region. Note associated enlargement of lateral and third ventricles from obstruction of cerebrospinal fluid flow at cerebral aqueduct., xial gadolinium-enhanced T1-weighted MR image shows homogeneous enhancement (arrows) of lesion., Sagittal gadolinium-enhanced T1-weighted MR image shows enhancing pineal mass (arrows) that was found to be primary lymphoma at pathology after surgical resection. Primary and secondary pineal gland tumors and exophytic thalamic gliomas may yield similar findings. Fig year-old man with IDS who presented with ataxia and weakness in extremities. Note pontine involvement by lymphoma. xial gadolinium-enhanced T1-weighted MR image shows solid homogeneous parenchymal enhancement (arrow ) in left side of pons. In contrast to the large high-attenuation mass in a hemispheric or central location that is seen in immunocompetent patients, primary NS lymphoma in HIV patients may present as a single lesion or as multiple lesions in deep portions of the brain. necrotic core within the tumor and peculiar enhancement in an unusual location are also more likely because of HIV-associated lymphoma. Subependymal enhancement should be actively sought on imaging studies as a potential clue to lymphomatous involvement. Presence of a T2-hypointense component resulting from increased cellularity should also be noted. JR:176, May
8 Erdag et al. Downloaded from by on 02/11/18 from IP address opyright RRS. For personal use only; all rights reserved These imaging features may allow earlier detection of primary NS lymphoma and facilitate optimal treatment. References Fig year-old immunocompromised woman who presented with headache. Note unusual hypothalamic location of primary lymphoma. Hypothalamic glioma should be considered in differential diagnosis., oronal gadolinium-enhanced T1-weighted MR image shows solitary mass (arrows) in hypothalamus at region of tuber cinereum, causing splaying of postchiasmatic optic nerves., Sagittal gadolinium-enhanced T1-weighted MR image shows markedly enhancing midline mass (arrows). Upper aspect of pituitary stalk also appears to be involved. Fig year-old man with IDS who presented with headache and blurred vision. Note primary lymphoma involving cavernous sinus, pituitary gland, and cranial nerve. Invasive pituitary adenoma and cavernous sinus meningioma may look similar., oronal gadolinium-enhanced T1-weighted MR image shows pituitary mass (arrowheads) and asymmetric thickening of right cavernous sinus (arrow ). Flow voids in both internal carotid arteries appear to be preserved., oronal gadolinium-enhanced T1-weighted MR image posterior to shows marked enhancement and thickening of adjacent dura (arrowhead ) and right trigeminal nerve (double arrows). Left trigeminal nerve (single arrow ) is normal. 1. Maher E, Fine H. Primary NS lymphoma. Semin Oncol 1999;26: Dengelis LM, Yahalom J. Primary central nervous system lymphoma. In: DeVita VT Jr, Hellman S, Rosenberg S, eds. ancer: principles and practice of oncology. Philadelphia: Lippincott-Raven, 1997: Ruiz, Post MJD, undschu, Ganz WI, Georgiou M. Primary central nervous system lymphoma in patients with IDS. Neuroimaging lin N m 1997;7: Koeller KK, Smirniotopoulos JG, Jones RV. Primary central nervous system lymphoma: radiologic-pathologic correlation. RadioGraphics 1997;17: Johnson, Fram EK, Johnson P, Jacobowitz R. The variable MR appearance of primary lymphoma of the central nervous system: comparison with histopathologic features. JNR 1997;18: Lanfermann H, Heindel W, Schaper J, et al. T and MR imaging in primary cerebral non-hodgkin s lymphoma. cta Radiol 1997;38: Roman-Goldstein SM, Goldman DL, Howieson J, elkin R, Neuwelt E. MR of primary NS lymphoma in immunologically normal patients. JNR 1992;13: Dina TS. Primary central nervous system lymphoma versus toxoplasmosis in IDS. Radiology 1991;179: aldemeyer KS, Edwards MK, Smith RR, Moran. Viral and postviral demyelination central nervous system infection. Neuroimaging lin N m 1993;3: JR:176, May 2001
CT and MRI Findings of Intracranial Lymphoma
Neuroradiology- Slone et al. CT and MRI of Intracranial Lymphoma Downloaded from www.ajronline.org by 37.44.204.233 on 02/10/18 from IP address 37.44.204.233. Copyright RRS. For personal use only; all
More informationStructural and functional imaging for the characterization of CNS lymphomas
Structural and functional imaging for the characterization of CNS lymphomas Cristina Besada Introduction A few decades ago, Primary Central Nervous System Lymphoma (PCNSL) was considered as an extremely
More informationThe MRI Appearance of Tumefactive Demyelinating Lesions
ownloaded from www.ajronline.org by 37.44.198.148 on 12/05/17 from IP address 37.44.198.148. opyright RRS. For personal use only; all rights reserved The MRI ppearance of Tumefactive emyelinating Lesions
More informationMasses of the Corpus Callosum
Masses of the Corpus Callosum Kesav Raghavan, HMS Year III Dr. Agenda Corpus Callosum Development and Anatomy Our Patient: Clinical Presentation Differential Diagnosis of Masses in the Corpus Callosum
More informationClinics in diagnostic imaging (175)
Singapore Med J 2017; 58(3): 121-125 doi: 10.11622/smedj.2017017 CMEArticle Clinics in diagnostic imaging (175) Vijay Krishnan 1, MD, FRCR, Tze Chwan Lim 1, MBBS, FRCR, Francis Cho Hao Ho 2, MBBS, FRANZCR,
More informationDisclosure. + Outline. Case-based approach to neurological emergencies that might present to the ED
Kathleen R. Fink, MD University of Washington 5 th Nordic Emergency Radiology Course May 21, 2015 Disclosure My spouse receives research salary support from: Bracco BayerHealthcare Guerbet Outline Case-based
More informationRING ENCHANCING LESION BY M.S. HEMHNATH
RING ENCHANCING LESION BY M.S. HEMHNATH A 21 YRS FEMALE CAME WITH H/O HEADACHE AND SEIZURE FOR THE PAST ONE MONTH. NO OTHER FOCAL NEUROLOGICAL DEFICIT. DIFFERENTIAL DIAGNOSIS For this case are Neurocysticerosis
More informationon MR imaging, which shows a homogeneous well-circumscribed lesion displaying the characteristic short-t1 and T2 signal of fat [1] (Fig. 1).
Downloaded from www.ajronline.org by 37.44.199.34 on 02/07/18 from IP address 37.44.199.34. opyright RRS. For personal use only; all rights reserved T he corpus callosum is made up of dense myelinated
More informationRadiologic Pathologic Correlation of Intraosseous Lipomas. Tim Propeck 1, Mary Anne Bullard 1, John Lin 1, Kei Doi 2, William Martel 1
Downloaded from www.ajronline.org by 148.251.232.83 on 04/10/18 from IP address 148.251.232.83. opyright RRS. For personal use only; all rights reserved Radiologic Pathologic orrelation of Intraosseous
More informationNeuroradiology of AIDS
Neuroradiology of AIDS Frank Minja,, HMS IV Gillian Lieberman MD September 2002 AIDS 90% of HIV patients have CNS involvement 1 10% of AIDS patients present first with neurological symptoms 2 73-80% of
More informationRINGS N THINGS: Imaging Patterns in Differential Diagnosis. Anne G. Osborn, M.D.
RINGS N THINGS: Imaging Patterns in Differential Diagnosis Anne G. Osborn, M.D. ExpDDxs: Intra-axial (Parenchymal) Lesions Ring-enhancing lesions, solitary 1 Ring-enhancing lesion crossing corpus callosum
More informationCerebro-vascular stroke
Cerebro-vascular stroke CT Terminology Hypodense lesion = lesion of lower density than the normal brain tissue Hyperdense lesion = lesion of higher density than normal brain tissue Isodense lesion = lesion
More informationCT Findings in Posttransplantation Lymphoproliferative Disorder of Renal Transplants
Downloaded from www.ajronline.org by 37.44.207.92 on 12/15/17 from IP address 37.44.207.92. opyright RRS. For personal use only; all rights reserved Pictorial Essay T Findings in Posttransplantation Lymphoproliferative
More informationPrimary Jugular Foramen Meningioma: Imaging Appearance and Differentiating Features
ndré J. Macdonald 1 Karen L. Salzman 1 H. Ric Harnsberger 1 Erik Gilbert 2 lough Shelton 2 Received May 16, 2003; accepted after revision ugust 12, 2003. 1 Department of Diagnostic Radiology, University
More informationMR neuroimaging of HIV infected patients : A pictorial review
MR neuroimaging of HIV infected patients : A pictorial review Poster No.: R-0198 Congress: 2014 CSM Type: Scientific Exhibit Authors: P. F. Kwan, R. Thomas, A. Dixon; SOUTH YARRA/AU Keywords: Neuroradiology
More informationSWI including phase and magnitude images
On-line Table: MRI imaging recommendation and summary of key features Sequence Pathologies Visible Key Features T1 volumetric high-resolution whole-brain reformatted in axial, coronal, and sagittal planes
More informationCase 9511 Hypertensive microangiopathy
Case 9511 Hypertensive microangiopathy Schepers S, Barthels C Section: Neuroradiology Published: 2011, Nov. 3 Patient: 67 year(s), male Authors' Institution Department of Radiology, Jessa ziekenhuis campus
More informationMetastasis. 57 year old with progressive Headache and Right Sided Visual Loss
Metastasis 1% of sellar/parasellar masses Usually occurs with known primary Can involve third ventricle, hypothalamus, infundibular stalk May be both supra-, intrasellar 57 year old with progressive Headache
More information1 MS Lesions in T2-Weighted Images
1 MS Lesions in T2-Weighted Images M.A. Sahraian, E.-W. Radue 1.1 Introduction Multiple hyperintense lesions on T2- and PDweighted sequences are the characteristic magnetic resonance imaging (MRI) appearance
More informationAutomated Identification of Neoplasia in Diagnostic Imaging text reports
Automated Identification of Neoplasia in Diagnostic Imaging text reports "This work has been funded in whole or in part with Federal funds from the National Cancer Institute, National Institutes of Health,
More informationPathologic Analysis of CNS Surgical Specimens
2015 Kenneth M. Earle Memorial Neuropathology Review Pathologic Analysis of CNS Surgical Specimens Peter C. Burger, MD Interdisciplinary Quality Control Familiarity with entities Use of diagnostic algorithm
More informationCNS TUMORS. D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria)
CNS TUMORS D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria) CNS TUMORS The annual incidence of intracranial tumors of the CNS ISmore than intraspinal tumors May be Primary or Secondary
More informationCNS Imaging. Dr Amir Monir, MD. Lecturer of radiodiagnosis.
CNS Imaging Dr Amir Monir, MD Lecturer of radiodiagnosis www.dramir.net Types of radiological examinations you know Plain X ray X ray with contrast GIT : barium (swallow, meal, follow through, enema) ERCP
More informationNEURO IMAGING 2. Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity
NEURO IMAGING 2 Dr. Said Huwaijah Chairman of radiology Dep, Damascus Univercity I. EPIDURAL HEMATOMA (EDH) LOCATION Seventy to seventy-five percent occur in temporoparietal region. CAUSE Most likely caused
More informationbrain MRI for neuropsychiatrists: what do you need to know
brain MRI for neuropsychiatrists: what do you need to know Christoforos Stoupis, MD, PhD Department of Radiology, Spital Maennedorf, Zurich & Inselspital, University of Bern, Switzerland c.stoupis@spitalmaennedorf.ch
More informationPearls and Pitfalls in Neuroradiology of Cerebrovascular Disease The Essentials with MR and CT
Pearls and Pitfalls in Neuroradiology of Cerebrovascular Disease The Essentials with MR and CT Val M. Runge, MD Wendy R. K. Smoker, MD Anton Valavanis, MD Control # 823 Purpose The focus of this educational
More informationPrinciples Arteries & Veins of the CNS LO14
Principles Arteries & Veins of the CNS LO14 14. Identify (on cadaver specimens, models and diagrams) and name the principal arteries and veins of the CNS: Why is it important to understand blood supply
More informationThe central nervous system
Sectc.qxd 29/06/99 09:42 Page 81 Section C The central nervous system CNS haemorrhage Subarachnoid haemorrhage Cerebral infarction Brain atrophy Ring enhancing lesions MRI of the pituitary Multiple sclerosis
More informationPrimary Central Nervous System Lymphoma with Lateral Ventricle Involvement
The Open Medical Imaging Journal, 2012, 6, 103-107 103 Open Access Primary Central Nervous System Lymphoma with Lateral Ventricle Involvement Yumi Oie 1,*, Kazuhiro Murayama 1, Shinya Nagahisa 2, Masato
More informationThe Variable MR Appearance of Primary Lymphoma of the Central Nervous System: Comparison with Histopathologic Features
The Variable MR Appearance of Primary Lymphoma of the Central Nervous System: Comparison with Histopathologic Features Blake A. Johnson, Evan K. Fram, Peter C. Johnson, and Ronald Jacobowitz PURPOSE: To
More informationAttenuation value in HU From -500 To HU From -10 To HU From 60 To 90 HU. From 200 HU and above
Brain Imaging Common CT attenuation values Structure Air Fat Water Brain tissue Recent hematoma Calcifications Bone Brain edema and infarction Normal liver parenchyma Attenuation value in HU From -500
More informationEssentials of Clinical MR, 2 nd edition. 14. Ischemia and Infarction II
14. Ischemia and Infarction II Lacunar infarcts are small deep parenchymal lesions involving the basal ganglia, internal capsule, thalamus, and brainstem. The vascular supply of these areas includes the
More informationKeep Imaging Simple: An Introduction To Neuroimaging
Keep Imaging Simple: An Introduction To Neuroimaging Meghan Elkins, OD, FAAO Please silence all mobile devices and remove items from chairs so others can sit. Unauthorized recording of this session is
More informationPediatric MS MRI Study Methodology
General Pediatric MS MRI Study Methodology SCAN PREPARATION axial T2-weighted scans and/or axial FLAIR scans were obtained for all subjects when available, both T2 and FLAIR scans were scored. In order
More informationIntracranial Ganglioglioma: MR, CT,
109 Intracranial Ganglioglioma: MR, CT, and Clinical Findings in 18 Patients Mauricio Castillo 1 Patricia C. Davis 1 Yoshii Takei 2 James C. Hoffman, Jr. 1 Eighteen cases of pathologically proved intracranial
More informationFor Emergency Doctors. Dr Suzanne Smallbane November 2011
For Emergency Doctors Dr Suzanne Smallbane November 2011 A: Orbit B: Sphenoid Sinus C: Temporal Lobe D: EAC E: Mastoid air cells F: Cerebellar hemisphere A: Frontal lobe B: Frontal bone C: Dorsum sellae
More informationIndex. aneurysm, 92 carotid occlusion, 94 ICA stenosis, 95 intracranial, 92 MCA, 94
A ADC. See Apparent diffusion coefficient (ADC) Aneurysm cerebral artery aneurysm, 93 CT scan, 93 gadolinium, 93 Angiography, 13 Anoxic brain injury, 25 Apparent diffusion coefficient (ADC), 7 Arachnoid
More informationYear 2003 Paper two: Questions supplied by Tricia
question 43 A 42-year-old man presents with a two-year history of increasing right facial numbness. He has a history of intermittent unsteadiness, mild hearing loss and vertigo but has otherwise been well.
More informationRole of imaging (images) in my practice. Dr P Senthur Nambi Consultant Infectious Diseases
Role of imaging (images) in my practice Dr P Senthur Nambi Consultant Infectious Diseases Medical images: My thoughts Images are just images Subject to the intellect of the interpreter View it in conjuction
More informationTRANSVERSE SECTION PLANE Scalp 2. Cranium. 13. Superior sagittal sinus
TRANSVERSE SECTION PLANE 1 1. Scalp 2. Cranium 3. Superior sagittal sinus 4. Dura mater 5. Falx cerebri 6. Frontal lobes of the cerebrum 7. Middle meningeal artery 8. Cortex, grey matter 9. Cerebral vessels
More informationTumors of the Nervous System
Tumors of the Nervous System Peter Canoll MD. PhD. What I want to cover What are the most common types of brain tumors? Who gets them? How do they present? What do they look like? How do they behave? 1
More informationBrainstem diffuse gliomas: radiologic findings.
Brainstem diffuse gliomas: radiologic findings. Poster No.: C-2220 Congress: ECR 2013 Type: Educational Exhibit Authors: E. GARCIA MARTINEZ 1, D. H. Jiménez 1, L. Navarro Vilar 2, C. P. Fernandez Ruiz
More informationSectional Anatomy Head Practice Problems
1. Which of the following is illustrated by #3? (Fig. 5-42) A) maxillary sinus B) vomer C) septal cartilage D) perpendicular plate of ethmoid bone 2. What number illustrates the cornea? (Fig. 5-42) A)
More informationBlood Supply of the CNS
Blood Supply of the CNS Lecture Objectives Describe the four arteries supplying the CNS. Follow up each artery to its destination. Describe the circle of Willis and its branches. Discuss the principle
More informationDownloaded from by on 02/06/18 from IP address Copyright ARRS. For personal use only; all rights reserved
Downloaded from www.ajronline.org by 46.3.205.55 on 02/06/18 from IP address 46.3.205.55. opyright RRS. For personal use only; all rights reserved Imaging of Parapharyngeal Space Lesions: Focus on the
More informationOligodendroglioma: imaging findings, radio-pathological correlation and evolution
Oligodendroglioma: imaging findings, radio-pathological correlation and evolution Poster No.: C-2104 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit A. Hernandez Castro, M. D. Monedero
More informationAstroblastoma: Radiologic-Pathologic Correlation and Distinction from Ependymoma
AJNR Am J Neuroradiol 23:243 247, February 2002 Case Report Astroblastoma: Radiologic-Pathologic Correlation and Distinction from Ependymoma John D. Port, Daniel J. Brat, Peter C. Burger, and Martin G.
More informationCASE REPORT PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA
CASE REPORT PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA Anvari S.S. MD 1 Karimzadeh P. MD 2, Tonekaboni S.H. MD 2, Mahvelati F. MD 3, Khatami A.R. MD 4, Gharib A. MD 5, Nazari Sh. MD 6, Farzan M. MD 7, Ghofrani
More informationMR Assessment of Myelination in Infants and Children: Usefulness of Marker Sites
731 MR ssessment of Myelination in Infants and Children: Usefulness of Marker Sites C. Roger ird 1 Mary Hedberg urton P. Drayer Paul J. Keller Richard. Flom John. Hodak retrospective study was made of
More informationSteven Herwick 1 Frank H. Miller Ana L. Keppke
Herwick et al. MRI of Islet ell Tumors of the Pancreas bdominal Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.203.29 on 02/19/18 from IP address 37.44.203.29. opyright RRS. For personal
More informationISCHEMIC STROKE IMAGING
ISCHEMIC STROKE IMAGING ผศ.พญ พญ.จ ร ร ตน ธรรมโรจน ภาคว ชาร งส ว ทยา คณะแพทยศาสตร มหาว ทยาล ยขอนแก น A case of acute hemiplegia Which side is the abnormality, right or left? Early Right MCA infarction
More informationHelpful Information for evaluation of new neurological symptoms in patients receiving TYSABRI
Helpful Information for evaluation of new neurological symptoms in patients receiving TYSABRI This information is provided as an educational resource for healthcare providers and should be considered current
More informationPediatric CNS Tumors. Disclosures. Acknowledgements. Introduction. Introduction. Posterior Fossa Tumors. Whitney Finke, MD
Pediatric CNS Tumors Disclosures Whitney Finke, MD Neuroradiology Fellow PGY-6 University of Utah Health Sciences Center Salt Lake City, Utah None Acknowledgements Introduction Nicholas A. Koontz, MD Luke
More informationM555 Medical Neuroscience Lab 1: Gross Anatomy of Brain, Crainal Nerves and Cerebral Blood Vessels
M555 Medical Neuroscience Lab 1: Gross Anatomy of Brain, Crainal Nerves and Cerebral Blood Vessels Anatomical Directions Terms like dorsal, ventral, and posterior provide a means of locating structures
More informationGeneral: Brain tumors are lesions that have mass effect distorting the normal tissue and often result in increased intracranial pressure.
1 Lecture Objectives Know the histologic features of the most common tumors of the CNS. Know the differences in behavior of the different tumor types. Be aware of the treatment modalities in the various
More informationInteractive Cases: Demyelinating Diseases and Mimics. Disclosures. Case 1 25 yo F with nystagmus; look for tumor 4/14/2017
Interactive Cases: Demyelinating Diseases and Mimics Disclosures None Brad Wright, MD 27 March 2017 Case 1 25 yo F with nystagmus; look for tumor What do you suspect? A. Demyelinating disease B. Malignancy
More informationMedical Neuroscience Tutorial Notes
Medical Neuroscience Tutorial Notes Blood Supply to the Brain MAP TO NEUROSCIENCE CORE CONCEPTS 1 NCC1. The brain is the body's most complex organ. LEARNING OBJECTIVES After study of the assigned learning
More informationPatologie infiammatorie encefaliche e midollari
Patologie infiammatorie encefaliche e midollari Maria Laura Stromillo Department of Medicine, Surgery and Neuroscience Inflammatory disorders of the CNS NMOSD ADEM Multiple Sclerosis Neuro-Myelitis Optica
More informationSupratentorial Gangliocytoma Mimicking Extra-axial Tumor: A Report of Two Cases
Supratentorial Gangliocytoma Mimicking Extra-axial Tumor: A Report of Two Cases Ho Sung Kim, MD 1 Ho Kyu Lee, MD 1 Ae Kyung Jeong, MD 1 Ji Hoon Shin, MD 1 Choong Gon Choi, MD 1 Shin Kwang Khang, MD 2 We
More informationANATOMY & PHYSIOLOGY DISSECTION OF THE SHEEP BRAIN LAB GROUP:
ANATOMY & PHYSIOLOGY DISSECTION OF THE SHEEP BRAIN LAB GROUP: Introduction The purpose of the sheep brain dissection is to familiarize you with the three dimensional structure of the brain and teach you
More informationDiffusion-weighted magnetic resonance imaging (MRI) allows for tissue
MAGNETIC RESONANCE IMAGING / IMAGERIE PAR RÉSONANCE MAGNÉTIQUE Nonischemic causes of hyperintense signals on diffusion-weighted magnetic resonance images: a pictorial essay Jeffrey M. Hinman, MD; James
More informationCT and MR findings of systemic lupus erythematosus involving the brain: Differential diagnosis based on lesion distribution
CT and MR findings of systemic lupus erythematosus involving the brain: Differential diagnosis based on lesion distribution Poster No.: C-2723 Congress: ECR 2010 Type: Educational Exhibit Topic: Neuro
More informationPrimary central nervous system lymphomas: CT, MRI and MR spectroscopy findings at presentation
Primary central nervous system lymphomas: CT, MRI and MR spectroscopy findings at presentation Poster No.: C-2577 Congress: ECR 2015 Type: Educational Exhibit Authors: A. Brakus, K. Petrovic, N. Vuckovic,
More informationRADIOLOGY TEACHING CONFERENCE
RADIOLOGY TEACHING CONFERENCE John Athas, MD Monica Tadros, MD Columbia University, College of Physicians & Surgeons Department of Otolaryngology- Head & Neck Surgery September 27, 2007 CT SCAN IMAGING
More informationFig.1: A, Sagittal 110x110 mm subimage close to the midline, passing through the cingulum. Note that the fibers of the corpus callosum run at a
Fig.1 E Fig.1:, Sagittal 110x110 mm subimage close to the midline, passing through the cingulum. Note that the fibers of the corpus callosum run at a slight angle are through the plane (blue dots with
More informationTable of Contents: SKULL AND BRAIN. Scalp, Skull. Anatomically Based Differentials. Skull Normal Variants. Scalp Mass, Child.
Table of Contents: SKULL AND BRAIN Scalp, Skull Skull Normal Variants Scalp Mass, Child Scalp Mass, Adult Congenital Anomalies of Skull Base Sellar/Parasellar Mass With Skull Base Invasion "Hair on End"
More informationNEURO IMAGING OF ACUTE STROKE
1 1 NEURO IMAGING OF ACUTE STROKE ALICIA RICHARDSON, MSN, RN, ACCNS-AG, ANVP-BC WENDY SMITH, MA, RN, MBA, SCRN, FAHA LYNN HUNDLEY, APRN, CNRN, CCNS, ANVP-BC 2 2 1 DISCLOSURES Alicia Richardson: Stryker
More informationChapter 3. Structure and Function of the Nervous System. Copyright (c) Allyn and Bacon 2004
Chapter 3 Structure and Function of the Nervous System 1 Basic Features of the Nervous System Neuraxis: An imaginary line drawn through the center of the length of the central nervous system, from the
More informationHead CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD
Head CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD Five Step Approach 1. Adequate study 2. Bone windows 3. Ventricles 4. Quadrigeminal cistern 5. Parenchyma
More informationAcute stroke. Ischaemic stroke. Characteristics. Temporal classification. Clinical features. Interpretation of Emergency Head CT
Ischaemic stroke Characteristics Stroke is the third most common cause of death in the UK, and the leading cause of disability. 80% of strokes are ischaemic Large vessel occlusive atheromatous disease
More informationLacrimal Gland Masses
Residents Section Pattern of the Month Gao et al. Lacrimal Gland Masses Residents Section Pattern of the Month ownloaded from www.ajronline.org by 148.251.232.83 on 03/30/18 from IP address 148.251.232.83.
More informationAnkur A. Gupta 1, Danny C. Kim, Glenn A. Krinsky, Vivian S. Lee
Pictorial Essay T and MRI of irrhosis and its Mimics nkur. Gupta 1, Danny. Kim, Glenn. Krinsky, Vivian S. Lee irrhosis is among the leading causes of death in the western world. irrhosis and its associated
More informationCorpus Callosal Signal Changes in Patients with Obstructive Hydrocephalus after Ventriculoperitoneal Shunting
AJNR Am J Neuroradiol 22:158 162, January 2001 Corpus Callosal Signal Changes in Patients with Hydrocephalus after Ventriculoperitoneal Shunting John I. Lane, Patrick H. Luetmer, and John L. Atkinson BACKGROUND
More informationDemyelinating Diseases of the Brain
Department of Radiology University of California San Diego Demyelinating Diseases of the Brain John R. Hesselink, M.D. T1-Weighted Images Normal White Matter Contents Axons with envelope of myelin Neuroglia
More informationCross sectional imaging of Intracranial cystic lesions Abdel Razek A
Cross sectional imaging of Intracranial cystic lesions Abdel Razek A Department of Radiology. Mansoura Faculty of Medicine, Mansoura. Egypt. arazek@mans.edu.eg Introduction Intracranial cystic lesions
More informationPituitary Macroadenoma Joseph Junewick, MD FACR
Pituitary Macroadenoma Joseph Junewick, MD FACR 08/13/2010 History 12 year old female with headache and visual disturbance. Diagnosis Pituitary Macroadenoma Additional Clinical Markedly elevated growth
More informationPITUITARY PARASELLAR LESIONS. Kim Learned, MD
PITUITARY PARASELLAR LESIONS Kim Learned, MD DIFFERENTIALS Pituitary Sella Clivus, Sphenoid Sinus Suprasellar Optic chiasm, Hypothalamus, Circle of Willis Parasellar Cavernous Sinus Case 1 17 YEAR-OLD
More informationPosterior fossa tumors: clues to differential diagnosis with case-based review
Posterior fossa tumors: clues to differential diagnosis with case-based review Poster No.: C-0323 Congress: ECR 2017 Type: Educational Exhibit Authors: H. A. Aboughalia, M. Abdelhady; Doha/QA Keywords:
More informationCerebral Parenchymal Lesions: I. Metastatic Neoplasms
Chapter 4 Cerebral Parenchymal Lesions: I. Metastatic Neoplasms After one has reasonably ruled out the possibility of a nonneoplastic diagnosis (see Chap. 3), one is left with considering a diagnosis of
More informationSURGICAL MANAGEMENT OF BRAIN TUMORS
SURGICAL MANAGEMENT OF BRAIN TUMORS LIGIA TATARANU, MD, Ph D NEUROSURGICAL CLINIC, BAGDASAR ARSENI CLINICAL HOSPITAL BUCHAREST, ROMANIA SURGICAL INDICATIONS CONFIRMING HISTOLOGIC DIAGNOSIS REDUCING TUMOR
More informationRole of Diffusion weighted Imaging in the Evaluation of Intracranial Tumors
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 12 Ver. IX (December. 2016), PP 99-104 www.iosrjournals.org Role of Diffusion weighted Imaging
More informationPROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL. Gross Anatomy and General Organization of the Central Nervous System
3 Gross Anatomy and General Organization of the Central Nervous System C h a p t e r O u t l i n e The Long Axis of the CNS Bends at the Cephalic Flexure Hemisecting a Brain Reveals Parts of the Diencephalon,
More informationMRI of Adenocarcinoma of the Pancreas
MRI of the Pancreas bdominal Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.192.155 on 12/14/17 from IP address 37.44.192.155. opyright RRS. For personal use only; all rights reserved
More informationIntroduction to the Central Nervous System: Internal Structure
Introduction to the Central Nervous System: Internal Structure Objective To understand, in general terms, the internal organization of the brain and spinal cord. To understand the 3-dimensional organization
More informationGeneral Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27
General Identification Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 Chief Complaint Sudden onset of seizure for several minutes Present illness This 29-year
More informationUsing T2-Weighted Sequences to More Accurately Characterize Breast Masses Seen on MRI
Residents Section Pattern of the Month Westra et al. MRI of reast Masses Residents Section Pattern of the Month Downloaded from www.ajronline.org by 46.3.195.58 on 12/28/17 from IP address 46.3.195.58.
More informationCase Report Multiple Dural Tuberculomas Presenting as Leptomeningeal Carcinomatosis
Case Reports in Neurological Medicine Volume 2011, Article ID 581230, 4 pages doi:10.1155/2011/581230 Case Report Multiple Dural Tuberculomas Presenting as Leptomeningeal Carcinomatosis Hasan Kocaeli,
More informationCase 7391 Intraventricular Lesion
Case 7391 Intraventricular Lesion Bastos Lima P1, Marques C1, Cabrita F2, Barbosa M2, Rebelo O3, Rio F1. 1Neuroradiology, 2Neurosurgery, 3Neuropathology, Coimbra University Hospitals, Portugal. University
More informationVascular Malformations of the Brain. William A. Cox, M.D. Forensic Pathologist/Neuropathologist. September 8, 2014
Vascular Malformations of the Brain William A. Cox, M.D. Forensic Pathologist/Neuropathologist September 8, 2014 Vascular malformations of the brain are classified into four principal groups: arteriovenous
More informationLaura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University
Laura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University Disclosures! No conflicts of interest to disclose Neuroimaging 101! Plain films! Computed tomography " Angiography " Perfusion! Magnetic
More informationMarisa Kastoff Blitstein 1 Glenn A. Tung
litstein and Tung MRI of Cerebral Microhemorrhages Neuroradiology Pictorial Essay 09_07_2249_litstein.fm 7/27/07 Marisa Kastoff litstein 1 Glenn. Tung litstein MK, Tung G Keywords: cerebral microhemorrhages,
More informationAnatomy & Physiology Central Nervous System Worksheet
1. What are the two parts of the CNS? 2. What are the four functions of the CNS Anatomy & Physiology Central Nervous System Worksheet 3. What are the four functions of the meninges? (p430) 4. Starting
More informationRadiologic-Pathologic Correlation of White Matter Disease
The Neuroradiology Journal 22 (Suppl. 1): 26-32, 2009 www. centauro. it Radiologic-Pathologic Correlation of White Matter Disease J.G. SMIRNIOTOPOULOS 1,2,3,.. SMITH 1,2, E. RUSHING 2,4, F.M. MURPHY 2,
More informationImaging of Metastatic CNS Neuroblastoma
Pediatric Imaging Pictorial Essay D mbrosio et al. Metastatic CNS Neuroblastoma Pediatric Imaging Pictorial Essay Downloaded from www.ajronline.org by 46.3.204.53 on 12/12/17 from IP address 46.3.204.53.
More informationDissection of the Sheep Brain
Dissection of the Sheep Brain Laboratory Objectives After completing this lab, you should be able to: 1. Identify the main structures in the sheep brain and to compare them with those of the human brain.
More informationMRI OF THE THALAMUS. Mohammed J. Zafar, MD, FAAN Kalamazoo, MI
1 MRI OF THE THALAMUS Mohammed J. Zafar, MD, FAAN Kalamazoo, MI Objectives: The thalamic nuclei can be involved in a wide variety of conditions. A systematic imaging approach would be useful for narrowing
More informationBiological Bases of Behavior. 3: Structure of the Nervous System
Biological Bases of Behavior 3: Structure of the Nervous System Neuroanatomy Terms The neuraxis is an imaginary line drawn through the spinal cord up to the front of the brain Anatomical directions are
More informationMR Imaging of Acute Coccidioidal Meningitis
AJNR Am J Neuroradiol 2:59 514, March 1999 MR Imaging of Acute Coccidioidal Meningitis William K. Erly, Richard J. Bellon, Joachim F. Seeger, and Raymond F. Carmody BACKGROUND AND PURPOSE: Our purpose
More informationOBJECTIVES. At the end of the lecture, students should be able to: List the cerebral arteries.
DR JAMILA EL MEDANY OBJECTIVES At the end of the lecture, students should be able to: List the cerebral arteries. Describe the cerebral arterial supply regarding the origin, distribution and branches.
More informationCerebral malaria: MR imaging spectrum
Cerebral malaria: MR imaging spectrum Poster No.: C-2705 Congress: ECR 2010 Type: Educational Exhibit Topic: Neuro Authors: P. S. Naphade, M. D. Agrawal, S. S. Sankhe, K. M. Siva, B. K. Jain; Mumbai/IN
More information