Brain Abscess-MRI

This is a case of brain abscess on MRI note the rim enhancement and diffusion restriction on DWI. Case was confirmed surgically.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Pericallosal Lipoma-MRI

This is a rare congenital lesion characterized by the presence of fatty deposits in inappropriate places in the central nervous system The embryological derangement that leads to the formation of lipomas is still debated; lipomas are variously considered to be the result of mesodermal inclusion due to dysraphism, hyperplasia of normal leptomeningeal fat cells, heterotopia of displaced dermal anlage or derivatives from the embryological meninx primitiva(most accepted theory). Common locations are pericallosal, quadrigeminal cistern, hypothalamic suprasellar and cerebellopontine regions usually asymptomatic but can present with seizures, headache and behavioural disturbances. can be associated with callosal abnormalities. Pericallosal lipoma is usually located within the interhemispheric fissure along the corpus callosum , and on the basis of MR imaging findings in adults and children, these lesions are classified as one of two types . The tubulonodular form is round, more than 2 cm in size, and is usually located at the genu area of the corpus callosum. The second form, on the other hand, is curvilinear; thin and elongated, it is less than 1 cm in diameter and is usually found more posterior to the corpus callosum. The former has ben more associated with callosal anomalies association with pericallosal lipomas include midline defects (cleft lip or palate, median cleft nose, hypertelorism, cerebellar vermis defects, frontal lipomas) and dysraphism (myelomeningocele, encephalocele, anomalies of the cervical spine, cranium bifidium, or other calvarial defects).

Case by Dr MGK Murthy, MD
Sr Consultant Radiologist
Teleradiology Providers

Optic chiasmatic-hypothalamic glioma-MRI

These are post gadolinium MRI images of the Optic chiasmatic-hypothalamic glioma extending along the posterior optic nerves and posterior optic pathways.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Bowel Carcinoid-MRI

Carcinoids from 2% of all gastrointestinal tumors and are the second most common small-bowel malignancy . they belong to a category of tumors called apudomas (amine precursor uptake and decarboxylation tumors) because they arise from endocrine amine precursor uptake and decarboxylation cells that can be found throughout the gastrointestinal tract and in other organs such as the pancreas and the lung. The tumor arises in the wall of the bowel as a submucosal mass that may result in scarring and kinking of the surface. Tumours originating from the foregut develop in the stomach, duodenum, and pancreas; those arising in the midgut develop in the small bowel, appendix, and right colon; and those arising from the hindgut develop in the transverse colon, left colon, or rectum. Small-bowel carcinoids are multiple in 29–41% of patients and will be associated with a second primary malignancy, usually in the gastrointestinal tract, in a significant percentage (29–53%) of patients most common in fifth or sixth decade with average of hormonal symptoms dating for 9 yrs arise from the Kulchitsky's cells in the crypts of Lieberkühn. Therefore, they grow as submucosal nodules, Visualization of the enhancing mural mass is improved if water is given as an oral contrast agent and if multiplanar reconstructions or 3D imaging software is used

CT could detect mesenteric infiltratin or liver metastases On early (arterial) phase imaging after the administration of an IV contrast agent, these metastases enhance brightly. On delayed imaging, these lesions may become isodense with the liver parenchyma.

On MRI the primary tumor appears as a discrete mass that enahnces with gadolinium. The appearance of unenhanced T1- and T2-weighted images varies. Most tumors are isointense to muscle on T1-weighted images and either hyperintense or isointense to muscle on T2-weighted images . During the portal venous phase, many lesions become isointense. In some cases, somatostatin receptor scintigraphy or biopsy may be necessary.

Case Submitted by Dr MGK Murthy, MD, Sr Consultant Radiology

Teleradiology Providers

Ischemic Stroke-MRI

This is diffusion weighted image showing left MCA territory acute infarct. MRA brain done at the time shows left MCA block with diffuse atherosclerotic changes.

Lymphocytic Hypophysitis-MRI

This is a case of histopathologically proved case of lymphocytic hypophysitis. MRI revealed enlargement of the pituitary gland and fossa, with traingular-dumbell shaped mass with significant heterogenous post contrast enhancement. There is suprasellar extension and alteration of the optic chiasm. Pituitary stalk cannot be identified.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Pigmented Villonodular Synovitis of Shoulder

These are MRI pictures of a case of PVNS. Pigmented villonodular synovitis is well known in knee and shoulder involvement is reported rarely. Note the erosive defects in the humeral head.

Case by Dr MGK Murthy, Sr Consultant Radiologist

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Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Cord Astrocytoma

This is cervical cord astrocytoma with associated syrinx seen on Gd-MRI scan of a child.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Chiari Malformation-MRI

MRI images showng lumbosacral myelomeningocele, dorsal syringohydromyelia and tonsillar herniation, classical Chiari II malformation.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences

Hirayama Disease-Dynamic MRI, a rare diagnosis

We report the MR findings in a case of Hirayama disease, a kind of cervical myelopathy related to flexion movements of the neck. In flexion MR studies, we can see the striking and pathognomonic picture of anterior shifting of posterior dura at the lower cervical spinal canal and prominent epidural venous plexus. In non-flexion studies, we find that asymmetric cord atrophy, especially at the lower cervical cord, though subtle, is highly suggestive of Hirayama disease. When it is seen, a flexion MR study is warranted to prove this diagnosis.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences