Author: Brent Weinberg, MD

Imaging brain tumors – 1 – Introduction and classification

Posted on by Brent Weinberg, MD

Imaging brain tumors – 1 – Introduction and classification

Brain tumors are one of the most common diagnoses addressed in neuroradiology. This covers a wide spectrum of disease, from primary brain tumors like gliomas and glioblastomas to secondary disease like metastases. This lecture covers the spectrum of the most common brain tumors, with an emphasis on primary brain tumor.

This first video discusses how brain tumors are classified, the genetics of these tumors, and a general approach to brain tumors. Tumors can be divided into a few categories, including astrocytomas, oligodendrogliomas, other low grade glial tumors, and common non-glial tumors. Since the WHO reclassification occurred in 2016, genetic information has been used to classify tumors, with the most important mutations being isocitrate dehydrogenase (IDH), 1p19q codeletion, and MGMT methylation. Oligodendrogliomas must be IDH mutants and 1p19q codeleted, and other tumors are now classified as astrocytomas.

IDH mutation is associated with lower grade astrocytomas and is associated with a survival advantage. Similar, MGMT methylation is associated with a better response to radiation, more pseudoprogression, and better survival.

Additional videos in the playlist will address the imaging findings of brain tumors, such as astrocytomas,oligodendrogliomas, other low grade glial tumors,and non-glial tumors. Other videos address how to form a differential diagnosis for a brain tumor, and some challenge cases to apply your skills.

The level of this lecture is appropriate for radiology residents, radiology fellows, and trainees in other specialties who have an interest in neuroradiology or may see patients with brain tumors.

Other videos on the brain tumor playlist are found here.

Imaging Brain Tumors

Posted on by Brent Weinberg, MD

Imaging Brain Tumors

Brain tumors are one of the most common diagnoses addressed in neuroradiology. This covers a wide spectrum of disease, from primary brain tumors like gliomas and glioblastomas to secondary disease like metastases. This lecture covers the spectrum of the most common brain tumors, with an emphasis on primary brain tumor.

Be sure to check back often as more videos are added that cover your favorite neuroradiology exams, or check out our full channel on Youtube.

Basic neuroradiology procedures part 3 – Myelogram

Posted on by Brent Weinberg, MD

Basic neuroradiology procedures part 3 – Myelogram

This video is the third part of a series of videos on common neuroradiology procedures, including lumbar punctures and myelograms.

This video specifically discusses how to perform a myelogram. This includes how to choose a contrast agent, how to attach your tubing and inject the contrast, and what kind of warning signs to look for when injecting.

Other videos discuss general considerations and other procedures, such as lumbar punctures.

The level of this lecture is appropriate for medical students, residents, and fellows in radiology who may be performing neuroradiology procedures. Trainees in others specialties may also find this video useful to learn more about what happens in image guided lumbar punctures.

Other videos on the procedure playlist are found here.

Basic neuroradiology procedures part 2 – Lumbar puncture

Posted on by Brent Weinberg, MD

Basic neuroradiology procedures part 2 – Lumbar puncture

This video is the second part of a series of videos on common neuroradiology procedures, including lumbar punctures and myelograms.

This video specifically discusses how to perform a fluoroscopy guided lumbar puncture, including what needles to use, how to steer the needle, and how to best position the patient. Pressure measurement and fluid collection is also discussed.

Other videos discuss general considerations and other procedures, such as myelograms.

The level of this lecture is appropriate for medical students, residents, and fellows in radiology who may be performing neuroradiology procedures. Trainees in others specialties may also find this video useful to learn more about what happens in image guided lumbar punctures.

Other videos on the procedure playlist are found here.

Basic neuroradiology procedures part 1 – General considerations

Posted on by Brent Weinberg, MD

Basic neuroradiology procedures part 1 – General considerations

Radiologists perform a number of procedures using imaging guidance to make procedures safer, easier, and more achievable than doing procedures without imaging guidance. Neuroradiologists perform many procedures, with the most common being lumbar puncture and myelogram. Other procedures include biopsy, pain procedures and blood patch.

This video is an introductory discussion of some of the considerations that should be considered before performing any procedure in neuroradiology. This includes allergies, anticoagulation, patient size, what type of imaging guidance should be used, and more.

Additional videos will discuss the procedures, such as lumbar puncture and myelogram, more specifically.

The level of this lecture is appropriate for medical students, residents, and fellows in radiology who may be performing neuroradiology procedures. Trainees in others specialties may also find this video useful to learn more about what happens in image guided neuroradiology procedures such as lumbar punctures.

Other videos on the procedure playlist are found here.

Neuroradiology procedures

Posted on by Brent Weinberg, MD

Neuroradiology procedures

Radiologists perform a number of procedures using imaging guidance to make procedures safer, easier, and more achievable than doing procedures without imaging guidance. Neuroradiologists perform many procedures, with the most common being lumbar puncture and myelogram. Other procedures include biopsy, pain procedures and blood patch.

Initial videos in this list include basic considerations for procedures, lumbar punctures, and myelograms.

Be sure to check back often as more videos are added that cover your favorite neuroradiology exams, or check out our full channel on Youtube.

Neuroradiology Unknown Videos – Case 1

Posted on by Brent Weinberg, MD

Neuroradiology Unknown Videos – Case 1

This unknown case is a 58 year-old presenting with confusion and transient weakness. The CT and MR show a large mass in the left frontal lobe as well as an additional mass in the posterior right frontal lobe.

The key points of this video are how to deal with creating a differential diagnosis in a patient with multiple enhancing masses. Generally speaking, the differential will include metastasis, lymphoma, glioblastoma, and infection. However, by using some more subtle clues you can often make a pretty good guess about which one it will be, which may help your surgeons as they go in for biopsy.

This will be part of an unknown case series that will be continuously updated. See the full playlist below:

Youtube Playlist

Neuroradiology search patterns

Posted on by Brent Weinberg, MD

Neuroradiology search patterns

As radiologists, we often forget that we didn’t know how to go through a study from the beginning. This playlist will be a collection of videos on how to approach studies from scratch. This may be particularly useful to beginning medical students and residents who haven’t sat down at the PACS and looked through a study many times.

Be sure to check back often as more videos are added that cover your favorite neuroradiology exams, or check out our full channel on Youtube.

Reporting a lumbar spine MRI – disc extrusion

Posted on by Brent Weinberg, MD

Reporting a lumbar spine MRI – disc extrusion

Lumbar spine MRI is probably one of the most commonly performed MRI exams in radiology. This is because back pain is extraordinarily common and increases with age. As a result, we do a number of studies to try to determine what is the cause of the back pain.

There are a number of things that can cause back pain. Discs can bulge (and protrude, or extrude), facets can degenerate, and endplates can erode. All of these can cause pain. Unfortunately, the nerves of the spinal cord and extremities pass through this region and their compression can cause a lot of pain.

Today we’ll do things a little differently. I’m going to show you an example case on the radiology PACS of a young patient with back pain radiating down the right leg. I’ll show you how I set up the study to view and systematically how I look at it. In addition, I’ll show you how our reports are formatted and how you can as well.

This patient has a disc extrusion at L4-L5 which is pressing on the exiting nerve root in the lateral recess (or subarticular zone). This is just one of the many reasons to have radicular pain.

The level of this video is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in spine imaging. General medicine practitioners will see plenty of back pain and may wonder what we are thinking. Neurosurgeons and orthopedic surgeons can learn more to strengthen their practice as well.

See this and other videos on our Youtube channel.

Noncontrast MRA (magnetic resonance angiogram) neck radiology search pattern

Posted on by Brent Weinberg, MD

Noncontrast MRA (magnetic resonance angiogram) neck radiology search pattern

Another frequent study will encounter in neuroradiology is an MRA (magnetic resonance angiogram) of the neck. This test is frequently used to evaluate the arteries of the neck, including the carotid and vertebral arteries.

MRA of the neck can be performed without contrast using a technique called time of flight imaging, which depends on signal from flowing blood to create the image. MRA of the neck can also be performed with contrast in certain situations, such as need to better evaluate the aortic arch and great vessel origins or need to imaging dynamically.

MRA of the neck is primarily used to evaluate for vessel occlusion or narrowing, although vascular malformations may also be evaluated. It can also be used to follow up on vascular findings seen on other studies, such as doppler ultrasound of the carotids. The most common indication, however, is to evaluate for stroke, when it is combined with MRI and MRA of the brain.

This video will walk you through a step-by-step approach to evaluating an MRA of the neck, including how to approach each vessel. I use an approach that moves from anterior to posterior and then right to left. While others may have a different strategy, the most important part is to have a strategy and stick to it.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with atherosclerotic disease or stroke.

See this and other videos on our Youtube channel.