Brain MRI – Seizure search pattern

Many times when patients have a history of seizures, they undergo a workup including a physical exam, detailed EEG analysis, and finally brain MRI to try to identify any potential structural causes of seizures. In this video, Dr. Michael Hoch walks us through his approach to a brain MRI to maximize your sensitivity for finding abnormalities.

 

Dr. Hoch suggests a 4-step approach using the mnemonic “3-2-1 go to the hippocampus”. In this way, he divides his search into more digestible parts.

“3” indicates the 3 planes that you have in a non-contrast T1 weighted MP-RAGE MRI. On this you should focus on the cortex, particularly at the 3 poles, the frontal, temporal, and occipital poles.

“2” indicates the 2 planes of FLAIR and 2 window settings you should use. You should review FLAIR images in both the coronal and axial planes. You should also use a window that is normal and a window that is narrow, or aggressive, to highlight lesions, particularly in the cortex, which are hard to see.

“1” indicates the single plane of blood sensitive imaging, either GRE or SWI, which can often see areas of prior hemorrhage or cavernou

“Go” to the hippocampus last to look for signs of mesial temporal sclerosis, which is manifested as a small hippocampus with loss of internal architecture and abnormal T2/FLAIR hyperintensity. This can be either from primary epilepsy or secondary to another lesion.

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Board Review 3 – Full lecture

This lecture is a board review lecture geared towards preparation for the radiology resident ABR core exam, although similar material is used for the ABR certifying exam general and neuroradiology sections.

The format of this lecture is case-based. Each case consists of a series of images followed by 1 or 2 questions. The first question is usually to name the diagnosis, while the second is a multiple choice question to test deeper understanding of the specific condition. Try to get the diagnosis before you see the second questions.

The first 10 cases cover brain tumors and the remaining 9 cover general neuroradiology. The final case will be a high speed multiple choice review.

Noncontrast MRI cervical spine search pattern

Magnetic resonance imaging (MRI) of the cervical spine is a very commonly encountered test which can be performed for a variety of indications, including degenerative disease, trauma, demyelinating disease, and metastatic disease. Most of these cases will be done without contrast, as most of the information is there on a non-contrast exam.

This video will walk you through a step-by-step approach to evaluating an MRI of the cervical spine. The optimal approach is to use select sequences to evaluate each part of the study in the following order:

Alignment
Vertebral bodies
Marrow signal
Intervertebral discs
Spinal cord/canal
Soft tissues
Individual levels

Each sequence in the study has strengths at looking at one or more of these things. As we walk through, we’ll take a look at how to use each one.

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 spine diseases.

See this and other videos on our Youtube channel.

CT (computed tomography) face radiology search pattern

When you start taking call as a radiology resident, a common test you are going to encounter is a maxillofacial CT, or face CT. This is especially true if you are taking call at a level 1 or level 2 trauma center. A lot of times, this is done in conjunction with a head and/or cervical spine CT. This is an extremely common test in the setting of trauma, including assault and car accidents (MVA or MVC). The key in these settings is to rule out a significant fracture or soft tissue injury to the face.

Because there are a lot of structures, it is important to have a useful search pattern. Reconstructions, especially the coronal reconstruction, are key when interpreting CT of the face. These allow you to see key structures that are parallel to the slice plane on axial images. Symmetry is extremely helpful, as the left should match the right. Additionally, making sure all the fat and fascia planes are clean is very useful.

This video will walk you through a step-by-step approach to evaluating a CT of the face. I recommend a pattern where you start with the coronals at the cranial (top) part of the image, and then work your way down. In this way, you can look at the brain, orbits, sinuses, palate, mandible, and so forth, minimizing the risk of missing a significant finding. Then you can repeat the pattern with the axial images. Finally, the sagittal images are a nice troubleshooting tool, especially for the mandible and cervical spine. As you practice, you will find you can move more quickly through your search without necessarily focusing on each individual element for too long.

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 be involved with patients with facial injuries and other abnormalities.

 

See this and other videos on our Youtube channel.

Board Review 2 – Full lecture

This lecture is a board review lecture geared towards preparation for the radiology resident ABR core exam, although similar material is used for the ABR certifying exam general and neuroradiology sections.

The format of this lecture is case-based. Each case consists of a series of images followed by 1 or 2 questions. The first question is usually to name the diagnosis, while the second is a multiple choice question to test deeper understanding of the specific condition. Try to get the diagnosis before you see the second questions.

These are all general neuroradiology questions.

Board Review 2 – Introduction

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

This video is a brief introduction before beginning the case style review.

Introduction to Neuroradiology Board Review: Part 2

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.

MRA (magnetic resonance angiogram) head radiology search pattern

As a neuroradiologist, one of the most frequently ordered tests you will encounter is an MRA (magnetic resonance angiogram) of the brain. This test is frequently used to evaluate the vessels of the brain, including the carotid and vertebral arteries and their intracranial branches of the circle of Willis.

MRA of the brain can evaluate for vessel occlusion, dissection, aneurysm, and vascular malformations. It can also be used to follow up on vascular findings seen on other studies. The most common indication, however, is to evaluate for stroke, when it is combined with MRA of the neck and an MRI of the brain.

This video will walk you through a step-by-step approach to evaluating an MRA of the brain, 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 stroke or other vascular malformations of the brain.

See this and other videos on our Youtube channel.

Cervical spine CT (computed tomography) radiology search pattern

For those aspiring radiologists out there, has anyone ever explained to you what you should do when you sit down at the PACS station to look at a cervical spine CT? What are the common indications to get a cervical spine CT?

For those non-radiologists out there, have you ever wondered what exactly is going through a radiologists mind as they look through the images? How do you even begin to look at all of the imaging findings?

This video attempts to demystify a lot of that by showing exactly how you might sit down and look at a cervical spine CT on your own. It starts with the reformatted images (those in sagittal and coronal planes) to get an overview of the alignment and anatomy before reviewing the axial images. This video doesn’t include everything you should look at, but is a guide for how you might begin.

The level of this video is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology. It may also be of interest to those with an interest in radiology who are simply curious to learn more about radiology.

See this and other videos on our Youtube channel.