Imaging brain tumors – 7 – Bonus cases

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 tumors.

This video gives some additional cases in which you can apply the principles learned in the other videos to form a differential. These are challenging cases, and your top differential will not always be correct, but it is more about going through the thought process.

If you have not seen the other brain tumor videos, it may be useful to check them out before watching this video. They address imaging tumor types including astrocytomas,oligodendrogliomas, other low grade glial tumors,and non-glial tumors. Other videos address general topics in brain tumor imagingand how to form a differential diagnosis for a brain tumor.

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.

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:

Basic Spine – Chapter 5 – Case Review

This is the final chapter in a review of basic spine imaging. This chapter reviews some of the key concepts using a few unknown cases.

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

Board Review 1 – 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 5 cases of this review are a case based review of neurodegenerative disorders and dementia. Cases 6-20 are general neuroradiology board review. Enjoy.

Board Review 1 – Case 20

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.

More description and the answer (spoiler!) are seen below the video.

This case shows a CT of the orbits with proptosis and enlargement of the extraocular muscles. There is relative sparing of the myotendinous junction (where the muscles meet the globe).

The diagnosis is: Graves ophthalmopathy

Graves disease is one of the most common causes of bilateral opthalmopathy, although findings do not have to be symmetric. Findings often do not improve with treatment of Graves disease.

Board Review 1 – Case 19

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.

More description and the answer (spoiler!) are seen below the video.

The initial CT in this patient shows subtle hyperintensity in the pons which could easily be mistaken for artifact. However, MRI confirms a central and symmetric hyperintensity within the pons.

The diagnosis is: osmotic demyelination

Osmotic demyelination is a diagnosis characterized by central FLAIR hyperintensities in the pons, although abnormalities can occur anywhere in the brain. They are associated with abnormalities in serum osmolality, particularly sodium concentration. The primary differential consideration is infarct, although these are rarely bilaterally symmetric.

Board Review 1 – Case 18

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.

More description and the answer (spoiler!) are seen below the video.

This case starts with a CT of the thoracic spine which demonstrates a dumbell shaped mass in the left posterior mediastinum which extends into the left sided neural foramen. There is smooth remodeling of the adjacent bone, suggesting that this is a chronic finding. MRI shows a T2 hyperintense and avidly enhancing mass.

The diagnosis is: schwannoma

Schwannomas of the spine can be intradural or extradural masses. Their characteristic appearance is an avidly enhancing mass that extends through and remodels the neural foramina. Primary differential considerations include meningioma and neurofibroma.

Board Review 1 – Case 17

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.

More description and the answer (spoiler!) are seen below the video.

In this patient with trigeminal neuralgia, there is a mass in the left cerebellopontine angle which is causing mass effect on the pons and cerebellar peduncle. Its imaging appearance is close to that of CSF on all sequences except diffusion weighted imaging (DWI), on which it is bright.

Lesions of the cerebellopontine angle can be cystic or solid. Cystic appearing masses include arachnoid cysts and epidermoid.

The diagnosis is: epidermoid

Epidermoids of the cerebellopontine angle are inclusion cysts which contain secretions which are bright on DWI, distinguishing them from arachnoid cysts. They tend to have minimal if any enhancement.

Board Review 1 – Case 16

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.

More description and the answer (spoiler!) are seen below the video.

This case shows a solitary lesion with central T2 hyperintensity and surrounding siderosis (dark on T2). The area shows no real enhancement, although there is a linear branching structure adjacent to the lesion

The diagnosis is: cerebral cavernous malformation

Cerebral cavernous malformations are angiographically occult vascular malformations which consist of clusters of abnormal capillaries without a shunt. Their characteristic appearance is a rim of hemosiderin which may take on the appearance of a popped popcorn kernel. Developmental venous anomalies (DVAs), are often seen with isolated cavernous malformations.

Other times, patients may have multiple lesions which can be associated with familial syndromes.

Board Review 1 – Case 15

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.

More description and the answer (spoiler!) are seen below the video.

This case starts with a CT showing bilateral temporal bone fractures after a major trauma. There are a number of potential complications of temporal bone fractures, but on the left the ossicles are no longer in alignment.

The diagnosis is: ossicular dissociation from trauma

Fractures of the temporal bone can cause a number of complications, including meningitis, conductive hearing loss, and facial nerve injury. This shows dislocation of the malleus and incus on the left. Fractures should be classified by whether they involve the otic capsule or spare the otic capsule.