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Up for a Sunday tweetorial? š¤
If you see this multicystic lung lesion š« in the posterobasal region of the lower lobes in a young patient š¹šŗwith no pathological history, two differential diagnoses should be considered: CPAM vs pulmonary sequestration ā
#radiology #FOAMrad
If you see this multicystic lung lesion š« in the posterobasal region of the lower lobes in a young patient š¹šŗwith no pathological history, two differential diagnoses should be considered: CPAM vs pulmonary sequestration ā
#radiology #FOAMrad
These two congenital lesions are areas of aberrant lung parenchyma not connected to the central airways. Their main difference is the arterial supply. That's why the first thing to do is try to identify the systemic artery that supplies the lesion š£(most often an aortic branch)
This intralobar pulmonary sequestration was infected that's why it has
š”šµ Air-fluid levels inside
š¢ Peripheral GGO
š”šµ Air-fluid levels inside
š¢ Peripheral GGO
1/Time is brain! So you donāt have time to struggle w/that stroke alert head CT.
Hereās a #tweetorial to help you with the CT findings in acute stroke.
#medtwitter #FOAMed #FOAMrad #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter
Hereās a #tweetorial to help you with the CT findings in acute stroke.
#medtwitter #FOAMed #FOAMrad #ESOC #medstudent #neurorad #radres #meded #radtwitter #stroke #neurology #neurotwitter
2/CT in acute stroke has 2 main purposesā(1) exclude intracranial hemorrhage (a contraindication to thrombolysis) & (2) exclude other pathologies mimicking acute stroke. However, that doesnāt mean you canāt see other findings that can help you diagnosis a stroke.
3/Infarct appearance depends on timing. In first 12 hrs, the most common imaging finding isā¦a normal head CT. However, in some, you see a hyperdense artery or basal ganglia obscuration. Later in the acute period, you see loss of gray white differentiation & sulcal effacement
1/Donāt let all your effort be in VEIN!
Developmental venous anomalies (DVAs) are often thought incidental but ignore them at your own risk!
A #tweetorial about how to know when DVAs are the most important finding
#meded #medtwitter #neurorad #neurotwitter #radtwitter #radres
Developmental venous anomalies (DVAs) are often thought incidental but ignore them at your own risk!
A #tweetorial about how to know when DVAs are the most important finding
#meded #medtwitter #neurorad #neurotwitter #radtwitter #radres
2/DVAs arenāt hard to recognize on imagingāthey have a typical ācaput medusaeā appearance.
Dilated medullary veins look like snakes all converging into the medusa head of a large draining vein.
Dilated medullary veins look like snakes all converging into the medusa head of a large draining vein.
3/DVAs are incredibly commonā1 in 50 may have one
Although >90% are asymptomatic, that would still results in a relatively large number of patients w/symptoms
Also, w/increasing knowledge of DVA physiology, we may find theyāre responsible for more symptoms than we realize
Although >90% are asymptomatic, that would still results in a relatively large number of patients w/symptoms
Also, w/increasing knowledge of DVA physiology, we may find theyāre responsible for more symptoms than we realize
1/Time is brain! But what time is it?
If you donāt know the time of stroke onset, are you able to deduce it from imaging?
Hereās a #tweetorial to help you date a #stroke on MR!
#medtwitter #meded #neurotwitter #neurology #neurorad #radres #radtwitter #radiology #FOAMed #FOAMrad
If you donāt know the time of stroke onset, are you able to deduce it from imaging?
Hereās a #tweetorial to help you date a #stroke on MR!
#medtwitter #meded #neurotwitter #neurology #neurorad #radres #radtwitter #radiology #FOAMed #FOAMrad
2/In up to 25% of acute stroke patients, the time of last known well is well, not known. Then itās important to use the strokeās MR imaging features to help date its timing. Is it hyperacute? Acute? Subacute? Or are the āstrokeā symptoms from a seizure from their chronic infarct?
3/Strokes evolve, or grow old, the same way people evolve or grow old. The appearance of stroke on imaging mirrors the life stages of a personāyou just have to change days for a stroke into years for a person. So 15 day old stroke has features of a 15 year old person, etc.
1/Feeling unarmed when it comes to evaluating cervical radiculopathy & foraminal narrowing on MR?
Hereās a #tweetorial thatāll take that weight off your shoulder & show you how to rate cervical foraminal stenosis!
#medtwitter #meded #FOAMed #radtwitter #neurorad #spine #radres
Hereās a #tweetorial thatāll take that weight off your shoulder & show you how to rate cervical foraminal stenosis!
#medtwitter #meded #FOAMed #radtwitter #neurorad #spine #radres
2/First, the anatomy. Nerve rootlets arise from the anterior & posterior horns, merging to form anterior (motor) & dorsal (sensory) nerves roots in the thecal sac.
These come together & the dorsal root has its dorsal root ganglion before the spinal nerve extends extravertebral
These come together & the dorsal root has its dorsal root ganglion before the spinal nerve extends extravertebral
3/Think of it like a road system but carrying information/impulses instead of cars. Small roads (rootlets) merging to make larger roads (roots), before these finally merge together onto the big highway, which is the dorsal root ganglion and spinal nerve
1/I call the skullbase āhomebaseā bc you canāt make an anatomy homerun without it!
Most know the arteries of the skullbase, but few know the veins. Do you?
Hereās aš§µto help you remember #skullbase venous #anatomy!
#medtwitter #meded #neurorad #radtwitter #neurosurgery #radres
Most know the arteries of the skullbase, but few know the veins. Do you?
Hereās aš§µto help you remember #skullbase venous #anatomy!
#medtwitter #meded #neurorad #radtwitter #neurosurgery #radres
2/When I look at the skullbase veins, I see an angry Santa yelling at me. His eyebrows are raised, his mouth is open, & he has a mustache w/a big beard hanging down.
Each I look at the skullbase, I look for this Santaābc each part of him is an important venous structure.
Each I look at the skullbase, I look for this Santaābc each part of him is an important venous structure.
3/So letās start w/Santaās eyes. The eyes are actually not a venous structure, but an important landmarkāforamen ovale, where the V3 trigeminal nerve exit.
I remember ovale is Santa's eyes bc eyes are OVAL, so his eyes are OVALE
I remember ovale is Santa's eyes bc eyes are OVAL, so his eyes are OVALE
1/Does trying to remember inferior frontal gyrus anatomy leave you speechless?
Do you get a Brocaās aphasia trying to name the parts?
Hereās a #tweetorial to help you remember the #anatomy of this important region
#medtwitter #meded #neurotwitter #neurorad #radtwitter #radres
Do you get a Brocaās aphasia trying to name the parts?
Hereās a #tweetorial to help you remember the #anatomy of this important region
#medtwitter #meded #neurotwitter #neurorad #radtwitter #radres
2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonaldās arches.
To find the IFG on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, "iām lovin it."
To find the IFG on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, "iām lovin it."
3/Inferior frontal gyrus also looks like a sideways 3 on sagittal images, if you prefer.
This 3 is helpful bc the inferior frontal gyrus has 3 partsāor "pars"
This 3 is helpful bc the inferior frontal gyrus has 3 partsāor "pars"
1/To be or not 2b?? That is the question!
Do you have questions about how to remember cervical lymph node anatomy & levels?
Hereās a #tweetorial to show you how--#Superbowl weekend edition!
#medtwitter #meded #neurorad #HNrad #FOAMed #FOAMrad #radres #radtwitter #ENT #radiology
Do you have questions about how to remember cervical lymph node anatomy & levels?
Hereās a #tweetorial to show you how--#Superbowl weekend edition!
#medtwitter #meded #neurorad #HNrad #FOAMed #FOAMrad #radres #radtwitter #ENT #radiology
2/Google cervical lymph node anatomy & you always get this anatomic picture w/the head flung back like a model posing.
But unless you live in LA, your patients donāt look like this & understanding anatomy from this image is difficult
But unless you live in LA, your patients donāt look like this & understanding anatomy from this image is difficult
3/First, you need to know how lymph node drainage works in the neck.
Nodes drain like riversāsmaller streams drain into larger rivers.
In the neck, there are outer circle nodes (peripheral) & inner circle nodesāboth drain into the large river of the deep cervical nodes
Nodes drain like riversāsmaller streams drain into larger rivers.
In the neck, there are outer circle nodes (peripheral) & inner circle nodesāboth drain into the large river of the deep cervical nodes
1/If all you know is: To Zanzibar By Motor Carāthen you donāt even know half of facial nerve anatomyāliterally!
Hereās a #tweetorial on the facial nerve anatomy you donāt know!
#medtwitter #neurotwitter #neurorad #radres #meded #FOAMed #neurosurgery #neurology #radtwitter
Hereās a #tweetorial on the facial nerve anatomy you donāt know!
#medtwitter #neurotwitter #neurorad #radres #meded #FOAMed #neurosurgery #neurology #radtwitter
2/On coronal MRI sequences, the brainstem in the region of the facial nerve looks like a bodybuilder.
But it looks like one of those body builders who concentrates only on upper body workouts, so they are huge up top (the pons) & but have chicken legs (the medulla)
But it looks like one of those body builders who concentrates only on upper body workouts, so they are huge up top (the pons) & but have chicken legs (the medulla)
3/Facial nerve comes out in this region from between the pons & medulla.
It looks like a weightlifting belt, coming out from the waist between the giant pons upper body & the medulla chicken legs
It looks like a weightlifting belt, coming out from the waist between the giant pons upper body & the medulla chicken legs
1/Time to FESS up! Do you understand functional endoscopic sinus surgery (FESS)?
If you read sinus CTs, you must know what theyāre doing to make the helpful findings
Hereās a #tweetorial to help you!
#medtwitter #meded #FOAMed #FOAMrad #radres #neurorad #HNrad #radtwitter
If you read sinus CTs, you must know what theyāre doing to make the helpful findings
Hereās a #tweetorial to help you!
#medtwitter #meded #FOAMed #FOAMrad #radres #neurorad #HNrad #radtwitter
2/The first step is to insert the endoscope into the nasal cavity.
The first two structures encountered are the nasal septum and the inferior turbinate.
The first two structures encountered are the nasal septum and the inferior turbinate.
3/So on every sinus CT you read, the first question is whether there is enough room to insert the scope. Will it go in smoothly or will it be a tight fit?
31yo F, brother sudden cardiac death at 34yo, father sudden cardiac death at 45yo
Should she be worried??
#radtwitter #medtwitter #cardiotwitter #whyCMR
Should she be worried??
#radtwitter #medtwitter #cardiotwitter #whyCMR
Patient also had basal septal hypertrophy up to 21mm (left), associated with delayed enhancement (right)
Dad was thought to have died from MI. Brother had suspicion of ARVD on echo, died before CMR, no autopsy. Her CMR was requested to rule out ARVD.
21 month old male, cough, prolonged fever, normal chest X-ray, abnormal echo
#radtwitter #medtwitter #pedsrad #cardiotwitter
#radtwitter #medtwitter #pedsrad #cardiotwitter
coronary artery aneurysms secondary to Kawasaki disease
Kawasaki disease: preschool age, fever, conjunctivitis, rash peeling on fingers/toes, red tongue
1/Is your ability to remember temporal lobe anatomy seem, well, temporary?
Hereās a #tweetorial to help you remember the structures of the temporal lobe!
#medtwitter #meded #neurotwitter #radtwitter #radres #neurorad #FOAMed #neurosurgery #medstudenttwitter #neurology
Hereās a #tweetorial to help you remember the structures of the temporal lobe!
#medtwitter #meded #neurotwitter #radtwitter #radres #neurorad #FOAMed #neurosurgery #medstudenttwitter #neurology
2/Temporal lobe can be divided centrally & peripherally. Centrally is the hippocampus. Itās a very old part of the brain & is relatively well preserved going all the way back to rats. Its main function is memoryāgetting both rats & us through mazesāincluding the maze of life
3/Peripherally is the neocortex. Although rats also have neocortex, theirs is much different structurally than humans.
So I like to think of neocortex as providing the newer (neo) functions of the temporal lobes seen in humans: speech, language, visual processing/social cues
So I like to think of neocortex as providing the newer (neo) functions of the temporal lobes seen in humans: speech, language, visual processing/social cues
1/Nothing strikes fear into the heart of a radiologist like the question,āIs it safe to do an MRI on this pt w/an implanted device?ā
Never fear again! Hereās a #tweetorial on how to navigate implanted devices & #MRI
#medtwitter #meded #radtwitter #radres #neurotwitter #neurorad
Never fear again! Hereās a #tweetorial on how to navigate implanted devices & #MRI
#medtwitter #meded #radtwitter #radres #neurotwitter #neurorad
2/MRI & CT are like nuclear & coal power, respectively. Everyone knows CT is worse for you & usually MRI is very safe & better for your body
But like nuclear power, when things go bad in MRI, they can go horribly wrong. Flying chairs into the magnet wrong. So, people are afraid
But like nuclear power, when things go bad in MRI, they can go horribly wrong. Flying chairs into the magnet wrong. So, people are afraid
3/The trouble is from the magnetic attractive forces. There are 3 ways these attractions can wreak havoc. First is translation. Magnet literally pulls an object, like a chair, towards itself. This is the strongest attractionālike two lovers who literally canāt stay apart.
62 y/o M presents with signs of raised intracranial pressure. CT shows a hyper dense mass crossing the corpus callosum. On MR, the mass is hypointense on T2WI, restricting diffusion, and homogenously enhancing along the periventricular surface.
#radtwitter #radres #neurotwitter
#radtwitter #radres #neurotwitter
The corpus callosum is composed of very dense white matter tracks. Only aggressive tumors or lesions that effect the white matter cross the midline through the CC.
Diff Diagnosis for CC masses
High grade astrocytoma/Glioblastoma
Primary CNS lymphoma
Tumefactive Demyelination
Diff Diagnosis for CC masses
High grade astrocytoma/Glioblastoma
Primary CNS lymphoma
Tumefactive Demyelination
Dx: Primary CNS lymphoma
PCNSL has a highly variable imaging appearance. Classically, it presents as a hyperdense mass with restricted diffusion and relatively hypointensity on T2WI due to hypercellularity. The mass enhances homogeneously and may cross the CC. #Neurosurgery
PCNSL has a highly variable imaging appearance. Classically, it presents as a hyperdense mass with restricted diffusion and relatively hypointensity on T2WI due to hypercellularity. The mass enhances homogeneously and may cross the CC. #Neurosurgery
45F presents with painless progressive left eye vision loss. MR shows homogenous enhancement encasing the left optic nerve with an associated lesion at the entrance of the optic canal (yellow arrow)
#radres #futureradres #NeuroRad #MedTwitter @AlbanyMedRadRes
#radres #futureradres #NeuroRad #MedTwitter @AlbanyMedRadRes
Differential Diagnosis:
Optic Neuritis
Optic nerve sheath meningioma
Optic nerve glioma
Orbital sarcoidosis
Orbital lymphoma
Orbital pseudotumor
#Ophthalmology #radtwitter
Optic Neuritis
Optic nerve sheath meningioma
Optic nerve glioma
Orbital sarcoidosis
Orbital lymphoma
Orbital pseudotumor
#Ophthalmology #radtwitter
Diagnosis: Optic nerve sheath meningioma
Remember the optic nerve is an extension of the CNS and therefore, is surrounded by meninges and arachnoid cap cells from which meningiomas arise. Look for the ātram-trackā sign of enhancement surrounding the optic nerve
#Ophthalmology
Remember the optic nerve is an extension of the CNS and therefore, is surrounded by meninges and arachnoid cap cells from which meningiomas arise. Look for the ātram-trackā sign of enhancement surrounding the optic nerve
#Ophthalmology
23 yr old with headache. MR shows a ābubblyā mass in the right lateral ventricle near the foramen of Monro. The mass abuts the septum pellucidum and displays mild contrast enhancement.
#neurotwitter #radtwitter #RadEd #MedTwitter #radres @TheASNR @ESNRad @ASHNRSociety
#neurotwitter #radtwitter #RadEd #MedTwitter #radres @TheASNR @ESNRad @ASHNRSociety
Differential diagnosis:
Subependymoma
Choroid plexus neoplasm
Central neurocytoma
Intraventricular meningioma
Mets
Subependymoma
Choroid plexus neoplasm
Central neurocytoma
Intraventricular meningioma
Mets
Answer: confirmed central neurocytoma
Classically, look for the ābubblyā mass abutting/attached to the septum pellucidum near the foramen of monro with enhancement.
#futureradres
Classically, look for the ābubblyā mass abutting/attached to the septum pellucidum near the foramen of monro with enhancement.
#futureradres
Child presents with weakness. MR shows enhancement of the pial surface of the conus and ventral cauda equina nerve roots.
#radtwitter #MedTwitter #radres #futureradres #Pediatrics #Neurology @TheASNR @The_ASPNR @AlbanyMedRadRes
#radtwitter #MedTwitter #radres #futureradres #Pediatrics #Neurology @TheASNR @The_ASPNR @AlbanyMedRadRes
Differential diagnosis:
Leptomeningeal carcinomatosis
Lymphoma
Arachnoiditis (all causes)
Guillain-barre
Neurosarcoidosis
Leptomeningeal carcinomatosis
Lymphoma
Arachnoiditis (all causes)
Guillain-barre
Neurosarcoidosis
Diagnosis: Guillain-BarrƩ syndrome
These are the typical imaging features for GBS. Contrast is absolutely necessary.
There was no history to suggest systemic sarcoidosis, malignancy, or recent procedure (risk factor for spinal meningitis/arachnoiditis)
These are the typical imaging features for GBS. Contrast is absolutely necessary.
There was no history to suggest systemic sarcoidosis, malignancy, or recent procedure (risk factor for spinal meningitis/arachnoiditis)
Patient presents with altered mental status. Unenhanced CT shows discrete hypodense foci in the bilateral paramedian thalami
#radres #futureradres #radtwitter @ACRRFS @RSNA
#radres #futureradres #radtwitter @ACRRFS @RSNA
Differential diagnosis includes:
Top of the basilar artery syndrome
Artery of Percheron infarct
Bilateral internal cerebral vein thrombosis
Top of the basilar artery syndrome
Artery of Percheron infarct
Bilateral internal cerebral vein thrombosis
Answer: Artery of Percheron infarct
The artery of Percheron is a rare anatomic variant where a single artery supplies both medial thalami, typically arising from the P1 segment of the PCA.
The artery of Percheron is a rare anatomic variant where a single artery supplies both medial thalami, typically arising from the P1 segment of the PCA.
80 yo āļø with chronic cough.
What would you do with this "ugly" lung lesion? š§µšš»
#radres #radtwitter #radiology #chestrad
What would you do with this "ugly" lung lesion? š§µšš»
#radres #radtwitter #radiology #chestrad
āāā
If you asked for a mediastinal window ššš
*ļøā£Lipoid pneumonia*ļøā£
Lung disease caused by fat accumulation that produces chonic inflammation
Two types:Endogenous and exogenous
Exogenous lipoid pneumonia is caused by aspiration of fatty or oil substances (laxatives in this case)
*ļøā£Lipoid pneumonia*ļøā£
Lung disease caused by fat accumulation that produces chonic inflammation
Two types:Endogenous and exogenous
Exogenous lipoid pneumonia is caused by aspiration of fatty or oil substances (laxatives in this case)
1/My hardest #tweetorial yet! Are you up for the challenge?
How stroke perfusion imaging works!
Ever wonder why itās Tmax & not Tmin? Do you not question & let RAPID read the perfusion for you? Not anymore!
#stroke #neurotwitter #neurorad #meded #FOAMed #radtwitter #medtwitter
How stroke perfusion imaging works!
Ever wonder why itās Tmax & not Tmin? Do you not question & let RAPID read the perfusion for you? Not anymore!
#stroke #neurotwitter #neurorad #meded #FOAMed #radtwitter #medtwitter
2/Perfusion imaging is based on one principle: When you inject CT or MR intravenous contrast, the contrast flows w/blood & so contrast can be a surrogate marker for blood. This is key, b/c we can track contrastāit changes CT density or MR signal so we can see where it goes
3/So if we can track how contrast gets to the tissue (by changes in CT density or MR signal), then we can approximate how BLOOD is getting to the tissue. And how much blood is getting to the tissue is what perfusion imaging is all about.
55 yr old with stuffy nose. CT demonstrates a destructive mass centered in the olfactory recess with extension through the cribriform plate. MR shows avid enhancement of the invasive mass.
#radres #NeuroRad #radtwitter #MedTwitter
#radres #NeuroRad #radtwitter #MedTwitter
Differential:
Sinonasal carcinoma (SCC, SNUC, adenocarcinoma)
Esthesioneuroblastoma
Lymphoma
Mets
Sinonasal carcinoma (SCC, SNUC, adenocarcinoma)
Esthesioneuroblastoma
Lymphoma
Mets
Answer: confirmed Esthesioneuroblastoma
Esthesioneuroblastoma presents as a destructive mass with intracranial extension and waist centered at the cribriform plate. Peritumoral cysts at the tumor-brain interface are classic though were not seen in this case.
Esthesioneuroblastoma presents as a destructive mass with intracranial extension and waist centered at the cribriform plate. Peritumoral cysts at the tumor-brain interface are classic though were not seen in this case.
1/āI LOVE spinal cord syndromes!ā is a phrase that has NEVER, EVER been said by anyone.
Never fearāhere is a #tweetorial on all the incomplete #spinalcord syndromes!
#medtwitter #neurotwitter #neurology #neurosurgery #neurorad #radres #meded #FOAMed #FOAMrad #radtwitter #spine
Never fearāhere is a #tweetorial on all the incomplete #spinalcord syndromes!
#medtwitter #neurotwitter #neurology #neurosurgery #neurorad #radres #meded #FOAMed #FOAMrad #radtwitter #spine
2/Spinal cord anatomy can be complex. On imaging, we can see the ant & post nerve roots. We can also see the gray & white matter. Hidden w/in the white matter, however, are numerous efferent & afferent tractsāenough to make your head spin.
3/Lucky for you, for the incomplete cord syndromes, all you need to know is gray matter & 3 main tracts. Anterolaterally, spinothalamic tract (pain & temp). Posteriorly, dorsal columns (vibration, proprioception, & light touch), & next to it, corticospinal tractsāproviding motor
1/Asking āHow old are youā can be diceyāboth in real life & on MRI! Do you know how to tell the age of blood on MRI?
Hereās a #tweetorial on how to date blood on MRI
#medtwitter #neurorad #radtwitter #RSNA2022 #RSNA22 #radres #neurosurgery #neurology #meded #neurotwitter #FOAMed
Hereās a #tweetorial on how to date blood on MRI
#medtwitter #neurorad #radtwitter #RSNA2022 #RSNA22 #radres #neurosurgery #neurology #meded #neurotwitter #FOAMed
2/If you ask someone how to date blood on MRI, theyāll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age
But mnemonics are crutchāthey help you memorize, but not understand. If you understand, you donāt need to memorize
But mnemonics are crutchāthey help you memorize, but not understand. If you understand, you donāt need to memorize
3/If you look at the mnemonic, you will notice one thingāthe T1 signal is all you need to tell if blood is acute, subacute or chronic
T2 signal will tell if it is early or late in each of those time periodsābut that type of detail isnāt needed in real life. So letās look at T1
T2 signal will tell if it is early or late in each of those time periodsābut that type of detail isnāt needed in real life. So letās look at T1
