When I was a PGY-1, neuro-oncologist Dr. Darin Carabenciov taught me a quick yet systematic approach to MR imaging of brain lesions. I am on call this weekend and am still utilizing his teachings to this day! A thread: (1/7)
In general, there are 4 MR sequences that will tell you 99% of what you need to know:
1. T2 FLAIR
2. T1 post-contrast
3. DWI
4. GRE/SWI/SWAN/T2*
1. T2 FLAIR: "What is grossly abnormal?"
anything abnormal = bright on T2 FLAIR
2. T1+gadolinium*: "Where is the BBB disrupted?"
Also:
-"What is the vascular composition?"
**always compare T1+gad sequences to pure T1 without contrast (if also bright on pure T1, then BBB not necessarily disrupted)**
3. DWI*:
bright = abnormal = "diffusion-restricting" = could be hypercellularity, ischemia, demyelination, abscess, &c
**the above applies only if the corresponding area is dark on ADC sequence (if also bright on ADC, then just T2 shine-through)**
4. GRE/SWI/SWAN/T2*: helps to distinguish nuances among entities on your differential.
in general, abnormal = dark (blood, vascularity, &c; abscesses tend to have dark rims on SWI)
^disclaimer: this thread is obviously intended to be a simplification; curious to hear any thoughts/tips from others!
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