Post

How to get URL link on X (Twitter) App

On the Twitter thread, click on or icon on the bottom
Click again on or Share Via icon
Click on Copy Link to Tweet
Paste it above and click "Unroll Thread"!
More info at Twitter Help

Lea Alhilali, MD

@teachplaygrub

Jul 29, 2025 • 9 tweets • 4 min read • Read on X

Scrolly

1/Talk about bad blood!

Do you know when a hematoma is going to expand?

Read on for month’s @theAJNR SCANtastic on all you need to know about imaging intracranial hemorrhage!

ajnr.org/content/46/7/1…

@TheAJNR 2/Everyone knows about the spot sign for intracranial hemorrhage

It’s when arterial contrast is seen within a hematoma on CTA, indicating active
extravasation of contrast into the hematoma.

But what if you want to know before the CTA?

@TheAJNR 3/Turns out there are non-contrast head CT signs that a hematoma may expand that perform similarly to the spot sign—and together can be very accurate.

How can you remember what they are?

@TheAJNR 4/If you are wondering if a hematoma will expand, look for the same features as the
most expansive thing in the universe: a black hole.

There are many signs, but 3 best are also seen w/black holes

@TheAJNR 5/First is the blend sign

Here, part of the hematoma has a different attenuation, meaning different age blood & thus active bleeding

It looks like a halo & black holes have halos in the event horizon!

@TheAJNR 6/Next is the black hole sign

Here, regions have very low density, indicating unclotted blood similar to water density.

If blood is still flowing like water, then hematoma may expand

Black holes obviously have black holes too!

@TheAJNR 7/Finally is the island sign

Here, there are satellite hematomas, indicating multiple regions of bleeding, increasing risk of expansion

Black holes usually have satellites orbiting around them from their gravitational pull!

@TheAJNR 8/In this month’s @theAJNR Tran et al. worked to optimize a deep learning model that could predict hematoma expansion with an AUC of 0.8!

In the future, AI may make all these signs obsolete!!

@TheAJNR 9/Now you know the imaging signs for hematoma expansion—until deep learning can assess it for you!

Hopefully, now you will know which clot is hot!

ajnr.org/content/46/7/1…

• • •

Missing some Tweet in this thread? You can try to force a refresh

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @teachplaygrub

Lea Alhilali, MD

@teachplaygrub

Jan 27

1/The hardest thread yet! Are you up for the challenge?

How stroke perfusion imaging works!

Ever wonder why it’s Tmax & not Tmin?

Here’s what to know from @theAJNR SCANtastic!

ajnr.org/content/47/1/28

@TheAJNR 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 contrast—it changes CT density or MR signal so we can see where it goes.

@TheAJNR 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.

Read 19 tweets

Lea Alhilali, MD

@teachplaygrub

Jan 19

1/Do you get a Broca’s aphasia trying remember the location of Broca's area?

Does trying to remember inferior frontal gyrus anatomy leave you speechless?

Don't be at a loss for words when it comes to Broca's area

Here’s a 🧵to help you remember the anatomy of this key region!

2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonald’s arches.

So, to find this area on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, i’m lovin it.

3/Inferior frontal gyrus also looks like a sideways 3, if you prefer. This 3 is helpful bc the inferior frontal gyrus has 3 parts—called pars

Read 13 tweets

Lea Alhilali, MD

@teachplaygrub

Dec 5, 2025

1/They say form follows function!

Brain MRI anatomy is best understood in terms of both form & function.

Here’s a short thread to help you to remember important functional brain anatomy--so you truly can clinically correlate!

2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.

3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)

Read 12 tweets

Lea Alhilali, MD

@teachplaygrub

Dec 1, 2025

1/To call it or not to call it? That is the question!

Do you feel a bit wacky & wobbly when it comes to calling normal pressure hydrocephalus on imaging?

You don’t want to overcall it, but you don’t want to miss it either!

Let me help you out w/a thread about imaging in NPH!

2/First, you must understand the pathophysiology of “idiopathic” or iNPH.

It was first described in 1965—but, of the original six in the 1965 cohort, 4 were found to have underlying causes for hydrocephalus.

This begs the question—when do you stop looking & call it idiopathic?

3/Thus, some don’t believe true idiopathic NPH exists.

After all, it’s a syndrome defined essentially only by response to a treatment w/o ever a placebo-controlled trial.

However, most believe iNPH does exist--but its underlying etiology is controversial. Several theories exist

Read 19 tweets

Lea Alhilali, MD

@teachplaygrub

Nov 21, 2025

1/Time to go with the flow!

Hoping no one notices you don’t know the anatomy of internal carotid (ICA)?

Do you say “carotid siphon” & hope no one asks for more detail?

Here’s a thread to help you siphon off some information about ICA anatomy!

2/ICA is like a staircase—winding up through important anatomic regions like a staircase winding up to each floor Lobby is the neck.

First floor is skullbase/carotid canal. Next it stops at the cavernous sinus, before finally reaching the rooftop balcony of the intradural space.

3/ICA is divided into numbered segments based on landmarks that denote transitions on its way up the floors.

C1 is in the lobby or neck.

You can remember this b/c the number 1 looks elongated & straight like a neck.

Read 10 tweets

Lea Alhilali, MD

@teachplaygrub

Nov 4, 2025

1/The 90s called & wants its carotid imaging back!

It’s been 30 years--are you still on NASCET?

Feeling vulnerable about plaque vulnerability?

This month’s @theAJNR SCANtastic has what you need to know about carotid plaque

ajnr.org/content/46/10/…

2/Everyone knows the NASCET criteria:

If the patient is symptomatic & the greatest stenosis from the plaque is >70% of the diameter of normal distal lumen, patient will likely benefit from carotid endarterectomy

But that doesn’t mean the remaining patients are just fine!

3/Yes, carotid plaques resulting in high-grade stenosis are high risk

But assuming that stenosis is the only mechanism by which a carotid plaque is high risk is like assuming that the only way to kill someone is by strangulation.

Read 13 tweets

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Share this page!

Enter URL or ID to Unroll

Lea Alhilali, MD

Try unrolling a thread yourself!

More from @teachplaygrub

Lea Alhilali, MD

Lea Alhilali, MD

Lea Alhilali, MD

Lea Alhilali, MD

Lea Alhilali, MD

Lea Alhilali, MD

Did Thread Reader help you today?

Don't want to be a Premium member but still want to support us?

Send Email!