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ABPN extra > Neuroimaging > Flashcards

Neuroimaging Flashcards

1
Q

Diffusion restricting lesions

A

In the brain: cytotoxic edema/excitotoxic injury
– Infarct, hypoxic-ischemic encephalopathy
– Cerebritis, herpes encephalitis, CJD, PML
– Acute demyelination, Wallerian degeneration
– Diffuse axonal injury, shaken baby syndrome
– Status epilepticus, osmotic myelinolysis

In a cavity or cyst: pus or ?protein
– Abscess: distinguish from necrotic tumor
– Epidermoid cyst: distinguish from arachnoid cyst

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2
Q

MRI perfusion

A

MRI: Perfusion(PWI), ±contrast
– CBV: Cerebral blood volume (ml/100g)
– CBF: Cerebral blood flow (ml/min/100g)
– MTT: Mean transit time (sec)
•Acute stroke: ↑MTT ↓CBF ↓CBV
– ?Determine ischemic penumbra, “tissue at risk”
– Jury still out (DIAS, DEDAS, DEFUSE, EPITHET)
Tumor: ↑CBF ↑CBV in high-grade tumors
– Pre-operatively predict tumor grade
– Distinguish recurrent tumor v radiation necrosis

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3
Q

MRI spectroscopy

A

Metabolites resonate at specific frequencies
• 2.0 ppm: N-Acetyl Aspartate
– “NAA”, neuronal integrity
• 3.0 ppm: Creatine + PCr
– “Cr”, energy metabolite
• 3.2 ppm: Choline + PC
– “Cho”, membrane turnover
• ~1.3 ppm: Lipid/lactate
– “Lip/lac”, necrosis
• “Tumor signature”: ↑Cho, ↓NAA
• Canavan’s disease: ↑NAA due to enzyme deficiency (aspartoacylase)

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4
Q

Intra-axial brain tumors - imaging

A

Metastasis
Glioma
Astrocytoma, oligodendroglioma, ependymoma, CPP
Lymphoma

Abscess vs High grade Glioma
Double Rim sign w/abscess: On T2F & GRE: outer rim hypo-intense while inner rim hyper-intense (GBM both rims hypo-intense)
Homogenous enhancement (GBM heterogeneous enhancement)
Time course quicker onset of symptoms and growth rate for abscess

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5
Q

Extra-axial brain tumors - imaging

A

Meningioma
– Hemangiopericytoma
Nerve sheath tumor
Metastasis
– Lymphoma, sarcoid
Aneurysm

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6
Q

Cerebellopontine angle brain tumors

A

Schwannoma (75%)
Meningioma (10%)
Epidermoid (5%)

(Aneurysm)

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7
Q

CPP angle - schwannoma vs meningioma vs epidermoid cyst

A

Internal auditory canal - IAC

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8
Q

Suprasellar/sellar brain tumors

A

“SATCHMOE”:
– Sarcoid, suprasellar extension of adenoma
– Aneurysm, arachnoid cyst
– Teratoma/germinoma
– Craniopharyngioma, chordoma
– Hypothalamic glioma, hamartoma
– Metastatic disease, meningioma, mucocele – Optic nerve glioma
– Epidermoid/dermoid, Eosinophilic granuloma

Anterior to third ventricle

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9
Q

Pineal region tumors

A

Germ cell tumors
- Germinoma
- Teratoma
- Choriocarcinoma
- Yolk sac tumor
- Embryonal cell cancer

Pineal origin tumors
- Pineocytoma
- Pineoblastoma

“Other” tumors
- Meningioma
- Tectal glioma
- PNET

Posterior to third ventricle

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10
Q

Intramedullary spine tumors - imaging

A

Ependymoma
Astrocytoma
1st two comprise 90-95% of intramedullary tumors
Hemangioblastoma
Metastases

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11
Q

Intradural/extramedullary spine tumors - imaging

A

Nerve sheath tumor
Drop metastasis
Meningioma
90-95% of intradural tumors
Myxopapillary ependymoma at conus/filum

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12
Q

Drop/CSF metastases

A

Gliomas (esp. GBM, ependymoma)
Germ cell tumors
PNET
Lung, breast, melanoma, lymphoma, leukemia

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13
Q

Extradural, extra medullary spinal cord tumors

A

Vertebral/discogenic origin

Metastasis
Myeloma, lymphoma, leukemia
Other vertebral tumors

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14
Q

Posterior fossa tumors - children

A
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15
Q

Posterior fossa tumors - adults

A
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16
Q

Other intraventricular tumors

A
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17
Q

Calcified brain tumors

A
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18
Q

Hemorrhagic brain tumors

A

Hemorrhagic metastases
– Lung, breast, renal, thyroid, melanoma, choriocarcinoma
Gliomas, esp high-grades III and IV (GBM)
PNET, Rhabdoid tumor
Pituitary adenoma

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19
Q

Purely cystic brain tumors

A

Differential diagnosis: (purely) cystic brain tumors
- Arachnoid cyst
- Epidermoid cyst
- Dermoid cyst
- Colloid cyst
- Rathke cleft cyst
- Pineal cyst
- Choroid plexus cyst

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20
Q

Differential diagnosis - cystic/solid brain tumors

A

Metastasis (esp lung)
Glioma, esp oligo, JPA
Craniopharyngioma
Ganglion cell tumor
– ganglioglioma, gangliocytoma
Hemangioblastoma
Pleomorphic xanthoastrocytoma
Schwannoma > meningioma
Pituitary adenoma (post-radiation change)

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21
Q

Differential diagnosis - T1 hyperintense brain tumors

A

Hemorrhagic tumors
Craniopharyngioma
Lipoma
Epidermoid cyst
Melanoma

(Vascular lesions): cavernoma, aneurysm

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22
Q

Differential diagnosis: Hyperdense (CT) brain tumors

A

(Often, also T2- and/or ADC-hypointense)
Hemorrhagic, calcific, vascular lesions/tumors
Cellular tumors
– Lymphoma/leukemia
– Meningioma (depending on type)
– GBM, PNET, Rhabdoid, germ cell tumor

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23
Q

Ependymoma - spine

A

Intramedullary
Multisegmental expansion, may be centrally located
May hemorrhage – look at T2/T2* weighted images

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24
Q

Astrocytoma - spine

A
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25
Q

Hemangioblastoma - spine

A

Pial-based “cyst/mural nodule”
May be visible on angiography
Association with Von-Hippel Lindau

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26
Q

Intramedullary metastasis

A

Lung, breast, renal, gastric, melanoma
Lymphoma/leukemia

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27
Q

Aneurysm rupture

A

Aneurysm rupture
~85% of nontraumatic SAH, 30% also have parenchymal hemorrhage
Dx: CT→ (±LP) → angiogram (or CTA?)
– CT 95% sensitive to detect SAH in 12-24 hrs
– ISAT compared coils/clips (Lancet. 2002: 360: 1267-74)

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28
Q

Perimesencephalic nonaneurysmal hemorrhage

A

~10% of nontraumatic SAH
Localized to cisterns around midbrain, pons • ?bleeding from venous source
Clinically benign course
– Angiogram to exclude aneurysm, dissection
– Repeat angio?/Cervical spine MRI?/neck MRA?

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29
Q

AVM

A

Intracranial hemorrhage
– esp parenchymal, intraventricular, subarachnoid
– High hemorrhage risk (~2-4%/yr)
Arteriovenous shunting with nidus (on angio) – Enlarged arteries and veins
Treatments: surgery, radiation, embolization

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30
Q

dAVF

A

Enlarged dural arteries/veins near sinus
– Likely acquired, traumatic? prior thrombosis?
– AV shunting but no nidus
– SDH/SAH/IPH hemorrhage
Sxs: tinnitus, intracranial hypertension, sz, ocular sx

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31
Q

Moya-moya

A
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32
Q

Spinal dAVF

A
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33
Q

Spinal dAVF

A
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34
Q

Vasculitis

A
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35
Q

Vasculitis

A
36
Q

RCVS

A
37
Q

Carotid stenosis

A
38
Q

Fibromuscular dysplasia

A
39
Q

Arterial dissection

A
40
Q

Spinal cord infarct

A
41
Q

Venous thrombosis

A
42
Q

Amyloid angiopathy

A
43
Q

Global anoxic injury

A
44
Q

Contusion

A
45
Q

Axonal shear injury

A
46
Q

Spontaneous intracranial hypotension

A
47
Q

IIH

A
48
Q

Spine fracture

A
49
Q

Central cord syndrome

A
50
Q

Wernicke’s encephalopathy

A
51
Q

Subacute combined degeneration

A
52
Q

Wilson’s disease

A
53
Q

FIBGC

A
54
Q

PKAN

A
55
Q

Osmotic demyelination

A
56
Q

Carbon monoxide toxicity

A
57
Q

RPLS

A
58
Q

MTS

A
59
Q

ALS

A
60
Q

Huntington’s disease

A
61
Q

Olivopontocerebellar degeneration

A
62
Q

DaT scan

A
63
Q

NPH

A
64
Q

MS

A
65
Q

Acute traverse myelitis

A
66
Q

Sarcoid

A
67
Q

GBS

A
68
Q

HSV I encephalitis

A
69
Q

CJD

A
70
Q

Meningitis - bacterial

A
71
Q

Abscess

A
72
Q

Subdural empyema

A
73
Q

HIV encephalopathy

A
74
Q

PML

A
75
Q

Cysticercosis

A
76
Q

Toxoplasmosis

A
77
Q

Diskitis/osteomyelitis

A
78
Q

Corpus callosum dysgenesis

A
79
Q

Septic-optic dysplasia/holoprosencephaly

A
80
Q

Schizencephaly

A
81
Q

Porencephalic cyst

A
82
Q

Heterotopia

A
83
Q

Pachygyria

A
84
Q

Dandy-Walker

A
85
Q

Chiari malformations

A
86
Q

Chiari II

A

ABPN extra (5 decks)

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