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Moya Moya Disease-MRI

Moya Moya is a rare idiopathic vasoocclusive disease characterized by progressive irreversible occlusion of main blood vessels to the brain as they enter into the skull. The occlusive process stimulates the development of an extensive network of enlarged basal, transcortical and transdural collateral vessels . In Japanese, Moya Moya means hazy. The disease derives its peculiar name from the angiographic appearance of cerebral vessels in the disease that resembles "puff of smoke". The process of blockage, once it begins tends to continue despite any known medical management unless treated with surgery.

MRI not only reveals areas of infarctions but also allows direct visualization of these collateral vessels as multiple small flow voids at the base of brain and basal ganglia. MR angiography is used to confirm the diagnosis and to see the anatomy of the vessels involved. It typically reveals the narrowing and occlusion of proximal cerebral vessels and extensive collateral flow through the perforating vessels demonstrating the classic puff of smoke appearance.

Our patient is 17 yr old female with history of recurrent seizures. MRI T1 weighted images show extensive collateralization of vessels in region of circle of willis. MRA reveals reduced luminal caliber of left internal carotid artery in petrous, cavernous and supraclinoid segments. Left MCA also shows attenuation of its luminal caliber when compared to its counterpart on right side along with collaterals at the base of the brain and basal gnaglia.

Hematomyelia-MRI

Spinal cord hematoma or hematomyelia is an infrequently encountered condition that is the result of several unusual disease processes. The causes of spontaneous, nontraumatic spinal cord hematoma include vascular malformations of the spinal cord (the most common), clotting disorders, inflammatory myelitis, spinal cord tumors, abscess, syringomyelia, and unknown etiologies. Traumatic events, such as spinal cord injury (closed or penetrating), and operative procedures involving the spinal cord also can cause a spinal cord hematoma. Reported by Teleradiology Providers.

Intraventricular Cysticercosis-MRI

Intraventricular infestation of neurocysticercosis is relatively rare, and it is usually associated with multiple sites of ventricular and parenchymal lesions. Intraventricular cysts are typically 1-2 cm in diameter and show surrounding ependymal inflammatory reaction. Note the cystic lesion in IV ventricle with turbulent flow in IV ventricle and ependymal reaction. There was resultant obstructive hydrocephalus.

Allergic Bronchopulmonary Aspergillosis-HRCT

Bronchiectasis and peribronchial thickening are the most common CT findings in ABPA. ABPA typically involves the segmental and subsegmental bronchi, particularly those in the upper lobes. High-attenuating mucoid impaction is a characteristic finding. Mucus plugging of the small airways can be observed on high-resolution CT scans, with resultant centrilobular nodularity and the tree-in-bud sign.

Osteoid Osteoma-Posterior Element Lumbar Spine

Patient came to us back pain and we noted a small lyic lesion in the junction of the lamina with pars interarticularis along with nidus and suspicion of osteoid osteoma was given which was later confirmed on bone scan.

T1 Hyperintense Pineal Tumour

Masses in the pineal region that may demonstrate intrinsic T1 hyperintensity can be following and can be excluded with routine MR imaging techniques. For example, a fat-saturated T1-weighted sequence may exclude a teratoma, dermoid, or lipoma as in our case. A partially thrombosed aneurysm or venous malformation with subacute blood products can be excluded with MR or CT angiography and absence of pulsation artifacts. A hemorrhagic metastasis from a renal, thyroid, or melanoma primary may be excluded by the lack of susceptibility effects on gradient-echo sequences. Melanotic melanomas will also demonstrate susceptibility effects. Also note intrinsic T1 hyperintensity may be a characteristic imaging appearance for a Papillary tumour of the pineal region. In the imaging absence of fat, hemorrhage, melanin, or calcification in a mass of the posterior commissure or pineal region, the diagnosis of a PTPR may be suggested. This is 50 year old female with headache. Differential of papillary tumour or malignant melanoma was suggested.

CT Coronary Angiography-3D Images

Few sample 3D images submitted by our Cardiac radiologist Dr Priya Darshan, from Prime Telerad Providers (P) Ltd.

Subspeciality Practise in Radiology

Has the time come for the radiologists to now look into subspecialisation?

Very often nowadays, we see clinicians, and by clinicians, i am implying good specialists in their own branches like neurology and orthopaedics, commenting-- i can see the study better than the radiologists and reports are just a formality for the insurance and claims settlement.

Further, in our own teleradiology practise, we have noticed that we have a distinct edge over other because of our subspecialty exposure in neuroradiology and musculoskeletal imaging. Further with addition of people with exposure in cardiac radiology and breast imaging we could get more work. This is probably because of peculiar way radiology practise is based in India. Although it is difficult to get fully trained radiologist at most places, getting a general radiologist is not so much of an issue. So, with most of the imaging centres looking to get things done in cost effective manner to say the least, getting routine work via teleradiology/ outsourcing has become difficult.

However, there is still a room for doubt solving wherein you get an atypical case and specialists want specific answers. I don’t know if it is a trend but sooner rather than later we might see a growing trend towards fellowships and subspeciality training in radiology also.

What are your thoughts on this?

Pneumocele-Frontal Sinus with Proptosis

Note the expansion of the frontal and ethmoid sinuses with resultant axial proptosis.
Reported by -- Teleradiology Providers

Diffuse Axonal Injury-MRI

Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution. The most common MRI finding is the presence of multifocal areas of abnormal signal (bright on T2-weighted images) at the white matter in the temporal or parietal corticomedullary junction or in the splenium of the corpus callosum.