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Bilateral Central Gray Matter Abnormality

CASE A A 50-year-old man with a history of chronic obstructive pulmonary disease and hypertension was found unresponsive. ADC, apparent diffusion coefficient; Ax, axial; CT, computed tomography; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery. Open full size image CASE B A 67-year-old man presenting with ataxia, rapidly progressive deterioration in mental status, and myoclonus. ADC, apparent diffusion coefficient; Ax, axial; DWI, diffusion-weighted imaging; FLAIR, fluid…

Extraaxial Lesions

CASE A A 75-year-old woman presenting with ataxia. Ax, axial; Cor, coronal; CT, computed tomography; FLAIR, fluid attenuated inversion recovery; Sag, sagittal. Open full size image CASE B A 51-year-old woman presenting with headaches and weakness of the right leg. Ax, axial; Cor, coronal; CT, computed tomography; FLAIR, fluid attenuated inversion recovery; Sag, sagittal. Open full size image CASE C A 73-year-old woman presenting with headaches,…

Lesions Containing Fat

CASE A A 65-year-old woman with memory loss. CT, computed tomography; HU, Hounsfield units; ROI, region of interest. Open full size image CASE B A 45-year-old woman with a headache. CT, computed tomography; DWI, diffusion-weighted imaging; FS , fat saturated; HU, Hounsfield units; ROI, region of interest. Open full size image CASE C A 29-year-old woman with headaches. FLAIR, fluid attenuated inversion recovery; GRE, gradient refocused…

Dural Enhancement

CASE A A 45-year-old man with new-onset postural headache. Open full size image CASE B A 72-year-old man, history withheld. Open full size image CASE C A 39-year-old woman with breast cancer. Open full size image CASE D A 63-year-old man with a history of kidney transplantation. FLAIR, fluid attenuated inversion recovery. Open full size image CASE E A 55–year-old woman, history withheld. FLAIR, fluid attenuated…

Leptomeningeal Enhancement

CASE A A 44-year-old man who had upper respiratory infection symptoms 4 weeks earlier now presenting with severe headache, purulent otorrhea, irritability, and progressive decline of mental status. Ax , axial; Cor , coronal; Sag , sagittal. Open full size image CASE B A 38-year-old woman with a history of diabetes insipidus and hyperprolactinemia presenting with a complex partial seizure. Ax , axial; Cor , coronal;…

Ring-Enhancing Lesions

CASE A A 39-year-old man who had a dental procedure several weeks earlier now presenting with right leg numbness and weakness. Ax, axial; Cor, coronal; DWI, diffusion-weighted imaging. Open full size image CASE B A 37-year-old woman with a 1-month history of right-sided numbness presenting with a 3-day history of right-sided weakness. Ax, axial; Cor, coronal; DWI, diffusion-weighted imaging. Open full size image CASE C A…

Multiple Susceptibility Artifact Lesions

CASE A A 48-year-old asymptomatic man with a strong family history of cerebral microhemorrhage. GRE, gradient refocused echo. Open full size image CASE B An 87-year-old woman with a history of hyperlipidemia, hypertension, and heart disease. GRE, gradient refocused echo. Open full size image CASE C An 18-year-old unrestrained female driver after a motor vehicle accident. ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; GRE, gradient refocused…

T1 Hyperintense Lesions

CASE A A 64-year-old man with a history of amyloid angiopathy–related hemorrhages. Open full size image CASE B A 64-year-old man with a history of renal cell carcinoma, difficulty walking, and diplopia. Open full size image CASE C A 25-year-old man presenting after sustaining trauma. Open full size image CASE D A 50-year-ol man presenting with a history of headaches. Open full size image CASE E…

Computed Tomography Hyperdense Lesions

CASE A A 66-year-old man presenting with sudden-onset left-sided weakness. CT, computed tomography; CTA, CT angiogram. Open full size image CASE B A 77-year-old man with a history of lung cancer. CT, computed tomography. Open full size image CASE C A 73-year-old man with depression, falls, and difficulty completing sentences. CT, computed tomography; CTA, CT angiogram; FLAIR, fluid attenuated inversion recovery; gad, gadolinium; MIPS, maximum intensity…

Lower Limb

Open full size image Open full size image Open full size image Open full size image Open full size image Saphenous Veins Clinical Note The superficial veins of the lower limb, including the saphenous veins, drain to deep veins via perforator veins with valves responsible for unidirectional flow to the deep system. When those valves are incompetent (often damaged by phlebitis), increased pressure in the superficial…

Upper Limb

Open full size image Open full size image Open full size image Open full size image Open full size image Anterior View of the Shoulder Girdle Clinical Note The glenoid labrum is a fibrocartilaginous ring that surrounds and deepens the glenoid cavity. The long head of the biceps brachii tendon attaches to the top of the labrum at the supraglenoid tubercle (biceps anchor). A superior labrum…

Pelvis and Perineum

Open full size image Open full size image Open full size image Open full size image Open full size image Pelvis Clinical Note The crest of the ilium is the most common site for the harvesting of red bone marrow for allogenic or autologous transplantation after loss of marrow due to disease, or chemotherapeutic or radiation treatments for cancer. It is also the site for obtaining…

Abdomen

Open full size image Open full size image Open full size image Open full size image Open full size image Rectus Abdominis Clinical Note Surgical incisions through the rectus abdominis can be made transversely because the abdominal nerves run in that direction and the healed scar appears very similar to one of the many tendinous intersections within the muscle. The rectus sheath is composed of the…

Thorax

Open full size image Open full size image Open full size image Open full size image Open full size image Breast, Lateral View Clinical Note Dimpling of the skin of the breast over a carcinoma is caused by involvement and retraction of the suspensory ligaments (of Cooper), and obstruction of lymphatic drainage by carcinoma may cause edematous skin changes known as peau d'orange. Standard projections for…

Back and Spinal Cord

Open full size image Open full size image Open full size image Open full size image Open full size image Thoracic Spine Clinical Note Excessive kyphosis is an abnormal increase in the thoracic curvature. This occurs frequently in osteoporotic women who develop anterior wedging–type compression fractures of thoracic vertebrae. The thoracic region of the vertebral column is the least mobile of the presacral vertebral column because…

Head and Neck

Open full size image Open full size image Open full size image Open full size image Open full size image Skull, Basal View Clinical Note Maxillofacial three-dimensional (3-D) displays are very helpful in preoperative planning to correct deformities caused by trauma, tumor, or congenital malformations. 3-D volume reconstructions have been shown to be useful for detecting the extent and exact nature of fractures of the skull…

Foot and Ankle

How to Image the Foot and Ankle See the protocols for foot and ankle magnetic resonance imaging (MRI) at the end of this chapter. The foot and ankle are among the most difficult anatomic sites to image, simply because of the angle formed between them. Even the terminology for plane orientation in the foot and ankle is confusing and certainly not universal. Coils and patient position:…

Knee

How to Image the Knee See the protocols for knee MRI at the end of this chapter. Magnetic resonance imaging (MRI) of the knee is the most frequently requested MRI joint study in musculoskeletal radiology. The reasons for this are simple: it works, and so referring physicians request it. MRI provides a comprehensive examination of the knee, giving surgeons information they could not otherwise obtain clinically…

Hips and Pelvis

How to Image the Hips and Pelvis See the hip and pelvis protocols at the end of the chapter. Coils and patient position: Generally, when evaluating the hips for entities such as avascular necrosis (AVN) or fractures, it is possible in many patients to use a torso phased array coil. For larger patients, the body coil is necessary. Both hips and the entire pelvis are imaged…

Spine

How to Image the Spine See spine protocols at the end of the chapter. Coils and patient position: Phased array spine coils should be used for all spine imaging. Patients are supine in the magnet. Image orientation ( Box 13.1 ): Sagittal and axial images are acquired in the cervical, thoracic, and lumbar regions. In the axial imaging plane, we obtain stacked cuts that cover an…