Case 4: Imaging Description

A brain MR examination was performed without and with contrast. Select images are depicted above.

Questions

1. What are the above sequences?

• Images A & B are T1 MR images. You know this because the CSF/subarachnoid space is dark, but also because the white matter is white and the gray matter is gray.
• Images C & D are T1+ Contrast images. These images look similar to images A & B, but the vascular structures and dura are now bright, which are both hallmarks of a post contrast scan. Gadolineum contrast is given intravenously and is useful to identify areas of blood-brain barrier breakdown.
• Images E & F are T2 MR images. You can tell this because the subarachnoid space/CSF is white. Notice also that the white matter is darker than the gray matter (which is reversed compared to T1).
• Images G & H are FLAIR images. FLAIR is a sequence that looks like a T2, but the CSF is dark. You can tell this is a FLAIR because the CSF is dark, but that the white matter is darker than the gray matter. This sequence is useful to highlight areas of edema.

For review on MR sequences click HERE

2. Where is the abnormality located?

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3. Describe the abnormalities using appropriate terminology.

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4. What is your imaging differential diagnosis for the imaging findings?

Answer