MR susceptibility (SWI)
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
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Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CB1090-MR susceptibility (SWI)
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CB1090-MR susceptibility (SWI)
Case ReportHistory
Exam
Prior Study
1. Extensive fracture of the left facial bones, left orbital apex, left otomastoid, left greater & lesser sphenoid wings. There are inner bone table fractures of both frontal bones, both ethmoid bones and the roof of the left otomastoid bones.
Noncontrast head CT
1. Extensive fractures mainly involving the left face (i.e. LeFort-3 complex). There are bilateral frontal bone fractures and ethmoid fractures with inner table fracture, likely the source of the intracranial air. There is a transverse fracture of the left temporal bone. There are fractures involving the left orbital apex including a posterior ethmoid bone spicule in close proximity to the optic nerve.
2. There are left intraorbital injuries with retroconal hemorrhages, probable Tenon's space hematoma, and ocular proptosis without obvious tenting.
3. There is a 4-5 mm subdural hematoma within the left anterior temporal fossa extending laterally along the basilar and low convexity of the temporal lobe. The does not produce uncal herniation.
Noncontrast MR T1-w post contrast
1. The T1-w MR adds no additional information not supplied by the head CT.
MR flair & MR T2-w
1. There are multiple sites of brain contusion not evident on prior sequences, see above
2. There is focal edema in the left mesial globus pallidus, consistent with a vascular perforator shear injury.
3. There is optic hydrops consistent with raised intracranial pressure
Findings
MR susceptibility (SWI)
There is susceptibility artifact caused by the left subdural, but it is obscured by bone artifact.
There is extensive bilateral frontopolar, left basifrontal, left anterior temporal parenchymal concussive hemorrhages without substantial mass effect. There is also a small left cerebellar hemorrhage.
There are extensive bifrontal and left anterior temporal subpial hemorrhages.
There are microhemorrhages in the left mesial globus pallidus again suggesting vascular (perforator) arterial shear injuries.
Impression
2. MR susceptibility confirms the presence of micorhemorrhage within the left mesial globus pallidus in the site of apparent perforator shear injury.
3. MR susceptibility confirms the presence of linear micorhemorrhage within the left cerebellum consistent with a site of venous avulsion shear injury and parenchymal laceration.
