Hemorrhage - Case 6 MR T2-w
Claim CME CreditPOINT OF CARE INFORMATION
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.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
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.
CB1705-Hemorrhage - Case 6 MR T2-w
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CB1705-Hemorrhage - Case 6 MR T2-w
Case ReportHistory
Exam
Prior Study
1. There is a single mass lesion (consistent with low grade tumor based on history) that has undergone recent hemorrhage necrosis the blood products evident in the dorsal anterior aspect of the tumor, which has released a small amount of blood into the ventricles. There is no secondary hydrocephalus.
2. The mass causes only local mass-effects with effacement of the left frontal horn but not the left cerebral aqueduct.
3. There is age-related ex vacuo ventriculomegaly and frontotemporal atrophic changes.
T1-w MR pre and post contrast
1. The left basifrontal intraaxial mass has contrast enhancement throughout. It has very distinct tumoral margin. The features are those of a low grade paraventricular brain tumor most consistent with low grade ependymoma.
2. There is evidence of some internal hemorrhagic necrosis, which is the source of the minimal intraventricular blood products.
Findings
T2-w spin echo
The hemorrhagic components, both in the dorsal aspect of the tumor and within the tumor, are hypointense when seen. It is likely the hemorrhage is actual dispersed within the tumor rather than being a sequestered tumor, which would account for the difficulty in detecting the hemorrhage on both the CT and T1-w MR.
There is a 3.7 x30 x 28 cm, intraaxial, tumoral mass located in the basifrontal parenchyma extending into the anterior basal ganglia. The margins of the tumor are very clearly defined on T2-w spin echo with no evidence of diffuse infiltration. There is no perilesional edema nor tumor infiltration to suggest aggressive tumoral biology. This is a single lesion with no other lesions to suggest metastatic disease. The tumor features suggest the lesion is a low grade CNS parenchymal tumor in this location adjacent to the ependymal surface would be low grade ependymoma. Filling defects in the enhancing tumor likely reflect the internal microhemorrhages, since no calcification was evident on the head CT.
