MR FLAIR
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.
CA0634-MR FLAIR
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CA0634-MR FLAIR
Case ReportExam
Prior Study
Negative study for acute arterial or venous occlusion.
There is a small completed lacunar infarct in the left caudate head.
The combination of a completed stroke and mild global atrophy and prominent basal ganglia calcificiation suggests the presence of underlying vasculopathy.
CT Perfusion
CT perfusion and CTA evidence of moyamoya disease with expected alteration of blood flow, as above.
Small completed infarct in the left caudate head.
CTA neck
Arterial vascular changes consistent with moyamoya disease.
CTA head
1. Evidence of moyamoya disease vasculopathy.
2. There is a prior small completed lacunar stroke in the left caudate head.
3. There is delayed filling of distal MCA pial arteries on the right.
Post contrast CT head
1. The brain CT density within the venocapillary pool is essentially normal, despite the delayed pial filling in the right MCA on the CTA head.
2. There are two small areas of persistent oligemia in the caudate head on the left and basifrontal white matter on the right. Both are likely sites of previous ischemic injury.
3. The classic features of moyamoya disease are again evident.
T1-w MR pre and post contrast
1. The vasculopathy of moyamoya disease are evident on both the pre and post contrast T1-w sequences.
2. Two sites of chronic lacunar stroke are evident. One seen in the left caudate head was also seen on the prior Post contrast head CT. The second is a very small lacunar stroke in the right caudate head adjacent to the frontal horn.
3. There is no contrast leak to suggest post ischemic dysautoregulation.
MR diffusion
Negative MR diffusion with no acute stroke. Small caudate head lacunes are evident on the Bo sequence.
Findings
MR Flair
MR flair does not delineate the details of the moyamoya vasculopathy as well as other sequences, however it clearly detects the hyperemia in the enlarge lenticulostriate arteries and the pial collaterals. It demonstrates the moyamoya disease has had more extensive secondary vascular effects in the right cerebrum than the left.
There is prominent MR flair signal in the hyperemic right MCA pial collaterals. There is suggestion that there is some perivascular protein leak surrounding these vessels.
The phase image sequence clearly shows the prominently calcified mesial globus pallidus bilaterally. It also detects the deep medullary venous hyperemia.
Impression
2. Both sites of caudate head completed strokes are evident; the cavities are clearly evident consistent with late effects of prior artery of Huebner terminal branch strokes.
Recommendations
No recommendation
