MR Susceptibility SWI
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.
CA0583-MR Susceptibility SWI
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CA0583-MR Susceptibility SWI
Case ReportExam
Prior Study
CT Head
There is thrombosis of the right vein of Trolard. There is hemorrhagic conversion of the thrombosed vein of Trolard producing local mass effects. There are small volume subarachnoid blood products evident within vertex sulci bilaterally and in both the suprasellar and prepontine cisterns.
CT Perfusion
No imaging available
CTV/MRV of the Neck
No imaging available
MRV of the Head
There is mesial segmental occlusion of the right vein of Trolard. Focal displacement of cortical veins in the right parietal vertex is related to the parenchymal hematoma associated with the vein of Trolard thrombosis.
Anomolous, hypoplastic frontal SSS segmental hypoplasia is evident as an anatomic variant.
Delayed Post Contrast CT of the Venocapillary Pool
No imaging available
T1-W Sequence
No imaging available
MR Diffusion
Focal right vertex hemorrhage matching the course of the right vein of Trolard obscurs any evidence of MR diffusion positivity to confirm venous stroke.
MR FLAIR plus T2-W Sequences
Subtle FLAIR signal abnormality is evident within the thrombosed segment of the vein of Labbe'.
Focal hematoma is evident adjacent to the right Trolard vein thrombosis. The hematoma, plus the surrounding edema, produces some local mass effect, but no appreciable brain herniation.
There is a dilated collateral pial vein adjacent to the posterior and lateral margin of the hematoma, which is secondary evidence of CVT.
Findings
MR SWI
There is blooming artifact in the right vein of Trolard. The thrombosed vein is displaced anteriorly from the hematoma. There is a prominent pial collateral vein encircling the posterior and lateral aspect of the hematoma; its' circuitous course is related to the mass effect of the hematoma. There is some collateral hyperemia in the mesial surface parietal veins.
The subarachnoid blood is easily detected in vertex and intrasylvian sulci bilaterally; this is not evidence of additional cortical vein CVT.
The full extent of the parenchymal hemorrhage is better appreciated on the MR swi. The deeper part of the hematoma actually extends as inferior as the right splenium of the corpus callosum.
Impression
2. SWI confirms the presence of local pial venous collaterals.
3. SWI confirms the hemorrhagic conversion of the right vein of Trolard CVT.
Recommendations
Proceed to the summary video and case report to view all of the imaging findings in this case plus the "Lessons to be learned" from this specific instructional case.
