1.Mimics and diagnostic pitfalls of intracranial lesions in conventional MRI: Clues on advanced MRI
Alan Basil Peter ; Norlisah Ramli ; Kartini Rahmat ; Faizatul Izza Rozalli ; Che Ahmad Mazlan
Neurology Asia 2015;20(2):161-165
Objective: To delineate and differentiate between late subacute hemorrhage and intracranial lipomas
in clinically available conventional and advanced MR sequences. Methods: Two cases of late subacute
hemorrhage and two cases of intracranial lipoma were reviewed with CT scans and 3.0T scanner MRI.
The sequences evaluated in MRI were T1-weighted (T1W) fast spin echo (FSE), T2-weighted (T2W)
FSE, gradient echo T2*-weighted (GRE T2*W) images, diffusion weighted (DWI), apparent diffusion
coefficient (ADC) and multivoxel spectroscopy. Results: Late subacute hemorrhage and intracranial
lipoma have similar imaging features on T1W, T2W FSE with blooming artefact at the margins on
GRE T2*W. However on GRE T2*W sequence, the central area of lipoma demonstrates low signal;
while hemorrhage demonstrates high signal. In DWI, late subacute hemorrhage shows hyperintensity;
while in lipoma there is loss of signal.
Conclusion: Awareness of the potential pitfalls in standard sequence are important, as these entities
appear to have similar T1W/ T2W characteristic with blooming artefact on T2*W. Knowing the
distinctive central signal intensity pattern on GRE T2W* and DWI is therefore essential to differentiate
between these lesions as there are differences to their clinical management.
Magnetic Resonance Imaging
2.Chronic Back Pain in a Young Female Patient: A Case of Ependymoma Originating from the Conus Medullaris
Siti Fairus ASAHAR ; Khasnur Abd MALEK ; Wan Najwa Wan Mohd ZOHDI ; Alan Basil PETER
Korean Journal of Family Medicine 2020;41(1):68-72
We present the case of a 14-year-old Malay girl with an ependymoma of the conus medullaris who presented to multiple general practitioner clinics with a 24-month history of chronic low back pain. The pain was symptomatically managed as a simple musculoskeletal pain and sciatica. Further imaging to aid diagnosis was delayed until the appearance of severe pain with neurological deficits. Magnetic resonance imaging revealed an enhancing spinal mass at L1 through L3, and histopathological investigations confirmed the grade II ependymoma according to the World Health Organization classification. She underwent gross resection of the tumor. After the surgery, she developed neurogenic urinary bladder and bowel, which required intermittent self-catheterization, intermittent enema use, and intensive physical therapy.