for detailed assessment of the midline structures including corpus
callosum, sella and suprasellar structures, clivus, craniocervical
junction, as well as the bone marrow.
signal abnormality in the posterior aspect of the corpus callosum (lipoma).
Also, there is an optic tract glioma
signal anterior to the pons representing prepontin acute hemorrhage
sequence showing empty sella
2- Axial DW:
useful to determine if there is acute or subacute infarct. Its
sensitivity is quite high, while the specificity is limited and requires
Acute small thalamic infarct
temporoparietoccipital infact (left)
in the anterior left middle cranial fossa - also demonstrates
abscess adjacent to the right mastoid (secondary to mastoiditis)
3- Axial EP
useful to determine if the hyperintensity on DF scan is due to infact or
artifactual ("T2 shine-through phenomenon".
area in the left parietal area is due to acute infact
infarct in the right parietal area
4- Axial T2 spin
Axial T2 SE is
considered a gold standard to assess the brain anatomy, as well as
paranasal sinuses and temporal bone aeration.
leukomalacia: clearly demonstrated using axial T2 images.
5- Axial Flair
Flair is a
good supplement to T2 to assess the white matter conditions and generally
more sensitive than T2. Flair is also quite sensitive to
determine if there is subarachnoid hemorrhage.
tuberculosis is clearly more conspicuous on flair (1st: T2, 2nd:
6- Coronal Flair
is a good supplement to axial flair, to confirm the signal abnormalities
seen on axial scans, as well as for further assessment of the temporal lobes.
hemorrhage on CT and on Flair coronal scan as a hyperintense sulci.
7- Axial pre-contrast T1
spin echo (SE)
of this sequence is to establish a baseline for the post contrast scan.
Also, T1 spin echo can be useful to assess intracranial hemorrhage as
well as fat containing lesions.
8- Axial post-contrast
T1 spin echo (SE)
post-contrast scanning is a gold standard to rule out enhancing
intracranial lesions and also to assess the enhancement pattern of a known
secondary due mastoiditis (left side) demonstrating intense contrast
enhancement (same patient - see DW scan above). Also see sinusitis.
Precontrast scan is
normal. However, post contrast scan demonstrates intense diffuse menengial
enhancement (Intracranial hypotension).
Left temporal area
menengioma is not noticeable on pre-contrast T1 (first image) while it is
easily noticeable on post-contrast scan (second image). Post-contrast scan
is important to assess the extent of the tumor
9- Coronal post-contrast
T1 spin echo (SE)
supplement to axial post-contrast scan.
Small falx menengioma is clearly
spread of skin cancer to 5th nerve (T). Normal Meckel's Cave (cavum
trigeminale) seen on the contralateral side.