Interactive Transcript
0:01
Okay, here we have another plain radiograph.
0:04
I think plain radiographs, especially
0:06
in the pediatric population, are very
0:08
difficult to interpret because, you know,
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you've got all these areas of cartilage,
0:13
bowel gases everywhere, you've got a funny
0:16
looking pelvis and the spine and
0:18
everything else, but I think you have to
0:20
try to look for symmetry or asymmetry.
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That's going to be your biggest friend.
0:26
As we look at this, I see
0:27
a subtle difference in symmetry.
0:30
As far as the area in the iliac wing on the
0:33
right, it looks sort of less dense, if you
0:38
will, compared to the contralateral side.
0:40
Looking at the femoral head, this side is a
0:43
little brighter, or sclerotic, or, or what
0:45
have you, and more lucent on this side.
0:47
The question is, which is normal,
0:49
which is abnormal, meaning that, is
0:51
this not bright enough, or is this
0:53
too bright, similarly on either side.
0:56
Whatever the case may be.
0:58
One of those things is abnormal.
1:00
One of those things shouldn't be right
1:01
because it should be relatively symmetric.
1:03
And because of this, we considered some kind of
1:06
an infiltrative process and an MRI was obtained.
1:10
On the MRI, I'm leaving parameters here
1:12
for you just to convince you that I'm
1:14
not lying, that this indeed, the middle
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image here is a T1-weighted image because
1:22
notice the fat is very, very bright.
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Fat is bright here.
1:25
This is the bladder.
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The bladder is dark.
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Fluid is dark on T1.
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But the marrow should be bright on T1.
1:32
Let me blow that up.
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The marrow everywhere.
1:35
The iliac wings.
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The vertebral bodies.
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The femoral heads.
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The femoral shafts.
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Everywhere that marrow should
1:44
be is completely replaced.
1:46
And look at it.
1:47
It's almost the same signal as the muscle.
1:50
This diffuse infiltrative process is complete
1:54
and suspicious for a malignancy.
1:57
And if we look very closely, I'm going
1:58
to show this to you another,
2:00
another view, but there's actually something
2:02
wrong with the margins of this bone also.
2:06
So let's go and look at the STIR sequence
2:09
again to convince you this is not T1.
2:12
The image on your right, it sort of
2:14
looks like a T1 until you look at the
2:15
parameters and you notice that it's a
2:17
fat-suppressed fluid-sensitive sequence.
2:20
In that case, we have lots of edema
2:23
or lots of fluid-like something in the
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marrow of every single bone that we see.
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We know this is a fluid-sensitive sequence
2:30
because the bladder is nice and bright.
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It has fluid in it.
2:33
Remember I told you to take a look along
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the margins of that right iliac wing?
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Well, here is the margin
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of the right iliac wing.34 00:01:23,994 --> 00:01:24,914 Fat is bright here.
1:25
This is the bladder.
1:26
The bladder is dark.
1:27
Fluid is dark on T1.
1:29
But the marrow should be bright on T1.
1:32
Let me blow that up.
1:33
The marrow everywhere.
1:35
The iliac wings.
1:37
The vertebral bodies.
1:39
The femoral heads.
1:41
The femoral shafts.
1:42
Everywhere that marrow should
1:44
be is completely replaced.
1:46
And look at it.
1:47
It's almost the same signal as the muscle.
1:50
This diffuse infiltrative process is complete
1:54
and suspicious for a malignancy.
1:57
And if we look very closely, I'm going
1:58
to show this to you another,
2:00
another view, but there's actually something
2:02
wrong with the margins of this bone also.
2:06
So let's go and look at the STIR sequence
2:09
again to convince you this is not T1.
2:12
The image on your right, it sort of
2:14
looks like a T1 until you look at the
2:15
parameters and you notice that it's a
2:17
fat-suppressed fluid-sensitive sequence.
2:20
In that case, we have lots of edema
2:23
or lots of fluid-like something in the
2:26
marrow of every single bone that we see.
2:28
We know this is a fluid-sensitive sequence
2:30
because the bladder is nice and bright.
2:31
It has fluid in it.
2:33
Remember I told you to take a look along
2:34
the margins of that right iliac wing?
2:36
Well, here is the margin
2:38
of the right iliac wing.
2:40
Here is the margin.
2:41
It's sort of moth-eaten over here.
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I can't follow it.
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And there's stuff outside.
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So there's a collection that's extended
2:48
outside the bone into the periosteum,
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sort of giving us that mottled appearance
2:54
that we saw on the plain radiograph.
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So a biopsy was taken, and this
2:59
was another case of leukemia.
3:01
A very, very infiltrative process that you don't
3:05
want to miss, especially if you know what the
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marrow signal should look like on T1 versus
3:11
a fat-suppressed fluid-sensitive sequence.
3:14
It looks like it's the opposite view in here.
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