Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Pre-Course Activities
1 topic, 3 min.
Lesson
Introduction to Stroke Imaging
4 topics, 17 min.
Lesson
Noncontrast CT
5 topics, 14 min.
Lesson
CTA Neck
10 topics, 33 min.
Vascular Imaging in Stroke - CTA vs MRA
2 m.Carotid and Vertebral Vasculopathies Overview & Examples of Atherosclerotic Disease
3 m.Case - Atheromatous Disease with Severe ICA Stenosis
4 m.Carotid & Vertebral Artery Dissection Overview & Examples
3 m.Case - Embolic Stroke with ICA Dissection
5 m.Collagen Vascular Diseases Overview - Examples of FMD, Carotid Web
2 m.Case - Fibromuscular Dysplasia (FMD)
5 m.Case - Ehlers Danlos
7 m.Inflammatory Conditions with Stroke Symptoms - Examples of Takayasu's, TIPIC
4 m.Case - Takayasu’s Arteritis
4 m.Lesson
CTA Head
9 topics, 37 min.
CTA Head in Acute Stroke - Source Images, MIPS, Collaterals
4 m.Case - MCA Stem Embolus with Good Collaterals
5 m.Case - MCA Stem Embolus with Poor Collaterals
4 m.Case - Basilar Tip Thrombus
6 m.Circle of Willis Stenoses: Differential Diagnoses
2 m.Case - Moya Moya disease
6 m.Case - Reversible Cerebral Vasoconstrictive Syndrome (RCVS)
5 m.Case - Primary Angiitis of the CNS (PACNS)
7 m.Infectious Causes of Multifocal Circle of Willis Stenosis
2 m.Lesson
CT Perfusion
3 topics, 15 min.
Lesson
MRI (DWI, FLAIR, SWI) of Acute Stroke
3 topics, 14 min.
Lesson
MRA of Head and Neck
6 topics, 18 min.
Lesson
Multifocal Strokes With No Visualized Vascular Abnormality
6 topics, 26 min.
Lesson
Brain Ischemia, Hypoxia, & Death
6 topics, 16 min.
Lesson
Stroke Mimics & Other Causes of Restricted Diffusion
7 topics, 18 min.
Stroke Mimics - Other Causes of Restricted Diffusion
2 m.Case - Seizure (Stroke Mimic)
4 m.Case - MELAS (Stroke Mimic)
3 m.Case - Hypoglycemia (Stroke Mimic)
3 m.Case - Herpes Virus Encephalitis (Stroke Mimic)
4 m.Case - Osmotic Demyelination Syndrome (Stroke Mimic)
3 m.Case - Brain Metastases (Stroke Mimic)
4 m.Lesson
MR Perfusion
8 topics, 17 min.
MR Perfusion - Data, Maps and Uses
4 m.Case - MR Perfusion Target Mismatch (Good Collaterals)
2 m.Case - MR Perfusion Target Mismatch (Poor Collaterals)
3 m.Case - Ischemia Detected Only on MR Perfusion (Case 1)
2 m.Case - Ischemia Detected Only on MR Perfusion (Case 2)
3 m.Arterial Spin Labelling Perfusion - Usage Examples
3 m.Case - ASL Matched Defect
2 m.Case - ASL Showing Tissue at Risk
2 m.Lesson
Subacute Stroke & Differentials
5 topics, 13 min.
0:00
So, these are images of a 71-year-old male
0:03
with right sided weakness and aphasia.
0:07
And we started out with a head CT
0:10
and looked pretty normal.
0:12
Didn't see a dense MCA vessel sign.
0:14
Basal ganglia looked good,
0:16
insula looked good.
0:17
He has some chronic white matter changes.
0:21
We got a CTA.
0:23
Unfortunately, I don't have MIP images,
0:25
but you can see on these MIPs that I made
0:27
that the left MCA looks normal.
0:30
The right MCA looks normal.
0:31
There were pretty symmetric collaterals.
0:34
Didn't really see much on the CTA.
0:36
Was, you know, wondering what was going on
0:38
with his weakness.
0:39
So, we got a DWI image and perfusion image.
0:45
And here's the DWI.
0:47
And there was a little tiny infarct in the left cerebellum.
0:50
The rest of it was red as normal.
0:52
There's probably another tiny little infarct here,
0:55
but, you know, she's got these small infarcts.
0:58
The MRA looked normal.
1:00
So, you know,
1:01
what's going on as symptoms are kind of worse
1:04
than what we're seeing on the DWI.
1:06
And then, here's the time to peak map.
1:10
And you can see that there's prolonged time
1:12
to peak in the left temporal lobe
1:14
and the occipital lobe,
1:16
and going up into the parietal lobe.
1:19
So, essentially,
1:20
he has an embolus that just wasn't seen on CTA.
1:24
But now we know what's causing his symptoms.
1:27
He was given appropriate medications.
1:30
His blood pressure was kept up
1:32
to try to perfuse that area.
1:34
So, the perfusion map was really helpful here
1:36
in identifying an ischemic area that wasn't really
1:38
seen on the CT, the CTA, the DWI,
1:42
or the FLAIR images.
1:44
Here are the FLAIR images,
1:45
which really motion degraded
1:48
and weren't very helpful.
1:50
We got follow-up DWI for that patient,
1:53
and you can see now there is some small areas
1:56
of infarction in the left temporal lobe
1:59
and the left peritro white matter.
2:01
But much of that abnormality on the time to peak map
2:05
shown here was spared with appropriate therapy.
2:08
So, again,
2:09
the perfusion map was really instrumental in
2:11
identifying that area of ischemia
2:13
and maximizing therapy.
Case - Ischemia Detected Only on MR Perfusion (Case 2)
HIDEInteractive Transcript
0:00
So, these are images of a 71-year-old male
0:03
with right sided weakness and aphasia.
0:07
And we started out with a head CT
0:10
and looked pretty normal.
0:12
Didn't see a dense MCA vessel sign.
0:14
Basal ganglia looked good,
0:16
insula looked good.
0:17
He has some chronic white matter changes.
0:21
We got a CTA.
0:23
Unfortunately, I don't have MIP images,
0:25
but you can see on these MIPs that I made
0:27
that the left MCA looks normal.
0:30
The right MCA looks normal.
0:31
There were pretty symmetric collaterals.
0:34
Didn't really see much on the CTA.
0:36
Was, you know, wondering what was going on
0:38
with his weakness.
0:39
So, we got a DWI image and perfusion image.
0:45
And here's the DWI.
0:47
And there was a little tiny infarct in the left cerebellum.
0:50
The rest of it was red as normal.
0:52
There's probably another tiny little infarct here,
0:55
but, you know, she's got these small infarcts.
0:58
The MRA looked normal.
1:00
So, you know,
1:01
what's going on as symptoms are kind of worse
1:04
than what we're seeing on the DWI.
1:06
And then, here's the time to peak map.
1:10
And you can see that there's prolonged time
1:12
to peak in the left temporal lobe
1:14
and the occipital lobe,
1:16
and going up into the parietal lobe.
1:19
So, essentially,
1:20
he has an embolus that just wasn't seen on CTA.
1:24
But now we know what's causing his symptoms.
1:27
He was given appropriate medications.
1:30
His blood pressure was kept up
1:32
to try to perfuse that area.
1:34
So, the perfusion map was really helpful here
1:36
in identifying an ischemic area that wasn't really
1:38
seen on the CT, the CTA, the DWI,
1:42
or the FLAIR images.
1:44
Here are the FLAIR images,
1:45
which really motion degraded
1:48
and weren't very helpful.
1:50
We got follow-up DWI for that patient,
1:53
and you can see now there is some small areas
1:56
of infarction in the left temporal lobe
1:59
and the left peritro white matter.
2:01
But much of that abnormality on the time to peak map
2:05
shown here was spared with appropriate therapy.
2:08
So, again,
2:09
the perfusion map was really instrumental in
2:11
identifying that area of ischemia
2:13
and maximizing therapy.
Report
Faculty
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
Tags
Vascular Imaging
Perfusion
Neuroradiology
Neuro
MRP
MRI
Head and Neck
CTA
CT
Brain
© 2024 Medality. All Rights Reserved.