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.
1 topic, 3 min.
4 topics, 17 min.
5 topics, 14 min.
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.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.3 topics, 15 min.
3 topics, 14 min.
6 topics, 18 min.
6 topics, 26 min.
6 topics, 16 min.
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.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.5 topics, 13 min.
0:00
These are images of a 91-year-old female with
0:03
left-sided weakness and you can see there's
0:07
hypodensity in the right basal ganglia and
0:10
going up into the corona radiata a little bit.
0:13
MCA stem looks pretty good.
0:15
I don't see an obvious hyperdense vessel sign.
0:18
So, let's take a look at the CTA.
0:22
So when we look at the CTA MIP, we can see
0:24
that there is in fact an MCA cutoff.
0:27
There's good collateralization in the right MCA territory.
0:31
Not complete, though.
0:31
It's not quite as good as the other side.
0:34
So the patient then got perfusion
0:36
images and diffusion images.
0:39
And we can see on the diffusion map,
0:43
that there's really just a small infarct
0:46
involving the basal ganglia and the corona radiata.
0:49
But here's the ASL image and you can see that
0:52
there's a much larger area on
0:54
the ASL compared to the DWI.
0:57
So, it looks like there's a bit of tissue at
1:01
risk and there's also, you'll notice this
1:04
abnormality in the ACA territory as well.
1:06
And then if you go back and look at the CTA,
1:09
you can see there's a cutoff of one
1:11
of the ACA branches right here.
1:13
So, large area of tissue at risk.
1:15
They maximize therapy,
1:18
the patient had a follow-up CT.
1:21
And you can see that this ACA territory
1:25
did infarct and part of the MCA territory infarcted,
1:28
but lower down, there was some sparing.
1:30
So, just an example of ASL showing tissue at
1:34
risk and progression of the infarct
1:37
despite of maximum medical therapy.
Interactive Transcript
0:00
These are images of a 91-year-old female with
0:03
left-sided weakness and you can see there's
0:07
hypodensity in the right basal ganglia and
0:10
going up into the corona radiata a little bit.
0:13
MCA stem looks pretty good.
0:15
I don't see an obvious hyperdense vessel sign.
0:18
So, let's take a look at the CTA.
0:22
So when we look at the CTA MIP, we can see
0:24
that there is in fact an MCA cutoff.
0:27
There's good collateralization in the right MCA territory.
0:31
Not complete, though.
0:31
It's not quite as good as the other side.
0:34
So the patient then got perfusion
0:36
images and diffusion images.
0:39
And we can see on the diffusion map,
0:43
that there's really just a small infarct
0:46
involving the basal ganglia and the corona radiata.
0:49
But here's the ASL image and you can see that
0:52
there's a much larger area on
0:54
the ASL compared to the DWI.
0:57
So, it looks like there's a bit of tissue at
1:01
risk and there's also, you'll notice this
1:04
abnormality in the ACA territory as well.
1:06
And then if you go back and look at the CTA,
1:09
you can see there's a cutoff of one
1:11
of the ACA branches right here.
1:13
So, large area of tissue at risk.
1:15
They maximize therapy,
1:18
the patient had a follow-up CT.
1:21
And you can see that this ACA territory
1:25
did infarct and part of the MCA territory infarcted,
1:28
but lower down, there was some sparing.
1:30
So, just an example of ASL showing tissue at
1:34
risk and progression of the infarct
1:37
despite of maximum medical therapy.
Report
Faculty
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
Tags
Vascular Imaging
Neuroradiology
Neuro
MRI
Head and Neck
CTA
CT
Brain
© 2024 Medality. All Rights Reserved.