Syrinx and Chiari Malformation

This sagittal image is from a MRI of the cervical spine with and without contrast. In this pre contrast T2 image you can see a couple abnormalities, one being a Arnold-Chiari malformation. A Arnold-Chiari malformation is a downward displacement of the cerebellum through the foramen magnum. Another abnormality is that the patient has a large cervical syrinx that extended all the way to the margin of the field of view. We later found out the syrinx was the entire length of the patients spinal cord. A syrinx is a rare, fluid-filled neuroglial cavity within the spinal cord or brain stem. I have seen a syrinx on a patient before but it was only the length of one cervical vertebrea so this one definately stands out to me. The patient's symptom was occipital headaches. I wish I could follow-up on patients and see what kind of treatment is used and if it helps for different pathologies I see! And the image I posted isn't the best, it is a picture of the computer screen with my digital camera so not the best quality but you can see the pathologies I'm mentioning.

Large Aneurysm

This is an image from a MRI of the brain done on a 71 yr old patient that complained of visual disturbances and hypertension. This axial image shows a very large aneurysm measuring 2.4 x 2.3 cm. It is causing mass effect on the patients right optic nerve which would be a cause for the visual disturbances the patient is having. The doctor recommened MRA or CTA evaluation of the head to better evaluate the area. The lead tech saw this area while doing the MRI of the brain and after consulting with the radiologist called the ordering doctors office and had them send us an order for a MRA of the brain. The images were read as a stat call results priority. This is the biggest aneursym I have seen in the head and thought it would be a good exam to share.

30yr old with brain lesion

Above are axial MRI images of a 30yr old female brain, one being a T2 axial and the other a T1 axial post contrast injection. The patient came into the ER this day because her husband said she had a possible seizure while she was sleeping and the patient stated her body was really sore and weak feeling. A CT of the brain was performed through the ER showing an abnormality. The patient was admitted to the ICU and given meds to prevent another seizure then came to us for her MRI. I felt so sorry for her because as I was screening her I found out her only medical background was the birth of her daughter who was now 18 months old. You could tell she was scared and nervous. I made sure I explained everything that would happen during the MRI since she had never had anything like this done in the past. The thing I thought was unique about this exam is that the area of interest was dictated as being a lesion yet it did not enhance with the contrast injection. I think every mass or lesion I have ever seen has enhanced so this was a note-worthy exam for me to share. The radiologist suggested a differential diagnosis for this finding to be neoplasms with a propensity for the temporal lobe resulting in seizure activity, such as a dysembryoplastic neuroepithelial tumor (DNET). The radiologist also gave several other possible types of lesions the area could be. You can also see in the images that the lesion was causing a mass-effect midline shift in the patients brain.

Spring 2010 Introduction

Hello! My name is Ashley. I am now in my last year of school ever hopefully! I plan on graduating in December with my Bachelor's in Radiologic Sciences. I live in Western Kentucky and take all my classes at USI online through the distance education programs. I love that USI gives me the opprotunity to do this because being a single mom, owning a home, and having to work full time there is no way I would have the time to actually attend class. I graduated from a college here in western Kentucky in 2005 with an Associates Degree in Science from the Radiography Program and decided to go back to school to get my Bachelors in 2009. I work at Lourdes Hospital in Paducah, KY as a CT/MRI tech. I currently only have my R.T. (R) but plan on getting my MR and CT certification when I finish school. Wish me luck! I am doing my clinicals in MRI again this semester so hopefully I will see more interesting exams to post about.

MRI ABDOMEN W/WO

These images are the abdomen of a 35 year old male. He came in with abdomen pain and had an abnormal CT scan and ultrasound. The patient has a mass in his liver. It is large measuring 7x6cm. The radiologist read this hepatic lesion to most likely be a giant hemangioma due to its enhancement characteristics. In the images I provided you can clearly see the pathology in the patients liver. I found this exam to be very interesting because I have not seen a lot of abdomen scans in MRI. CT is usually the first choice for an abdomen scan because MRIs can be very time consuming and the pt has to do numerous breath holds and may not be in a suitible condition to do so especially if they are in a lot of pain.

CONTRAST ENHANCEMENT

This is an exam I did earlier in the semester that I found interesting. The patient was an 85 yr old man with history of lung cancer. The patient had a screening MRI of the brain about six months prior to the one we did in October to observe for mets due to mental status changes. His GFR was low and the radiologists had the tech do the study without contrast when usually anyone with a cancer history has studies with unless their are contradictions like kidney function. This time the patients GFR was still low but not as low as it was and this radiologist gave us the go ahead to inject contrast due to the patients history. These images are not the best because I took them off the screen at work with my camera phone but you can still see what I am talking about. In the pre images you can see maybe one are that might be something but might be atrophy due to age, it is uncertain if it is a pathology or metastatic disease. Then the injection is given and all I could say was oh my gosh!! All I could keep comparing this man's brain to was a dalmation dogs spots. It was unreal what you could see with the contrast enhancement that you couldn't without it! I wondered if all the mets had been there six months prior when contrast was not used? Look at the images and you will see why I was so shocked at the differences. They didn't upload in the order I wanted them to but the bottom two are the pre images.

MRI

Clinicals are still going smoothly. I am learning a lot. We have two new radiologist and one of them has a thing for MRI so he has been changing many of our protocols. We have also done a lot more abdomen MRIs than normal so I am beginning to get very familiar and comfortable with them. We are using a new contrast called Eovist that is specially designed for liver lesion enhancment. The magnet we work on is a Philips Acheiva 1.5T. It is a closed magnet but seems more open than others because it has a short bore. The short bore is very nice for the patients but sometimes it causes fat sat issues with our images. The lead tech said they have had problems with it ever since they got it and Philips said it is just something the short bore magnets run into sometimes. It usually only comes up when scanning feet and breast. One end of the foot might fat sat and the other not. It is really frustrating when doing a breast MRI because they are so lengthy. The majority of the time the fat sat does not work properly on patients with breast implants and we have to make different adjustments with techniques and factors and just keep running scans and keep changing factors until it works. Not the same changes work with every patient, it is like certain things work according to the patients tissue make up. I'm beginning to learn what adjustments to make with the shim box, spir and spair, etc. All in all it is a great learning experience having to know what to do when something doesn't go completely as planned.