(BQ) Part 2 book “Neuroradiology companion - Methods, guidelines, and imaging fundamentals” has contents: Brachial plexus, congenital malformations, degenerative spine, infection inflammation, vascular disorders, neck masses, temporal bone,… and other contents.
SECTION B IMAGING 974 SPINAL CHAPTER 20 Brachial Plexus Inflammatory and Infectious Plexitis Key Facts Viral and idiopathic plexitis: These are predominantly sensory and have an insidious onset Most patients are between 30 and 70 years of age (uncommon in the very young) Most resolve spontaneously in to 12 weeks after their onset Other causes include: drug reaction (allergic), post viral (autoimmune), due to a vasculitis and a heredofamilial type Main differential diagnosis: perineural tumor spread, post radiation changes, stretching injury, hypertrophic polyneuropathy, lymphoma, chronic inflammatory demyelinating polyneuropathy, thoracic outlet syndrome Radiation-induced plexitis: Generally occurs with doses >6,000 cGy In the acute type, symptoms tend to be permanent (probably due to vascular injury and nerve ischemia) In the subacute type (onset generally at about months after treatment), symptoms are transient and usually reversible Most radiation-induced plexopathies are predominantly sensory Diffuse thickening and enhancement of the brachial plexus may be indistinguishable from metastases and follow up is needed to rule out 975 progression, viral plexitis and chronic inflammatory demyelinating polyneuropathy may have a similar appearance FIGURE 20-1 Coronal fat suppressed T2 shows thickening and increased signal in the roots and trunks of the left brachial plexus due to a herpes zoster infection 976 FIGURE 20-2 Coronal fat suppressed T2, in a different patient, show diffuse thickening of the right plexus The cause was never found but symptoms resolved with only supportive treatment 977 FIGURE 20-3 Coronal fat suppressed T2 in a different patient with diffuse (presumably drug-induced) plexopathy shows diffuse thickening and increased signal in the brachial plexus bilaterally 978 FIGURE 20-4 Coronal post contrast T1 shows increased signal intensity from the left infraclavicular brachial plexus (arrow) in a patient post ipsilateral mastectomy and radiation therapy FIGURE 20-5 Corresponding coronal fat suppressed T2 shows increased signal (arrow) in the abnormal brachial plexus SUGGESTED READINGS Chhabra A, Thawait GK, Soldatos T, et al High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging AJNR Am J Neuroradiol 2013;34:486–497 Tharin BD, Kini JA, York GE, et al Brachial plexopathy: a review of traumatic and nontraumatic causes AJR Am J Roentgenol 2014;202:W67–W75 Traumatic Brachial Plexus Injuries Key Facts 979 Vascular injuries: Injuries to the subclavian artery may result in pseudoaneurysms and a compressive mixed sensory/motor neuropathy The brachial plexus may also be damaged during placement of subclavian catheters Hematomas are generally post traumatic and most are not associated with significant vascular injuries While well-encapsulated hematomas that result in a plexopathy may be surgically drained, most are diffuse and not amenable to drainage (in such patients the plexopathy is generally due to traction injuries or post-traumatic thoracic outlet syndrome) Avulsion and stretch injuries: Cervical nerve root avulsions are generally caused by traction injuries of the upper extremities (in the lower spine, they are related to spinal or pelvic fractures) With complete avulsion, the nerve roots retract leaving behind fluidfilled pseudomeningoceles Nerve avulsions at “root entry zones” may result in adjacent subarachnoid hematomas and edema/hemorrhage in the spinal cord Enhancement of intradural nerve roots indicates functional avulsion despite morphologic continuity Enhancement of paraspinal muscles (due to denervation) may be an indirect sign of avulsion injury Stretching of the brachial plexus may sometimes lead to neuroma formation 980 FIGURE 20-6 Coronal non contrast T1 shows large rounded and “laminated” appearance of a right subclavian artery pseudoaneurysm 981 FIGURE 20-7 Sagittal T1, in the same patient, clearly shows the concentric layers of varying signal intensities that are typical of giant aneurysms The plexus is compressed and not identifiable 982 FIGURE 20-8 Coronal T2, in a different patient, shows a fluid-filled pseudomeningocele (arrow) from avulsion of the left C7 nerve root 983 Thoracic myelogram Thrombosis basilar artery cortical vein venous sinus occlusion Thyroglossal duct cyst Thyroid mass Tinnitus, pulsatile Topical agents for IV insertion in children Tornwaldt cyst Total parenteral nutrition Toxoplasmosis Trauma to brain, imaging fundamentals and facts arterial dissection axonal injury, diffuse, and intermediary injuries from child abuse contusions epidural hematoma hygroma pneumocephalus skull fractures subarachnoid hemorrhage, traumatic subdural hematoma magnetic resonance imaging (MRI) protocols of the spine, imaging fundamentals and facts benign compression fractures chance-type fractures compression fractures, malignant contusion facet dislocation Hangman fracture Jefferson fracture occipitoatlantal separation odontoid fractures vertebral artery injury Tricyclic antidepressants, effect on seizure threshold 1750 Tuberculosis brain spine Tuberous sclerosis of brain harmartoma subependymal giant cell astrocytoma Tumors See also specfic tumors of the brachial plexus metastases Pancoast tumor involving schwannoma of the brain, extra-axial, imaging fundamentals and facts arachnoid cyst choroid plexus colloid cyst craniopharyngioma dermoid epidermoid lipoma meningioma pineal gland pituitary adenoma of the brain, intra-axial, imaging fundamentals and facts astrocytoma See (Astrocytoma) dysembryoplastic neuroepithelial tumors dysplastic cerebellar gangliocytoma gangliogliomas glioblastoma multiforme gliomatosis cerebri hemangioblastoma lymphoma medulloblastoma metastases neurocytoma, central neuronal cell oligoastrocytoma oligodendroglioma 1751 pilocytic astrocytoma magnetic resonance imaging (MRI) protocols of sinonasal cavities, malignant of the spine, imaging fundamentals and facts aneurysmal bone cyst astrocytoma chordoma eosinophilic granuloma ependymoma hemangioma, vertebral body hydromyelia leptomeningeal metastases meningioma metastases See (Metastases) osteoid osteoma perineural (Tarlov) cyst schwannoma spinal cord cyst subacute combined degeneration U Unilateral facet dislocation Urticaria V Vagal reaction Vascular anomalies and variants, middle ear Vascular injuries, brachial plexus and Vascular malformations and anomalies brain, imaging fundamentals and facts arteriovenous malformation (AVM) capillary telangiectasia carotid artery-cavernous sinus fistula of cavernous malformation dural arteriovenous malformations and fistula vein of Galen malformation venous malformation 1752 spinal, imaging fundamentals and facts arteriovenous fistula arteriovenous malformations cavernous malformation hematomas, epidural and subdural infarction Vasculitis angiography for evaluation of cerebral Vasospasm Vasovagal reaction in myelography Vein of Galen malformation Venous angioma Venous malformation of brain, developmental Venous sinus occlusion Venous system occlusion of brain, deep Vertebral arteries, angiography of Vertebral artery injury Vertebral body hemangioma Vertebral metastases Vestibular aqueduct syndrome, large Vestibular schwannoma Viral encephalitis Viral plexitis von Hippel-Lindau disease W Wallerian degeneration Watershed infarctions Wegener granulomatosis Wernicke encephalopathy While matter brain disorders See Leukodystrophies Wilson disease Wyburn–Mason syndrome, arteriovenous malformations in 1753 目录 Half Title Title Copyright Dedication Preface Acknowledgments.html Contents PART 1: IMAGING PROTOCOLS AND GUIDELINES CT Protocols Brain without Contrast Brain with Contrast Administration Deep Brain Stimulator Head Protocol Paranasal Sinus, Screening Paranasal Sinuses with Contrast Paranasal Sinuses, Preoperative for Computer Navigation Maxillofacial without Contrast Maxillofacial with IV Contrast Orbits Temporal Bones Neck CSF Leak Craniosynostosis Routine C-Spine Routine T-/L-Spine CTA Head CTA Neck/Carotids CT Perfusion Pituitary Protocol MRI Protocols 1754 10 11 21 22 22 23 24 24 25 26 26 27 28 28 29 30 30 31 31 32 33 34 34 36 Brain without and with Contrast Neonatal Brain Brain, Stroke Brain, Tumor Brain, Trauma Brain, Perfusion Carotid Arteries, Neck Venogram Brain, Pulsatile Tinnitus Pituitary Neck, General Temporomandibular Joints Cervical Spine Thoracic Spine Lumbar Spine Brachial Plexus Myelography Protocols General Guidelines Digital Subtraction Angiography Protocols General Guidelines Sedation and Anxiolysis Protocols Conscious Sedation Anxiolysis Medications in Neuroradiology Medications for Contrast Media Reactions Endotracheal Tubes Prevention of contrast reactions in allergic patients Management of contrast reactions Medications That May Affect the Performance of Invasive Procedures Medications (Generic Names) That May Lower Seizure Threshold Over-the-Counter Medications That Increase Bleeding Time CT Contrast Allergy 1755 36 37 37 37 38 38 38 39 39 39 40 40 40 40 41 41 43 43 49 49 55 55 61 63 63 65 65 65 68 69 70 72 Iodinated Contrast in Renal Insufficiency MR Contrast Administration in Adults (>18 Years of Age) MR Contrast Administration in Children (2 Years of Age) Contrast Extravasation PART 2: IMAGING FUNDAMENTALS SECTION A: Brain Imaging Trauma Arterial Dissection Child Abuse Contusions Diffuse Axonal Injury and Intermediary Injuries Epidural Hematoma Pneumocephalus Skull Fractures Subdural Hematoma and Hygroma Traumatic Subarachnoid Hemorrhage Stroke Acute Cerebellar Infarct Acute (