11/09/2025
๐งโ๐ซ๐ฉโ๐ซ ๐๐ฎ๐๐ฒ ๐ผ๐ณ ๐ง๐ต๐ฒ ๐ช๐ฒ๐ฒ๐ธ โ ๐ญ๐ฎ๐ฌ ๐
At Expert-i, weโre thrilled by the engagement and insightful responses to last weekโs quiz!
Itโs always inspiring to see radiologists coming together to exchange knowledge and expertise.
๐ก Last Weekโs Case Recap:
A Brain MRI study.
๐ง๐ฒ๐ฐ๐ต๐ป๐ถ๐พ๐๐ฒ:
โ
Axial T1, T2, FLAIR, Coronal T2, Sagittal T1 W Sequences.
โ
Diffusion weighted sequences.
โ
Post Contrast Axial, Sagittal & Coronal T1 with delayed images.
โ
MRA and MRV images with volumetric angiography sequence with reconstruction in two orthogonal planes.
๐ Your Diagnosis Choices Were:
1๏ธโฃ Reversible cerebral vasoconstriction syndrome.
2๏ธโฃ Intracranial atherosclerotic disease.
3๏ธโฃ Unilateral moyamoya affection.
๐ Correct Answer: ๐๐ต๐ผ๐ถ๐ฐ๐ฒ ๐ก๐ผ. ๐ฏ
๐ Here is the full study report for your reference:
๐๐๐ก๐๐๐ก๐๐ฆ:
๐๐ฒ๐ฟ๐ฒ๐ฏ๐ฟ๐ฎ๐น ๐ฝ๐ฎ๐ฟ๐ฒ๐ป๐ฐ๐ต๐๐บ๐ฎ:
๐ There is evidence of left basal ganglia caudate nucleus, Globus pallidus and putamen rather well defined cystic lesion with intermediate to low T1, bright T2 and low FLAIR signal intensity with marginal rim of bright FLAIR signal and minimal rim of peripheral bright T1 signal intensity, no evince of diffuse restriction detected , No evidence of post contrast significant enhancement , no evidence of significant mass effect detected.
๐ Otherwise No significant signal alteration of the white matter, No focal or enhancing lesions identified.
๐ข Cerebellum: Normal.
๐ข Brainstem: Normal.
๐ข Extra-axial spaces and basal cisterns: Normal in size and morphology for the patient's age.
๐ข Ventricular system: Normal in size and morphology for the patient's age.
๐ข Midline shift: None.
๐ข Vascular system: No gross vascular anomalies identified.
๐ข Paranasal sinuses and mastoid air cells: Clear.
๐ข Visualized orbits: Normal.
๐ข Sella: Normal appearance.
๐ข Moderate nasopharyngeal adenoid soft tissue enlargement
๐ ๐ฅ๐:
๐ Both internal carotids: There is mild narrowing of the left internal carotid artery mainly supra clinoid and cavernous portion compared to the right side, Otherwise normal signal of the petrous, intra-cavernous and supra-clinoid portions of right internal carotids.
๐ The left MCA shows luminal narrowing and irregularity affection M1 and M2 segments
๐ข Otherwise the remaining anterior and middle cerebral arteries: Normal course, caliber and branching pattern of the anterior and middle cerebral arteries
๐ข Vertebro-basilar system: Normal features of the visualized portions of the vertebro-basilar system and their main branches.
๐ข Aneurysms or arterio-venous malformations: No MRA evidences of aneurysms or arterio- venous malformations identified.
๐ ๐ฅ๐ฉ:
๐ข Normal flow signal noted in the superior sagittal, straight, right transverse and sigmoid sinuses denoting patency.
๐ข Hypo plastic left transverse and sigmoid sinus.
โจ ๐ฐ๐ด๐ท๐น๐ฌ๐บ๐บ๐ฐ๐ถ๐ต
๐ต Left basal ganglia different components lesion with MRI feature reflecting late subacute to chronic ischemic insult.
๐ต Luminal irregularity of the left internal carotid artery and MCA artery highly suggestive of vasculitis, unilateral moyamoya affection /syndrome and FMD affection are considered among the vasculopathy types for further clinical neurological work up.
๐ฌ Thank you to everyone who participated and shared their reasoning. Your contributions enrich our collective learning!
๐จ Stay tuned for the next week quizโcoming soon. Letโs keep learning together!
