Brain MRI - Seizure search pattern

Рет қаралды 30,579

Күн бұрын

Many times when patients have a history of seizures, they undergo a workup including a physical exam, detailed EEG analysis, and finally brain MRI to try to identify any potential structural causes of seizures. In this video, Dr. Michael Hoch walks us through his approach to a brain MRI to maximize your sensitivity for finding abnormalities.
The lecture is divided as follows:
00:00 - Introduction
01:53 - T1-MPRAGE Sagittal
03:43 - T1-MPRAGE Coronal
05:26 - T1-MPRAGE Axial
06:04 - FLAIR
07:39 - GRE
07:54 - Hippocampus
11:11 - Summary
Dr. Hoch suggests a 4-step approach using the mnemonic “3-2-1 go to the hippocampus”. In this way, he divides his search into more digestible parts.
“3” indicates the 3 planes that you have in a non-contrast T1 weighted MP-RAGE MRI. On this you should focus on the cortex, particularly at the 3 poles, the frontal, temporal, and occipital poles.
“2” indicates the 2 planes of FLAIR and 2 window settings you should use. You should review FLAIR images in both the coronal and axial planes. You should also use a window that is normal and a window that is narrow, or aggressive, to highlight lesions, particularly in the cortex, which are hard to see.
“1” indicates the single plane of blood sensitive imaging, either GRE or SWI, which can often see areas of prior hemorrhage or cavernous malformations.
“Go” to the hippocampus last to look for signs of mesial temporal sclerosis, which is manifested as a small hippocampus with loss of internal architecture and abnormal T2/FLAIR hyperintensity. This can be either from primary epilepsy or secondary to another lesion.
Check out this video and additional content on www.learnneuroradiology.com

Пікірлер: 44

@asasa08 Ай бұрын

Excellent concise to the point . Well done thank you very much

@LearnNeuroradiology Ай бұрын

Glad it was helpful!

@shivanimahajan965 2 жыл бұрын

Excellent talk

@martinnilsson495 3 жыл бұрын

Just great! Thank You...

@brainandsynapse 3 жыл бұрын

Great. Thank you.

@immane75 3 жыл бұрын

Excellent as usual . Thank you very much .

@LearnNeuroradiology 3 жыл бұрын

You are very welcome

@surendrayadav3332 2 жыл бұрын

Excellent 👍

@mohameddonia2250 3 жыл бұрын

Very impressive .... great

@LearnNeuroradiology 3 жыл бұрын

Glad you liked it. Thanks for checking out the videos

@surendrayadav3332 2 жыл бұрын

Excellent

@LearnNeuroradiology 2 жыл бұрын

Thank you so much 😀

@NadaAhmed-ul5xs 3 жыл бұрын

perfect one,, thank you

@LearnNeuroradiology 3 жыл бұрын

Glad you like it!

@EEGucation 2 жыл бұрын

Thank you for the nice summary.

@LearnNeuroradiology 2 жыл бұрын

My pleasure!

@dr.firasqawasmi4699 3 жыл бұрын

nice thank you sir

@DFMagee 3 жыл бұрын

I'm impressed - saw a few more nuances to be considered.

@LearnNeuroradiology 3 жыл бұрын

Glad you learned something! Thanks for checking out the channel.

@bumblebeebumble3052 2 жыл бұрын

Nice presentation

@LearnNeuroradiology 2 жыл бұрын

Glad you liked it

@goaeddisplace7617 9 ай бұрын

ThAnx SIR

@LearnNeuroradiology 9 ай бұрын

Most welcome

@Tintanse 3 жыл бұрын

👨‍🏫thank you.🙏

@LearnNeuroradiology 3 жыл бұрын

Welcome!

@12amirm 3 жыл бұрын

Great Do you have more lectures like this How about c spine and T spine

@LearnNeuroradiology 3 жыл бұрын

Glad you liked it. We have a bunch of other similar videos. If you want search pattern oriented videos, check out the search pattern playlist: kzfaq.info/sun/PLYSUjrPFpR_nxTKgPr2J65zlCrH1NlxWp We have videos for MRIs and MRAs of the brain and neck, MRI of the cervical spine, and more. We try to make more but we only have so much time! Check out the whole channel here: kzfaq.info/love/6RICkCkDRjxar5rdsVJStA

@immane75 3 жыл бұрын

Excellent presentation . What do you think about 3D sequences ?is FLAIR 3D enough ? what about 3D T2 FSE ? is MPRAGE done in 2D or 3D ? Is T1 BRAVO from GE equivalent ? Thank you very much for your response

@LearnNeuroradiology 3 жыл бұрын

This is a complex question but I'll try to answer the main parts: 1) 3D sequences are often a suitable replacement for 2D sequences, although they can add time and may be more sensitive to patient motion. The tradeoffs have to be considered. 2) 3D FLAIR in many ways is equivalent or better than 2D FLAIR and can probably be used 3) Depending on the implementation, 3D T2 sequences such as SPACE have less tissue contrast and may not be as effective at seeing hyperintensities in the hippocampus 4) MP-RAGE is a 3D T1 sequence originally Siemens specific but now available on other scanners. BRAVO is a similar sequence on GE scanners. Generally speaking you just need a high resolution 3D T1. These are complex answers but have to be tailored to the benefits and drawbacks of the individual scanners that you have.

@immane75 3 жыл бұрын

@@LearnNeuroradiology Thank you very much .

@quixotic4233 3 жыл бұрын

Inspired by the comment on secondary hippocampal sclerosis being more common in the pediatric population: should the approach presented here be considered age specific (e.g. for adults)? Would certain age groups (infant, toddler, teen, elderly) reasonably merit variation in the search pattern?

@LearnNeuroradiology 3 жыл бұрын

It's a good thought, and we do change our attention a little bit, but for the most part the same search pattern is still applicable. You might just be a little more on the lookout for certain things based on the age. For example, younger patients are more likely to have a low grade tumor (DNET or ganglioglioma) while older patients are more likely to have a metastasis. You gradually learn to be attuned to these things while keeping the same overall pattern. Great question though!

@LearnNeuroradiology 2 жыл бұрын

@@quixotic4233 Thank you! I'm glad you appreciate the channel and thanks for tuning in. My goal is to keep making useful videos!

@MegaBrolle 3 жыл бұрын

Hey Michael, I am new to your channel. Based on your experience, what is a proper way to learn anatomy to master radiology. My guess Is: 3D anatomy, then cross sectional anatomy, then dissection? How is it taught in radiology school?

@LearnNeuroradiology 3 жыл бұрын

Wow, that's a big question. There are as many ways to learn anatomy as there are people trying to learn anatomy. Most radiologists start learning anatomy while in medical school. This is a combination of books, dissection, and lectures. For books, you might try: Moore's Clinically Oriented Anatomy amzn.to/37qQZuo or Netter's Atlas of Human Anatomy amzn.to/2HhAxSq Anatomy: A photographic atlas amzn.to/35lzBUY Some sort of virtual dissection might be useful as well. There is something called the Visible Human Project, that has a number of applications. For example, this one from University of Utah: webpath.med.utah.edu/HISTHTML/HISTO.html#1 I'm sure there are a lot of online lectures on youtube as well that you can check out. Then, once you have some baseline knowledge, radiology is mostly on the job learning where you look at things one at a time and learn by doing. Hope this helps.

@immane75 3 жыл бұрын

What about perfusion and ASL ?

@LearnNeuroradiology 3 жыл бұрын

Perfusion MRI (including techniques such as DSC, DCE, and ASL) does not play a role in the routine evaluation of seizure. It may have a specialized role in seizure localization to look for areas of abnormal perfusion which may have concordance with EEG and other findings, similar to SPECT. However, it's not widely performed. It is a topic of active research and you can find a lot of articles out there, such as this: www.sciencedirect.com/science/article/pii/S1059131118307052

@eltiarribero 2 жыл бұрын

6:14😜we don't film anymore. I was under the impression that on Pacs Radiologists WL back and forth accordingly. 🤣Excellent video tho.

@LearnNeuroradiology 2 жыл бұрын

Yes, we do have the ability to window and level accordingly, which is what we are giving tips on how to do. However, even though there is not film there is still a default window that comes over on PACS. If you don't change it, you may miss something important.

@ashishmulavekar73 3 жыл бұрын

Very nice..excellent.. can it work on 1.5 T MRI?

@LearnNeuroradiology 3 жыл бұрын

Yes, all the concepts are essentially the same at 1.5T. The resolution of fine hippocampal structures and small cortical malformations is less, but still acceptable

@ashishmulavekar73 3 жыл бұрын

@@LearnNeuroradiology thanks a lot

@nurjahan31 3 жыл бұрын

I got the results of my MRI and shows a 1cm CSF signal intensity lesion in the right temporal lobe...What means that?

@LearnNeuroradiology 3 жыл бұрын

It's hard to tell without knowing, but there are a number of small cysts that can occur in that regions, such as arachnoid cysts, choroidal fissure cysts, and tumors that have cystic components. If the report didn't suggest that it was a tumor, it's probably a benign (relatively normal) finding, but you can ask your doctor for clarification.