Miscellany Consortium 2014
MRI pearls
1) T2 much better than flair in post fossa
2) Black holes can resolve sometimes; these are "active black holes"
3) Enhancement doesn't equal active lesions; consider eg. whether used image delay, whether received recent steroids, gad dose, fluctuating enhancement
4) Uspio may be better? Need 24 hour delay to image. Stay positive longer than gado
Pathology types and MRI pearls
type 1 associated with macrophages
Type 2 associated with complement deposition and antibodies
Type 3 associated with apoptosis
type 4 associated with mitochondrial injury
MRI correlates
Patterns one and 2 sharp border; ring enhancing often is macrophages full of iron patterns; also hypointesne rims; Ring on afc correlates with hypo intense rings but not with gad ring enhancement
Pattern 3 mixed border, no enhancement
Late progression compartmentaluzed inflamm with no gado enhancement
Includes meningeal inflammation = sub pial and slow progression older lesions these are hard to see even with 8t machines
Some disease is due to mitochondrial activation with oxidative injury
Dir wasn't correlated with path till 2012
Patterns of enhancement diffuse modular ring enhancing
Differential diagnosis:
1, Adc maps ms v abscess/tumor dark ring arc pattern V.Isointense ring pattern
2. Rapid shifts of adc typical ms not abscess/tumor
3. Ring enhancement and rim enhancement and response to plasmapheresis and steroids with type one and two
4. Nmo brain lesions in two and three
Concept of heterogeneity across patients and homogeneity within patients key
Also different bio markers
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