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BRAIN IMAGING MRI CT WITH AND An Image Pattern Approach B R A I N I M A G I N G M R I C T WITH AND An Image Pattern Approach Edited by Zoran Rumboldt ProfessorofRadiology,NeuroradiologySectionChiefand FellowshipProgramDirector,DepartmentofRadiology andRadiologicalScience,MedicalUniversityof SouthCarolina,Charleston,SouthCarolina,USA Mauricio Castillo ProfessorofRadiologyandSectionChiefof Neuroradiology,UniversityofNorthCarolinaSchoolof Medicine,ChapelHill,NorthCarolina,USA Benjamin Huang ClinicalAssistantProfessorofRadiologyinthe DivisionofNeuroradiology,Universityof NorthCarolinaSchoolofMedicine,ChapelHill, NorthCarolina,USA Andrea Rossi HeadoftheDepartmentofNeuroradiology, G.GasliniChildren’sResearchHospital,Genoa,Italy cambridge university press Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore,SaõPaulo,Delhi,MexicoCity CambridgeUniversityPress TheEdinburghBuilding,CambridgeCB28RU,UK PublishedintheUnitedStatesofAmericabyCambridgeUniversityPress,NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/9780521119443 ©CambridgeUniversityPress2012 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithout thewrittenpermissionofCambridgeUniversityPress. Firstpublished2012 PrintedandboundinGreatBritainbytheMPGBooksGroup AcataloguerecordforthispublicationisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData BrainimagingwithMRIandCT:animagepatternapproach/editedbyZoranRumboldt...[etal.]. p. cm. Includesbibliographicalreferencesandindex. ISBN978-0-521-11944-3(Hardback) I.Rumboldt,Zoran. [DNLM:1. Neuroimaging–methods. 2. Diagnosis,Differential. 3. MagneticResonanceImaging–methods. 4. Tomography,X-RayComputed–methods.WL141] 616.80047548–dc23 2012000482 ISBN978-0-521-11944-3Hardback CambridgeUniversityPresshasnoresponsibilityforthepersistenceor accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto inthispublication,anddoesnotguaranteethatanycontentonsuch websitesis,orwillremain,accurateorappropriate. Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformation whichisinaccordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcase historiesaredrawnfromactualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividuals involved.Nevertheless,theauthors,editorsandpublisherscanmakenowarrantiesthattheinformationcontained hereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychangingthroughresearchand regulation.Theauthors,editorsandpublishersthereforedisclaimallliabilityfordirectorconsequentialdamages resultingfromtheuseofmaterialcontainedinthisbook.Readersarestronglyadvisedtopaycarefulattentionto informationprovidedbythemanufacturerofanydrugsorequipmentthattheyplantouse. CONTENTS List of contributors xi 21 LimbicEncephalitis 42 List of abbreviations xii Mauricio Castillo Preface xv 22 CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarctsand Leukoencephalopathy) 44 Section 1 Bilateral Predominantly Zoran Rumboldt Symmetric Abnormalities 23 Megalencephalic Leukoencephalopathywith Subcortical Cysts 46 Mariasavina Severino Cases 24 CanavanDisease 48 1 HepaticEncephalopathy 2 AndreaRossiand Chen Hoffman MariaVittoria Spampinato 25 HIV Encephalopathy 50 2 Neurofibromatosis Type 1– UBOs 4 Zoran RumboldtandMauricio Castillo AndreaRossi 26 Radiation- and Chemotherapy-Induced 3 Carbon Monoxide Intoxication 6 Leukoencephalopathy 52 Benjamin Huang MariaVittoriaSpampinato 4 Pantothenate Kinase-Associated Neurodegeneration 27 Leukoaraiosis (Microangiopathy) 54 (Hallervorden–Spatz Syndrome) 8 AlessandroCianfoni AndreaRossi 28 Periventricular Edema inAcute 5 Methanol Intoxication 10 Hydrocephalus 56 Benjamin Huang AlessandroCianfoni 6 Wilson Disease 12 29 Hypoglycemia 58 Benjamin Huang Benjamin Huang 7 HypoxicIschemicEncephalopathyinTermNeonates 14 30 X-LinkedAdrenoleukodystrophy(X-ALD) 60 MariasavinaSeverino Mariasavina Severino 8 Cryptococcosis 16 31 Periventricular Leukomalacia (PVL) 62 Benjamin Huang AlessandroCianfoni 9 Gangliosidosis GM2 18 32 Posterior Reversible Encephalopathy MariasavinaSeverino Syndrome(PRES,Hypertensive 10 LeighDisease 20 Encephalopathy) 64 Mariasavina Severino MariaVittoriaSpampinato and Zoran Rumboldt 11 Deep Cerebral Vein Thrombosis(DCVT) 22 33 Alexander Disease 66 Benjamin Huang Mariasavina Severino 12 Creutzfeldt–JakobDisease (CJD) 24 34 Metachromatic Leukodystrophy 68 Benjamin Huang AndreaRossiand Zoran Rumboldt 13 Global Cerebral Anoxia inMatureBrain 26 35 Neurodegenerative Langerhans Cell Histiocytosis MariaVittoriaSpampinato and Zoran Rumboldt (ND-LCH) 70 14 Wernicke Encephalopathy 28 Zoran RumboldtandAndrea Rossi GiulioZuccoli 36 RemoteCerebellar Hemorrhage 72 15 AmyotrophicLateralSclerosis 30 MariaGisele Matheus Mauricio Castillo 37 Spontaneous Intracranial Hypotension 74 16 Glutaric Aciduria Type 1 32 MariaVittoriaSpampinato Mariasavina Severino 17 Subcortical Band Heterotopia 34 AndreaRossi Other Relevant Cases 18 Bilateral Perisylvian Polymicrogyria (BPP) 36 59 Multiple System Atrophy (MSA) 120 Mariasavina Severino Zoran RumboldtandMauricio Castillo 19 Lissencephaly 38 60 MapleSyrup UrineDisease (MSUD) 122 Mariasavina Severino AndreaRossi 20 HerpesSimplexEncephalitis 40 66 OsmoticMyelinolysis 134 Mauricio Castillo andZoran Rumboldt Mauricio Castillo v CONTENTS 87 Benign External Hydrocephalus 178 55 Aqueductal Stenosis 112 MariaVittoria Spampinato AndreaRossi 88 Normal PressureHydrocephalus 180 56 ProgressiveSupranuclear Palsy (PSP) 114 AlessandroCianfoni AlessandroCianfoni and Zoran Rumboldt 89 Alzheimer Disease 182 57 Joubert Syndrome 116 MariaVittoria Spampinato MariaVittoriaSpampinato 90 FrontotemporalLobar Degeneration 184 58 Rhombencephalosynapsis 118 MariaVittoria Spampinato Chen Hoffman 91 HuntingtonDisease 186 59 Multiple System Atrophy (MSA) 120 Zoran Rumboldt andBenjamin Huang Zoran RumboldtandMauricio Castillo 184 Congenital CytomegalovirusInfection 380 60 MapleSyrup UrineDisease (MSUD) 122 Zoran Rumboldtand Chen Hoffman AndreaRossi 61 Chiari 2Malformation 124 Section 2 Sellar, Perisellar and Mauricio Castillo 62 Tectal Glioma 126 Midline Lesions MariaGisele Matheus 63 BrainstemGlioma 128 Cases Donna Roberts 38 Rathke’sCleftCyst 78 64 DuretHemorrhage 130 Zoran Rumboldt Mauricio Castillo 39 PituitaryMicroadenoma 80 65 HypertrophicOlivary Degeneration 132 MatthewOmojola and Zoran Rumboldt Zoran RumboldtandBenjamin Huang 40 LymphocyticHypophysitis 82 66 OsmoticMyelinolysis 134 Zoran RumboldtandBenjamin Huang Mauricio Castillo 41 PituitaryMacroadenoma 84 67 Germinoma 136 MatthewOmojola and Zoran Rumboldt Mauricio Castillo andZoran Rumboldt 42 Ectopic Posterior PituitaryLobe 86 68 Pineoblastoma 138 Mauricio Castillo Mauricio Castillo andZoran Rumboldt 43 Langerhans Cell Histiocytosis 88 69 Pineal Cyst 140 Zoran RumboldtandAndrea Rossi Mauricio Castillo 44 Craniopharyngioma 90 70 Vein of Galen Aneurysmal Malformation (VGAM) 142 MariaVittoriaSpampinato AndreaRossi 45 Hypothalamic Hamartoma 92 71 Corpus Callosum Dysgenesis 144 AndreaRossi MariaGisele Matheus 46 Optic Glioma 94 72 Septo-OpticDysplasia 146 MariaGisele Matheus Mariasavina Severino 47 Perisellar Meningioma 96 73 Holoprosencephaly 148 AlessandroCianfoni AndreaRossi 48 Hemangioma of the CavernousSinus 98 74 AtreticParietal Encephalocele 150 Zoran Rumboldt MariaGisele Matheus 49 Tolosa–Hunt Syndrome 100 75 Dermoid Cyst 152 Benjamin Huang Benjamin Huang 50 Carotid-Cavernous Sinus Fistula 102 76 Lipoma 154 Zoran Rumboldt Benjamin Huang 51 Perisellar Aneurysm 104 AlessandroCianfoni Other Relevant Cases 52 Chordoma 106 14 WernickeEncephalopathy 28 AlessandroCianfoni and Zoran Rumboldt GiulioZuccoli 53 Chondrosarcoma 108 93 Dandy–Walker Malformation 190 Zoran Rumboldt AndreaRossi 54 ColloidCyst 110 113 SusacSyndrome 232 AlessandroCianfoni Mauricio Castillo vi CONTENTS Section 3 Parenchymal Defects or 59 Multiple System Atrophy (MSA) 120 Zoran RumboldtandMauricio Castillo Abnormal Volume 61 Chiari 2Malformation 124 Mauricio Castillo Cases 77 Hippocampal Sclerosis 158 Section 4 Abnormalities Without AlessandroCianfoni fi Signi cant Mass Effect 78 Wallerian Degeneration 160 AlessandroCianfoni 79 Rasmussen Encephalitis 162 Cases Chen Hoffman andZoran Rumboldt A. Primarily Non-Enhancing 80 ChronicInfarct 164 97 Dural Venous SinusThrombosis 200 AlessandroCianfoni 81 Post-Traumatic Atrophy 166 Giulio Zuccoli 98 Dural ArteriovenousFistula 202 Benjamin Huang 82 PostoperativeDefects 168 MatthewOmojola andZoran Rumboldt 99 Subarachnoid Hemorrhage 204 Benjamin Huang 83 PorencephalicCyst 170 MatthewOmojola 100 Laminar Necrosis 206 Benjamin Huang 84 Schizencephaly 172 MatthewOmojola 101 Neurocutaneous Melanosis 208 AlessandroCianfoni 85 Hemimegalencephaly 174 MajdaThurnher 102 Superficial Siderosis 210 AndreaRossi 86 Sturge–Weber Syndrome 176 Mauricio Castillo 103 Polymicrogyria 212 MariaGisele Matheus 87 Benign ExternalHydrocephalus 178 MariaVittoriaSpampinato 104 Seizure-RelatedChanges(Peri-IctalMRI MariaVittoriaSpampinato 88 Normal PressureHydrocephalus 180 Abnormalities) 214 Mauricio Castillo AlessandroCianfoni 89 Alzheimer Disease 182 105 Embolic Infarcts 216 Benjamin Huang MariaVittoriaSpampinato 90 Frontotemporal Lobar Degeneration 184 106 FocalCortical Dysplasia 218 Zoran Rumboldtand MariaGisele Matheus MariaVittoriaSpampinato 91 Huntington Disease 186 107 TuberousSclerosisComplex 220 MariaGisele Matheus Zoran RumboldtandBenjamin Huang 92 Congenital Muscular Dystrophies 188 108 Dysembroplastic Neuroepithelial Tumor (DNT, DNET) 222 AndreaRossi 93 Dandy–WalkerMalformation 190 GiovanniMorana 109 Nonketotic Hyperglycemia With Hemichorea– AndreaRossi 94 Microcephaly 192 Hemiballismus 224 Zoran Rumboldt Mariasavina Severino 95 Hydranencephaly 194 110 Hyperdensity Following Endovascular Intervention 226 AndreaRossi 96 AcquiredIntracranial Herniations 196 Zoran Rumboldtand Benjamin Huang 111 Early(Hyperacute) Infarct 228 Benjamin Huang Benjamin Huang Other Relevant Cases 112 Acute Disseminated Encephalomyelitis(ADEM) 230 16 Glutaric Aciduria Type 1 32 Benjamin Huang Mariasavina Severino 113 SusacSyndrome 232 31 Periventricular Leukomalacia (PVL) 62 Mauricio Castillo AlessandroCianfoni 114 Diffuse AxonalInjury 234 56 ProgressiveSupranuclear Palsy (PSP) 114 MajdaThurnher AlessandroCianfoni and Zoran Rumboldt 115 Multiple Sclerosis 236 57 Joubert Syndrome 116 MatthewOmojola and Zoran Rumboldt MariaVittoriaSpampinato 116 ProgressiveMultifocalLeukoencephalopathy 58 Rhombencephalosynapsis 118 (PML) 238 Chen Hoffman Zoran Rumboldt vii CONTENTS 117 Nodular Heterotopia 240 131 Leptomeningeal Cyst 270 MariaGisele Matheus Benjamin Huang 132 Epidural Hematoma 272 Other Relevant Cases Benjamin Huang 19 Lissencephaly 38 133 Subdural Hematoma 274 Mariasavina Severino Donna Roberts 20 HerpesSimplexEncephalitis 40 134 Empyema 276 Mauricio Castillo andZoran Rumboldt Mauricio Castillo 21 LimbicEncephalitis 42 135 Secondary(Systemic) Lymphoma 278 Mauricio Castillo Zoran Rumboldt 136 Idiopathic HypertrophicPachymeningitis 280 B. Primarily Enhancing Zoran Rumboldt 118 Neurosarcoidosis 242 137 OlfactoryNeuroblastoma 282 Zoran Rumboldt Zoran Rumboldt 119 Meningeal Carcinomatosis 244 138 Meningioma 284 AlessandroCianfoniand Zoran Rumboldt AlessandroCianfoni 120 Meningitis (Infectious) 246 139 Desmoplastic Infantile Ganglioglioma 286 GiovanniMorana Mauricio Castillo 121 Perineural Tumor Spread 248 140 Hemangiopericytoma 288 Zoran Rumboldt Zoran Rumboldt 122 Moyamoya 250 141 Schwannoma 290 GiulioZuccoli MariaVittoriaSpampinato 123 CentralNervousSystemVasculitis 252 142 Arachnoid Cyst 292 MariaGisele Matheus GiulioZuccoli 124 Subacute Infarct 254 143 Epidermoid 294 MariaGisele Matheus Benjamin Huang andZoran Rumboldt 125 ActiveMultipleSclerosis 256 144 Aneurysm 296 Mariasavina Severino Zoran Rumboldt 126 CapillaryTelangiectasia 258 145 Racemose Neurocysticercosis 298 Zoran Rumboldtand MauricioCastillo AlessandroCianfoni 127 Developmental Venous Anomaly 260 146 EpendymalCyst 300 GiovanniMorana GiulioZuccoli 128 ImmuneReconstitution Inflammatory 147 ChoroidPlexus Cyst 302 Benjamin Huang Syndrome (IRIS) 262 Zoran Rumboldt 148 ChoroidPlexus Papilloma 304 129 Ventriculitis 264 AndreaRossi 149 Intraventricular Meningioma 306 Zoran Rumboldtand MajdaThurnher Zoran Rumboldt 150 CentralNeurocytoma 308 Other Relevant Cases Mauricio Castillo 30 X-LinkedAdrenoleukodystrophy(X-ALD) 60 151 Ventricular Diverticula 310 Mariasavina Severino Zoran Rumboldt 33 Alexander Disease 66 Mariasavina Severino Other Relevant Cases 37 Spontaneous Intracranial Hypotension 74 54 ColloidCyst 110 MariaVittoriaSpampinato AlessandroCianfoni 86 Sturge–Weber Syndrome 176 67 Germinoma 136 MariaGisele Matheus Mauricio Castillo andZoran Rumboldt 68 Pineoblastoma 138 Section 5 Primarily Extra-Axial Focal Mauricio Castillo andZoran Rumboldt Space-Occupying Lesions 75 Dermoid Cyst 152 Benjamin Huang 76 Lipoma 154 Cases Benjamin Huang 130 Arachnoid Granulations 268 93 Dandy–WalkerMalformation 190 Zoran Rumboldt AndreaRossi viii