Incidental Findings in Neuroimaging and Their Management: A Guide for Radiologists, Neurosurgeons, and Neurologists

348 Pages·2020·57.762 MB·English

by  Kaye Westmark, Dong Kim, Roy Riascos

Incidental Findings in Neuroimaging and Their
Management
A Guide for Radiologists, Neurosurgeons, and Neurologists
Kaye D. Westmark, MD
Clinical Assistant Professor of Radiology, Neuroradiology
Department of Diagnostic and Interventional Imaging
The University of Texas Health Science Center at Houston
Houston, Texas
Dong H. Kim, MD
Professor and Chair
Vivian L. Smith Department of Neurosurgery
The University of Texas Health Science Center at Houston;
Director
Mischer Neuroscience Institute
Memorial Hermann–Texas Medical Center
Houston, Texas
Roy F. Riascos, MD
Professor and Chief of Neuroradiology
Department of Diagnostic and Interventional Imaging
McGovern Medical School
The University of Texas Health Science Center at Houston;
Director
Center for Advanced Imaging Processing
Memorial Hermann–Texas Medical Center
Houston, Texas
683 illustrations
Thieme
New York (cid:129) Stuttgart (cid:129) Delhi (cid:129) Rio de Janeiro
Library of Congress Cataloging-in-Publication Data is available Importantnote:Medicineisanever-changingscienceundergo-
fromthepublisher ingcontinualdevelopment.Researchandclinicalexperienceare
continuallyexpandingourknowledge,inparticularourknowl-
edgeofpropertreatmentanddrugtherapy.Insofarasthisbook
mentionsanydosageorapplication,readersmayrestassuredthat
the authors, editors, and publishers have made every effort to
ensurethatsuchreferencesareinaccordancewiththestateof
knowledgeatthetimeofproductionofthebook.
Nevertheless, this does not involve, imply, or express any
guaranteeorresponsibilityonthepartofthepublishersinrespect
toanydosageinstructionsandformsofapplicationsstatedinthe
book.Everyuserisrequestedtoexaminecarefullythemanufac-
turers’leafletsaccompanyingeachdrugandtocheck,ifnecessary
inconsultationwithaphysicianorspecialist,whetherthedosage
schedulesmentionedthereinorthecontraindicationsstatedbythe
manufacturers differ from the statements made in the present
book.Suchexaminationisparticularlyimportantwithdrugsthat
areeitherrarelyusedorhavebeennewlyreleasedonthemarket.
Everydosagescheduleoreveryformofapplicationusedisentirely
attheuser’sownriskandresponsibility.Theauthorsandpublishers
requesteveryusertoreporttothepublishersanydiscrepanciesor
inaccuraciesnoticed.Iferrorsinthisworkarefoundafterpubli-
cation,erratawillbepostedatwww.thieme.comontheproduct
descriptionpage.
Someoftheproductnames,patents,andregistereddesigns
referredtointhisbookareinfactregisteredtrademarksorpro-
prietarynameseventhoughspecificreferencetothisfact isnot
always made in the text. Therefore, the appearance of a name
without designation as proprietary is not to be construed as a
representationbythepublisherthatitisinthepublicdomain.
©2020Thieme.Allrightsreserved.
ThiemePublishersNewYork
333SeventhAvenue,NewYork,NY10001USA
[phone],[email protected]
GeorgThiemeVerlagKG
Rüdigerstrasse14,70469Stuttgart,Germany
+49[0]7118931421,[email protected]
ThiemePublishersDelhi
A-12,SecondFloor,Sector-2,Noida-201301
UttarPradesh,India
[phone],[email protected]
ThiemePublishersRiodeJaneiro,
ThiemePublicaçõesLtda.
EdifícioRodolphodePaoli,25ºandar
Av.NiloPeçanha,50–Sala2508
RiodeJaneiro20020-906Brasil
[phone]
Coverdesign:ThiemePublishingGroup
CoverImage:LauraOcasio
TypesettingbyDiTechProcessSolutions,India
Thisbook,includingallpartsthereof,islegallyprotectedbycopy-
PrintedinUSAbyKingPrintingCompany,Inc. 54321 right. Any use, exploitation, or commercialization outside the
narrowlimitssetbycopyrightlegislationwithoutthepublisher’s
ISBN978-1-62623-828-2 consentisillegalandliabletoprosecution.Thisappliesinparticular
tophotostatreproduction,copying,mimeographingorduplication
Alsoavailableasane-book: ofanykind,translating,preparationofmicrofilms,andelectronic
eISBN978-1-62623-829-9 dataprocessingandstorage.
Contents
Preface.............................................................................................. xix
Contributors ....................................................................................... xxi
SectionI NormalVariants................................................................................ 1
1. PersistentPrimitiveTrigeminalArtery............................................................. 3
KayeD.Westmark,LauraOcasio,andRoyF.Riascos
1.1 CasePresentation .......................... 3 1.3 DiagnosticPearlsandPitfalls............... 4
1.1.1 HistoryandPhysicalExamination ............. 3
1.4 EssentialInformationaboutPersistent
1.2 DifferentialDiagnosis....................... 4 PrimitiveTrigeminalArteries............... 5
2. ArachnoidGranulations............................................................................. 6
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
2.1 CasePresentation .......................... 6 2.4 EssentialInformationaboutArachnoid
Granulations................................ 7
2.1.1 HistoryandPhysicalExamination ............. 6
2.1.2 ImagingFindingsandImpression.............. 6
2.5 CompanionCase............................ 7
2.2 DifferentialDiagnosis....................... 6
2.5.1 HistoryandPhysicalExamination ............. 7
2.3 DiagnosticPearlsandPitfalls............... 7
3. AsymmetryoftheLateralVentricles............................................................... 9
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
3.1 CasePresentation .......................... 9 3.4 EssentialInformationaboutAsymmetric
LateralVentricles.......................... 10
3.1.1 HistoryandPhysicalExamination ............. 9
3.1.2 ImagingFindingsandImpression.............. 9
3.5 CompanionCase........................... 10
3.2 DifferentialDiagnosis...................... 10
3.5.1 HistoryandPhysicalExamination ............ 10
3.3 DiagnosticPearls.......................... 10 3.5.2 ImagingFindingsandImpression............. 10
4. BasalGanglia/DentateNucleiMineralization..................................................... 12
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
4.1 CasePresentation ......................... 12 4.4 EssentialInformationaboutBasal
GangliaMineralization..................... 13
4.1.1 HistoryandPhysicalExamination ............ 12
4.1.2 ImagingFindingsandImpression............. 12
4.5 CompanionCase........................... 13
4.2 DifferentialDiagnosis...................... 13
4.5.1 HistoryandPhysicalExamination ............ 13
4.5.2 ImagingFindingsandImpression............. 13
4.3 DiagnosticPearls.......................... 13
v
Contents
5. CavumSeptumPellucidum ........................................................................ 15
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
5.1 CasePresentation ......................... 15 5.4 EssentialInformationaboutCavum
SeptumPellucidum........................ 16
5.1.1 HistoryandPhysicalExamination ............ 15
5.1.2 ImagingFindingsandImpression............. 15
5.5 CompanionCases.......................... 16
5.2 DifferentialDiagnosis...................... 15
5.5.1 CompanionCase1........................... 16
5.5.2 CompanionCase2........................... 17
5.3 DiagnosticPearls.......................... 16
6. ChoroidFissureCyst................................................................................ 18
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
6.1 CasePresentation ......................... 18 6.3 DiagnosticPearls .......................... 19
6.1.1 HistoryandPhysicalExamination ............ 18
6.4 EssentialInformationaboutChoroid
6.1.2 ImagingFindingsandImpression............. 18
FissureCyst................................ 19
6.2 DifferentialDiagnosis...................... 19
7. EmptySellaConfiguration......................................................................... 20
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
7.1 CasePresentation ......................... 20 7.3 DiagnosticPearls .......................... 21
7.1.1 HistoryandPhysicalExamination ............ 20
7.4 EssentialInformationabout
7.1.2 ImagingFindingsandImpression............. 20
EmptySella................................ 21
7.2 DifferentialDiagnosis...................... 21
8. High-RidingJugularBulb........................................................................... 22
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
8.1 CasePresentation ......................... 22 8.5 EssentialInformationaboutHigh-Riding
JugularBulb ............................... 23
8.1.1 HistoryandPhysicalExamination ............ 22
8.1.2 ImagingFindingsandImpression............. 22
8.6 CompanionCase........................... 23
8.2 DifferentialDiagnosis...................... 23
8.6.1 HistoryandPhysicalExamination ............ 23
8.6.2 ImagingFindingsandImpression............. 23
8.3 DiagnosticPearls.......................... 23
8.4 Pitfalls..................................... 23
9. HyperostosisFrontalisInterna..................................................................... 25
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
9.1 CasePresentation ......................... 25 9.4 EssentialInformationaboutHyperostosis
FrontalisInterna........................... 26
9.1.1 HistoryandPhysicalExamination ............ 25
9.1.2 ImagingFindingsandImpression............. 25
9.5 CompanionCase........................... 26
9.2 DifferentialDiagnosis...................... 25
9.5.1 HistoryandPhysicalExamination ............ 26
9.5.2 ImagingFindingsandImpression............. 27
9.3 DiagnosticPearls.......................... 26
vi
Contents
10. ProminentPerivascularSpace..................................................................... 28
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
10.1 CasePresentation ......................... 28 10.4 Pitfalls..................................... 29
10.1.1 HistoryandPhysicalExamination ............ 28
10.5 EssentialInformationaboutProminent
10.1.2 ImagingFindingsandImpression............. 28
PerivascularSpace......................... 29
10.2 DifferentialDiagnosis...................... 29
10.6 CompanionCase........................... 29
10.3 DiagnosticPearls.......................... 29
10.6.1 ImagingFindingsandImpression............. 29
11. SimplePinealCyst.................................................................................. 31
SusanaCalle,PejmanRabiei,ShekharD.Khanpara,andRoyF.Riascos
11.1 CasePresentation ......................... 31 11.4 EssentialInformationaboutSimplePineal
Cyst........................................ 32
11.1.1 HistoryandPhysicalExamination ............ 31
11.1.2 ImagingFindingsandImpression............. 31
11.5 CompanionCase........................... 33
11.2 DifferentialDiagnosis...................... 32
11.5.1 HistoryandPhysicalExamination ............ 33
11.5.2 ImagingFindingsandImpression............. 33
11.3 DiagnosticPearls.......................... 32
SectionII IntracranialIncidentalFindings.............................................................. 35
12. DiffuseWhiteMatterHyperintensities ........................................................... 37
CarlosA.PérezandJohnA.Lincoln
12.1 Introduction............................... 37 12.7 ClinicalandDiagnosticImagingPitfalls.... 39
12.2 CasePresentation ......................... 37 12.8 CompanionCases.......................... 40
12.2.1 History ..................................... 37 12.8.1 CompanionCase1........................... 40
12.8.2 CompanionCase2........................... 41
12.3 ImagingAnalysis .......................... 37
12.8.3 CompanionCase3........................... 42
12.3.1 ImagingFindingsandimpression............. 37
12.9 ClinicalandDiagnosticImagingPearls:
12.3.2 AdditionalImagingRecommended ........... 37
“MS-Likelesions”versus
12.4 ClinicalEvaluation......................... 38 Hypoxic–IschemicLesions................. 43
12.4.1 NeurologistHistoryandPhysical
12.10 EssentialInformationaboutLeukoaraiosis
Examination ................................ 38
(“Age-Related”WhiteMatterChanges
12.4.2 RecommendedAdditionalTesting............ 38
andSmall-VesselIschemicDisease)........ 43
12.4.3 2015MAGNIMSStandardizedBrainand
SpineMRIProtocol .......................... 39
12.11 ClinicalQuestionsandAnswerswitha
12.4.4 ResultsofAdditionalTesting ................. 39
NeurologistaboutRadiologically
12.4.5 ClinicalImpression .......................... 39
IsolatedSyndrome......................... 43
12.4.6 ManagementDecisioninThisCase............ 39
12.5 DifferentialDiagnosisofWhiteMatter 12.12 KeyPointSummary........................ 45
Lesions..................................... 39
12.6 DiagnosticImagingPearls................. 39
vii
Contents
13. BrainCapillaryTelangiectasias .................................................................... 46
EmilioP.SupsupinJr.
13.1 Introduction............................... 46 13.8 CompanionCases.......................... 48
13.8.1 CompanionCase1:BreastCancerMetastases... 48
13.2 CasePresentation ......................... 46
13.8.2 CompanionCase2:Recent(Subacute)
PontineInfarct.............................. 49
13.3 ImagingAnalysis .......................... 46
13.8.3 CompanionCase3:ActivePontine
13.3.1 ImagingFindings............................ 46 Demyelination .............................. 50
13.8.4 CompanionCase4:CLIPPERS(Chronic
13.4 ClinicalEvaluationandManagement...... 46
LymphocyticInflammationwithPontine
PerivascularEnhancementResponsiveto
13.5 DifferentialDiagnosis...................... 47
Steroids).................................... 50
13.8.5 CompanionCase5:CapillaryTelangiectasia ... 51
13.6 DiagnosticImagingPearls................. 47
13.9 QuestionsandAnswers.................... 52
13.7 EssentialFactsaboutBCTs................. 47
13.10 KeyPointSummary........................ 53
14. DevelopmentalVenousAnomaly.................................................................. 54
EmilioP.SupsupinJr.
14.1 Introduction............................... 54 14.5.1 DiagnosticImagingandClinicalPearls ........ 55
14.6 EssentialImagingFactsaboutDVAs....... 56
14.2 CasePresentation ......................... 54
14.7 CompanionCases.......................... 56
14.3 ImagingAnalysis .......................... 54
14.7.1 CompanionCase1........................... 56
14.3.1 ImagingFindings............................ 54
14.7.2 CompanionCase2........................... 58
14.3.2 Impression.................................. 54
14.8 QuestionsandAnswers.................... 59
14.4 ClinicalEvaluation......................... 54
14.9 KeyPointSummary........................ 60
14.5 DifferentialDiagnosis...................... 55
15. CerebralCavernousMalformations............................................................... 62
EmilioP.SupsupinJr.andMarkDannenbaum
15.1 Introduction............................... 62 15.6 ClinicalEvaluationandManagement...... 63
15.6.1 NeurosurgicalEvaluation .................... 63
15.2 CasePresentation ......................... 62
15.6.2 EssentialDiagnosticImagingInformation
RegardingCavernousMalformations.......... 63
15.3 ImagingAnalysis .......................... 62
15.7 CompanionCases.......................... 64
15.3.1 ImagingFindings............................ 62
15.3.2 AdditionalImaging.......................... 62 15.7.1 CompanionCases1and2:DiffuseAxonal
15.3.3 ImagingFindings............................ 62 Injury ...................................... 64
15.3.4 Impression.................................. 62 15.7.2 CompanionCase3:AmyloidAngiopathy...... 65
15.7.3 CompanionCase4:HemorrhagicMetastatic
15.4 DifferentialDiagnosis...................... 62
Disease..................................... 66
15.7.4 CompanionCase:Classic“Popcorn”
15.5 DiagnosticImagingPearls................. 63
AppearanceofCCM.......................... 67
viii