TeleFast Rad, Dubai (2025)

27/08/2025

☢️Summary of the Role of Diffusion MRI in brain imaging ☢️

✅Diffusion-Weighted Imaging (DWI) and its derived techniques like Diffusion Tensor Imaging (DTI) play a key role in neuroradiology because it gives information about the microscopic motion of water molecules in brain tissue, which reflects both tissue structure and pathology.

Here’s a structured overview of the role:

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1. Acute Ischemic Stroke
• Most important role: DWI can detect ischemia within minutes of onset (much earlier than CT or conventional MRI).
• Acute infarct appears as restricted diffusion (bright on DWI, dark on ADC map).
• Helps in guiding thrombolysis/thrombectomy decisions.

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2. Brain Tumors
• Diffusion helps differentiate:
• High-grade vs low-grade tumors (high cellularity = restricted diffusion).
• Tumor recurrence vs radiation necrosis (recurrence shows lower ADC).
• Provides information about tumor infiltration and margins.

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3. Infections
• Abscess vs cystic/necrotic tumor: abscess shows marked diffusion restriction due to pus, while necrotic tumor usually does not.
• Encephalitis: areas of restricted diffusion can be seen, especially in herpes simplex encephalitis.

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4. White Matter Diseases
• Multiple Sclerosis (MS): DTI reveals microstructural white matter damage even in normal-appearing white matter.
• Helps quantify fractional anisotropy (FA) and tract integrity.

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5. Traumatic Brain Injury (TBI)
• Detects diffuse axonal injury (DAI) not visible on CT or conventional MRI.
• DTI shows reduced FA in injured tracts.

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6. Epilepsy
• DWI can detect acute seizure-related changes (transient restricted diffusion).
• DTI assists in presurgical mapping of eloquent white matter tracts (e.g., corticospinal tract, arcuate fasciculus).

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7. Other Roles
• Hydrocephalus: differentiates between obstructive vs non-obstructive causes.
• Cerebral infections (e.g., Creutzfeldt-Jakob disease): shows cortical ribboning and basal ganglia hyperintensity on DWI.
• Normal pressure hydrocephalus vs atrophy: diffusion parameters may help.

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✅ In summary:
Diffusion MRI is crucial in early stroke detection, tumor characterization, infection diagnosis, white matter integrity assessment, and pre-surgical brain mapping. It is one of the most clinically impactful MRI techniques in modern neuroradiology.

24/08/2025

☢️ The Lisfranc classification ..

✅The Lisfranc classification is used to describe Lisfranc injuries (tarsometatarsal joint complex injuries), which can range from ligamentous sprains to severe fracture-dislocations.
There are two main systems commonly used:

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✅1. Quenu and Kuss Classification (1909)

Based on the direction and pattern of displacement of the metatarsals:
🔸• Homolateral (Unilateral): All metatarsals displaced in the same direction (usually laterally).
🔸• Isolated (Partial): Only one or two metatarsals displaced, the others remain aligned.
🔸• Divergent: Metatarsals displaced in different directions (some laterally, some medially).

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✅2. Hardcastle Classification (1982) — Modified by Myerson (1986)

This is the most widely used clinically. It expands on Quenu and Kuss:
• 🔸Type A: Total incongruity
• All metatarsals displaced in the same direction (medial or lateral).
• 🔸Type B: Partial incongruity
• B1: Medial displacement of the first metatarsal.
• B2: Lateral displacement of one or more lesser metatarsals (2nd–5th).
• 🔸Type C: Divergent displacement
• C1: Partial divergent (only some metatarsals displaced medially/laterally).
• C2: Total divergent (all metatarsals spread apart in different directions).

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✅ Key point:
• Quenu & Kuss → original, broad pattern-based.
• Hardcastle/Myerson → refined, detailed, and most practical for treatment planning.

$☢️The “ Le Fort Classification “ ..✅The Le Fort classification describes midfacial fractures involving the maxilla and s...$

13/08/2025

☢️The “ Le Fort Classification “ ..

✅The Le Fort classification describes midfacial fractures involving the maxilla and surrounding structures, based on René Le Fort’s experiments in 1901.
It is divided into three main types according to the fracture pattern:

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✅Le Fort I — Horizontal fracture
• Fracture line: Runs above the teeth roots and below the nose, separating the maxilla from the nasal floor and pterygoid plates.
• Involved structures: Alveolar process, hard palate, lower part of nasal septum.
• Clinical signs:
• Mobility of the upper teeth and hard palate as one unit.
• Swelling and bruising of upper lip and nose base.
• Mnemonic: “Floating palate.”

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✅Le Fort II — Pyramidal fracture
• Fracture line: Extends from nasal bridge → medial orbital walls → infraorbital rim → down through maxilla → pterygoid plates.
• Involved structures: Nasal bones, maxilla, inferior orbital rim, lacrimal bones.
• Clinical signs:
• Step deformity at infraorbital rim.
• Nose and upper jaw move together.
• Periorbital edema and ecchymosis (“panda eyes”).
• Mnemonic: “Floating maxilla” (pyramid-shaped mobility).

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✅Le Fort III — Craniofacial disjunction
• Fracture line: Runs through nasofrontal suture, medial orbital walls, orbital floor, zygomatic arches, detaching the entire midface from the skull base.
• Involved structures: Zygomatic arches, orbital rims, ethmoid bone.
• Clinical signs:
• Complete facial mobility from the cranium.
• Severe facial flattening.
• CSF rhinorrhea possible.
• Mnemonic: “Floating face.”

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📌 Key points:
• Pterygoid plate involvement is present in all Le Fort fractures — important radiologic clue.
• Diagnosis confirmed with CT scan (facial bones).
• Often caused by high-energy blunt trauma (e.g., road traffic accidents).

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06/08/2025

☢️FIGO classification of uterine fibroids:

✅The FIGO classification of uterine fibroids (Leiomyomas) is an internationally accepted system developed by the International Federation of Gynecology and Obstetrics (FIGO).
It is based on the relationship of the fibroid to the endometrium and serosa.

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✅FIGO Leiomyoma Classification System

🔸Submucosal Fibroids
• Type 0: Pedunculated intracavitary fibroid (entirely within the uterine cavity, attached by a stalk).
• Type 1: < 50% intramural extension (more than 50% of the fibroid is in the cavity).
• Type 2: ≥ 50% intramural (more than half of the fibroid within the myometrium, but still distorting the cavity).

🔸Other Fibroids
• Type 3: Contacts the endometrium but is 100% intramural.
• Type 4: Completely intramural (does not contact endometrium or serosa).
• Type 5: Subserosal ≥ 50% intramural.
• Type 6: Subserosal < 50% intramural.
• Type 7: Subserosal pedunculated (attached by a stalk).
• Type 8: Other locations (e.g., cervical, parasitic).

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✅Clinical Use
• Guides surgical planning (hysteroscopic, laparoscopic, or open approach).
• Helps in fertility assessment and management decisions.

28/07/2025

☢️What is PI-RAD ?
✅PI-RADS stands for:
Prostate Imaging – Reporting and Data System

✅What it is:
• A standardized system for interpreting and reporting prostate MRI.
• Helps in detecting and assessing the risk of clinically significant prostate cancer.
• Developed by the American College of Radiology (ACR), European Society of Urogenital Radiology (ESUR), and AdMeTech Foundation.

✅Scoring:
• PI-RADS 1 → Very low likelihood of clinically significant cancer
• PI-RADS 2 → Low likelihood
• PI-RADS 3 → Intermediate (equivocal)
• PI-RADS 4 → High likelihood
• PI-RADS 5 → Very high likelihood

✅Main Items / Components of PI-RADS
🔸1. MRI Sequences Used
• T2-weighted imaging (T2WI)
• Best for anatomy and zonal anatomy (especially peripheral zone).
• Diffusion-weighted imaging (DWI) and Apparent Diffusion Coefficient (ADC) maps
• Best for detecting tumors (especially in peripheral zone).
• Dynamic contrast-enhanced (DCE) imaging
• Detects early enhancement of suspicious lesions (mostly supportive in equivocal cases).
🔸2. Scoring Approach by Zone
• Peripheral Zone (PZ)
• DWI is the dominant sequence for scoring.
• Transition Zone (TZ)
• T2-weighted imaging is the dominant sequence for scoring.
• DCE
• Mainly used to upgrade PI-RADS 3 lesions in the peripheral zone.
🔸3. Lesion Assessment & Reporting
• Location of the lesion (sector map)
• Size of the lesion (largest dimension)
• Final PI-RADS score (1–5)
• Clinical recommendation based on the score.

⤵️ In the attached diagram, there is illustration how to assess the lesion and give it the appreciate PI-RAD score.

13/07/2025

☢️ Neonatal hip ultasround☢️

Neonatal hip ultrasound is a non-invasive imaging technique used to evaluate the hips of newborns and infants, primarily to detect developmental dysplasia of the hip (DDH) — a condition where the hip joint is not properly formed.

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✅ Why It’s Done
• Screening for DDH in:
• Breech babies
• Girls (higher risk)
• First-born children
• Babies with a family history of DDH
• Babies with clinical signs (e.g., hip click, limited abduction)
• To monitor hip development over time in infants at risk

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🖥️ Technique

Performed with the baby in a lateral decubitus position (on the side), using a high-frequency linear transducer (7.5–12 MHz).

Two views are essential:
1. Coronal view in the neutral position
• Visualizes the relationship between the femoral head and acetabulum.
• Used to measure:
• Alpha angle (bony coverage): should be >60°
• Beta angle (cartilaginous roof)
2. Transverse view with flexion (dynamic view)
• Assesses femoral head movement in/out of acetabulum.
• Useful for detecting subluxation or dislocation during stress maneuvers (Barlow/Ortolani).

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📊 Graf Classification System (most common)

Used to categorize the hips based on alpha and beta angles (check the firstly uploaded image)

🧒 When to Perform
• Routine screening: 4–6 weeks of age
• At-risk infants: As early as 2 weeks, with follow-up

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🩺 Clinical Relevance

Early diagnosis and treatment of DDH are crucial to:
• Avoid long-term complications (limb length discrepancy, limp, arthritis)
• Reduce the need for surgery

Neonatal hip ultrasound is most commonly used for evaluating developmental dysplasia of the hip (DDH), but it has other clinical applications as well. Here are the key additional uses:

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✅ Other uses than DDH assesment !

🔹 1. Septic Arthritis or Osteomyelitis
• Detects joint effusion, which may indicate infection.
• Helps guide aspiration or drainage.
• May show adjacent bone involvement or soft tissue edema.

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🔹 2. Hip Effusion (Non-infectious)
• Differentiates between transient synovitis and infectious arthritis.
• Useful in infants with fever and limping or refusal to move the limb.

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🔹 3. Trauma Assessment
• Evaluate for:
• Joint effusion
• Fracture-related soft tissue changes
• Hemarthrosis
• Especially useful when X-rays are inconclusive in infants due to non-ossified bones.

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🔹 4. Guided Procedures
• Aspiration or injection under ultrasound guidance (e.g., in septic arthritis or hemarthrosis).

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🔹 5. Neonatal Tumors or Masses
• Identifies soft tissue or bony masses (e.g., teratomas, hemangiomas).
• Differentiates solid from cystic lesions.

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🔹 6. Vascular Abnormalities
• Assesses femoral artery and vein flow.
• Identifies vascular malformations or thrombosis, especially in infants with femoral catheterization.

09/07/2025

☢️ What is O-RADS ?

✅O‑RADS stands for Ovarian‑Adnexal Reporting and Data System, a standardized framework developed by the American College of Radiology (ACR) in 2018. It’s used by radiologists to consistently classify lesions on the ovaries and adnexa (including fallopian tubes and surrounding tissues) found during ultrasound or MRI examinations .

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🔍 Key Components

1. Dual Imaging Approach
• O‑RADS US (Ultrasound):
• Assigns categories from 0 to 5, indicating increasing risk of malignancy:
• 0 – Incomplete assessment
• 1 – Normal
• 2 – Almost certainly benign (

17/06/2025

☢️Bucket handle tear & its MRI features☢️

✅ A bucket handle tear is a specific type of meniscal tear in the knee, commonly involving the medial meniscus. It is a longitudinal, displaced tear where a central fragment of the meniscus is torn and flipped centrally into the intercondylar notch, resembling the handle of a bucket.

🦴☢️MRI features of a bucket handle meniscal tear
🛑Absent bow tie sign: On sagittal images, the normal meniscus body (seen on 2+ slices) disappears or appears on only 1 slice.
🛑Double PCL sign: A displaced meniscal fragment lies anterior to the posterior cruciate ligament, mimicking a second PCL.
🛑Intercondylar notch sign: The torn meniscal fragment is seen lying within the intercondylar notch.
🛑Flipped meniscus sign: The torn piece is displaced anteriorly and appears in front of the ACL.
🛑Double anterior horn sign: Both anterior and displaced posterior horns appear in the anterior compartment.
🛑Truncated meniscus: The expected normal crescent-shaped meniscus is missing from its location.
🛑Enlarged anterior horn: The anterior horn looks bulkier than normal due to displacement of the torn fragment

05/06/2025

Eid Adha Mubarak

02/06/2025

☢️ Sinus pericranii & its radiological features …

✅ Sinus pericranii (SP) is a rare vascular anomaly characterized by an abnormal communication between the intracranial dural venous sinuses (typically the superior sagittal sinus) and extracranial venous structures through dilated emissary veins. It usually presents as a soft, compressible, non-pulsatile scalp mass that may enlarge with maneuvers that increase intracranial pressure (like Valsalva maneuver or crying in children).

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✅ Key Features
• Location: Most often over the midline scalp, particularly the parietal or frontal region.
• Appearance: A soft, bluish, non-tender mass that can change in size with posture or straining.
• Communication: Between intracranial dural venous sinuses and extracranial veins via dilated diploic and emissary veins.
• Congenital or acquired: Most are congenital, but it can also be acquired following trauma or surgery.

☢️ Radiological features ..

Radiological features of sinus pericranii (SP) are key to diagnosis and treatment planning. Here’s a breakdown of the imaging modalities used and the characteristic findings seen in each:

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🧠 1. MRI & MR Venography (MRV)

MRI Brain:
• T1-weighted images: Lesion may appear isointense or slightly hypointense.
• T2-weighted images: Shows a hyperintense or flow void lesion, depending on blood flow.
• FLAIR: Typically no signal abnormality unless associated pathology exists.
• Post-contrast T1: Shows enhancement of the venous structure.
• Dynamic imaging (e.g., MRV): Confirms venous flow and communication with dural venous sinuses.

MRV:
• Direct visualization of the connection between extracranial venous structures and intracranial dural sinuses (especially the superior sagittal sinus).
• Venous channels traversing the diploic space and calvarial defect.

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🦴 2. CT & CT Venography (CTV)

Non-contrast CT Head:
• May show a calvarial defect or thinning at the point of communication.
• Well-defined scalp lesion, iso- or hypoattenuating depending on venous content.

CTV:
• Enhances venous structures.
• Shows transosseous venous channels connecting extracranial veins to intracranial venous sinuses.
• Bony remodeling or scalloping around the transosseous tract is often visible.

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🩻 3. Digital Subtraction Angiography (DSA)
• Gold standard, though often reserved for preoperative planning.
• Demonstrates delayed venous filling of the extracranial component during the venous phase.
• Dynamic assessment of venous flow direction.
• Identifies any abnormal shunts or high-flow features (rare in SP but relevant for differential diagnosis).

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🧪 4. Doppler Ultrasound (especially in children)
• Compressible, hypoechoic or anechoic lesion.
• Venous waveform on Doppler.
• Size increases with Valsalva or crying.
• Confirms vascular nature and compressibility.

24/05/2025

🧠 Hemorrhagic Infarction in the Brain

A hemorrhagic infarction in the brain refers to a cerebral ischemic stroke that becomes secondarily hemorrhagic, meaning bleeding occurs into the previously infarcted (dead or dying) brain tissue.

🔹 Why It Happens
• After a clot blocks a cerebral artery, brain tissue downstream is deprived of oxygen and dies (ischemic infarct).
• If blood flow is restored (either spontaneously or via treatment like thrombolytics or thrombectomy), the damaged blood vessels in the infarcted area may rupture and leak blood.
• This causes hemorrhage into the infarcted area, leading to a hemorrhagic transformation of an ischemic stroke.

🧠☢️ Radiological Features of Hemorrhagic Infarction

📌 1. Non-Contrast CT (NCCT)
• Hyperdense areas within a region of low attenuation (ischemic area), indicating blood in the infarcted tissue.
• Appears as:
• Patchy or confluent hyperdensities
• Often follows vascular territories (e.g., MCA distribution)
• May have mass effect if bleeding is significant
• Hemorrhagic transformation is typically seen 24–48 hours after the ischemic event.

Types on CT (based on ECASS classification):
• HI-1 (Hemorrhagic infarction 1): Small petechiae, no mass effect
• HI-2: More confluent petechiae, still no mass effect
• PH-1 (Parenchymal hematoma 1): Less than 30% of infarcted area with some mass effect
• PH-2: Dense hematoma >30% of infarcted area with significant mass effect

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📌 2. MRI (Especially Gradient Echo or SWI sequences)
• T2/GRE or SWI*: Blooming artifacts (signal voids) caused by susceptibility from blood breakdown products (like hemosiderin).
• T1 and T2: Signal changes vary with age of hemorrhage:
• Hyperacute (

18/05/2025

☢️ Organ of Zuckerkandl Paraganglioma ☢️

✅The Organ of Zuckerkandl is a small collection of chromaffin cells (neuroendocrine cells derived from the neural crest) located near the aortic bifurcation or along the abdominal aorta. It is a site where extra-adrenal paragangliomas can develop.

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🔬 What is a Zuckerkandl Paraganglioma?

A Zuckerkandl paraganglioma is a paraganglioma (a type of neuroendocrine tumor) that arises from the Organ of Zuckerkandl. It is an extra-adrenal pheochromocytoma, meaning it can produce catecholamines (norepinephrine, epinephrine, and dopamine) like adrenal pheochromocytomas but occurs outside the adrenal gland.

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📍 Location of the Organ of Zuckerkandl
• Near the inferior mesenteric artery to the aortic bifurcation (L2–L4 levels).
• Adjacent to the sympathetic chain.

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📸 Radiological Features of Zuckerkandl Paraganglioma

1. CT Scan
• Well-defined, hypervascular mass near the aortic bifurcation.
• Enhances intensely with contrast due to rich vascularity.
• May show central necrosis or hemorrhage in large tumors.
• Sometimes calcifications are seen.

2. MRI
• T1-weighted: Low to intermediate signal intensity.
• T2-weighted: Bright (hyperintense) signal – classic “light bulb” sign.
• Post-contrast: Strong enhancement.
• May demonstrate the classic “salt-and-pepper” appearance due to hemorrhage (pepper) and slow-flow vessels (salt).

3. Functional Imaging
• 123I-MIBG Scintigraphy: Uptake if tumor is functional.
• 68Ga-DOTATATE PET/CT or 18F-FDOPA PET/CT: Highly sensitive for detecting paragangliomas, especially in hereditary syndromes.
• 18F-FDG PET/CT: Useful in metastatic or aggressive tumors.

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🧬 Clinical Context
• May be functional (secreting catecholamines), causing:
• Hypertension
• Palpitations
• Headaches
• Sweating
• Often associated with hereditary syndromes like:
• SDHx mutations (e.g., SDHB, SDHD)
• MEN2
• VHL
• NF1

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