Limitations of T2*-Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma

A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on T2*-gradient recalled-echo or susceptibility-weighted sequences such as SWI and susceptibility-weighted angiography, which is not necessarily true. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of CSF with variable amounts of hemosiderin staining along the neomembranes. We review the physiology and MR imaging physics behind the appearance of a chronic subdural hemorrhage, highlighting that the absence of a BBB can allow hemosiderin to be completely removed from the subdural compartment. Finally, we stress the importance of reviewing all multiplanar sequences for the presence of neomembranes, which can be quite subtle in the absence of hemosiderin staining and are critical for making the diagnosis of chronic subdural hemorrhage.

The oculomotor cistern: anatomy and high-resolution imaging

BACKGROUND AND PURPOSE

The oculomotor cistern (OMC) is a small CSF-filled dural cuff that invaginates into the cavernous sinus, surrounding the third cranial nerve (CNIII). It is used by neurosurgeons to mobilize CNIII during cavernous sinus surgery. In this article, we present the OMC imaging spectrum as delineated on 1.5T and 3T MR images and demonstrate its involvement in cavernous sinus pathology.

MATERIALS AND METHODS

We examined 78 high-resolution screening MR images of the internal auditory canals (IAC) obtained for sensorineural hearing loss. Cistern length and diameter were measured. Fifty randomly selected whole-brain MR images were evaluated to determine how often the OMC can be visualized on routine scans. Three volunteers underwent dedicated noncontrast high-resolution MR imaging for optimal OMC visualization.

RESULTS

One or both OMCs were visualized on 75% of IAC screening studies. The right cistern length averaged 4.2 +/- 3.2 mm; the opening diameter (the porus) averaged 2.2 +/- 0.8 mm. The maximal length observed was 13.1 mm. The left cistern length averaged 3.0 +/- 1.7 mm; the porus diameter averaged 2.1 +/-1.0 mm, with a maximal length of 5.9 mm. The OMC was visualized on 64% of routine axial T2-weighted brain scans.

CONCLUSION

The OMC is an important neuroradiologic and surgical landmark, which can be routinely identified on dedicated thin-section high-resolution MR images. It can also be identified on nearly two thirds of standard whole-brain MR images.

Microwave incubation improves lipolytic enzyme preservation for ultrastructural cytochemistry

Standard methods for the ultrastructural detection of lipase and sphingomyelinase activities in the skin result in considerable loss of structural preservation, often interfering with accurate delineation of enzyme localization in association with specific organelles. Moreover, poor preservation occurs, even after extensive aldehyde prefixation, owing to the prolonged incubation times needed to detect residual enzyme activity, which often require non-physiological conditions. A modified incubation protocol is described here, which uses microwave irradiation in conjunction with drastically shortened incubation times, resulting in both superior ultrastructural preservation and excellent localization in mammalian epidermis. This method should be useful generally not only for the study of lipase localization in skin, but also in conjunction with the cytochemical detection of a variety of enzymes in various types of tissue.