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Training Collections
Library Memberships
Black Friday Save 30%On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Black Friday Save 30%Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Black Friday Save 40%Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
BLACK FRIDAY SAVE 30%Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Pre-Course Activities
1 topic, 3 min.
Lesson
Introduction to Stroke Imaging
4 topics, 17 min.
Lesson
Noncontrast CT
5 topics, 14 min.
Lesson
CTA Neck
10 topics, 33 min.
Vascular Imaging in Stroke - CTA vs MRA
2 m.Carotid and Vertebral Vasculopathies Overview & Examples of Atherosclerotic Disease
3 m.Case - Atheromatous Disease with Severe ICA Stenosis
4 m.Carotid & Vertebral Artery Dissection Overview & Examples
3 m.Case - Embolic Stroke with ICA Dissection
5 m.Collagen Vascular Diseases Overview - Examples of FMD, Carotid Web
2 m.Case - Fibromuscular Dysplasia (FMD)
5 m.Case - Ehlers Danlos
7 m.Inflammatory Conditions with Stroke Symptoms - Examples of Takayasu's, TIPIC
4 m.Case - Takayasu’s Arteritis
4 m.Lesson
CTA Head
9 topics, 37 min.
CTA Head in Acute Stroke - Source Images, MIPS, Collaterals
4 m.Case - MCA Stem Embolus with Good Collaterals
5 m.Case - MCA Stem Embolus with Poor Collaterals
4 m.Case - Basilar Tip Thrombus
6 m.Circle of Willis Stenoses: Differential Diagnoses
2 m.Case - Moya Moya disease
6 m.Case - Reversible Cerebral Vasoconstrictive Syndrome (RCVS)
5 m.Case - Primary Angiitis of the CNS (PACNS)
7 m.Infectious Causes of Multifocal Circle of Willis Stenosis
2 m.Lesson
CT Perfusion
3 topics, 15 min.
Lesson
MRI (DWI, FLAIR, SWI) of Acute Stroke
3 topics, 14 min.
Lesson
MRA of Head and Neck
6 topics, 18 min.
Lesson
Multifocal Strokes With No Visualized Vascular Abnormality
6 topics, 26 min.
Lesson
Brain Ischemia, Hypoxia, & Death
6 topics, 16 min.
Lesson
Stroke Mimics & Other Causes of Restricted Diffusion
7 topics, 18 min.
Stroke Mimics - Other Causes of Restricted Diffusion
2 m.Case - Seizure (Stroke Mimic)
4 m.Case - MELAS (Stroke Mimic)
3 m.Case - Hypoglycemia (Stroke Mimic)
3 m.Case - Herpes Virus Encephalitis (Stroke Mimic)
4 m.Case - Osmotic Demyelination Syndrome (Stroke Mimic)
3 m.Case - Brain Metastases (Stroke Mimic)
4 m.Lesson
MR Perfusion
8 topics, 17 min.
MR Perfusion - Data, Maps and Uses
4 m.Case - MR Perfusion Target Mismatch (Good Collaterals)
2 m.Case - MR Perfusion Target Mismatch (Poor Collaterals)
3 m.Case - Ischemia Detected Only on MR Perfusion (Case 1)
2 m.Case - Ischemia Detected Only on MR Perfusion (Case 2)
3 m.Arterial Spin Labelling Perfusion - Usage Examples
3 m.Case - ASL Matched Defect
2 m.Case - ASL Showing Tissue at Risk
2 m.Lesson
Subacute Stroke & Differentials
5 topics, 13 min.
0:00
These are images of a 71-year-old male
0:02
who had right-sided hemiparesis.
0:04
This is the non-contrast CT.
0:06
You can see the dense MCA vessel sign.
0:09
There's some hypodensity in the insula
0:11
and the basal ganglia.
0:14
Cortex doesn't look too bad.
0:16
Maybe a little bit in cortex.
0:19
On CTA,
0:20
this is just the MIP,
0:21
you can see top of the ICA
0:23
going into MCA lesion,
0:25
and there's pretty bad collateralization.
0:28
So, almost malignant collaterals in that area.
0:32
So, we got an MR and diffusion-weighted images
0:38
show a pretty big infarct
0:39
involving the anterior temporal lobe, the insula,
0:42
basal ganglia, and the frontal lobe.
0:45
And when we look at the perfusion images
0:49
together with the diffusion images, we can see,
0:52
so these are the Tmax maps,
0:54
you can see there is a mismatch here.
0:57
There is tissue at risk.
0:59
There's quite a bit of tissue at risk
1:00
in the left temporal lobe,
1:01
where you don't see any DWI abnormality,
1:05
and then there's some risk in the parietal lobe.
1:08
This is artifact back here.
1:09
So, this is a core penumbra mismatched.
1:12
It's just that the core is already over 70 CCs,
1:15
and the patient has malignant collaterals,
1:18
and the infarct is growing really fast.
1:20
So the patient's unlikely to
1:22
do well with thrombolysis.
1:24
You might spare some tissue,
1:25
but the infarct's growing so fast,
1:27
it might be hard to spare that.
1:31
So, large infarct core
1:32
with a core penumbra mismatch.
1:34
This patient did not go to thrombolysis.
1:38
Here's the follow-up.
1:40
So, here's the initial DWI on the top
1:43
and the follow-up on the bottom.
1:45
And you can see that area that was at risk
1:47
on the perfusion maps,
1:50
now is infarcted.
1:52
So basically,
1:53
it extended into the mismatched area.
1:55
You can see the same thing at the vertex.
1:58
So, this is an example of a large core
2:01
with a core penumbra mismatch
2:03
but had malignant collateral
2:05
so it was growing too fast.
2:06
Did not go to thrombolysis,
2:07
and the infarct extended.
Case - MR Perfusion Target Mismatch (Poor Collaterals)
HIDEInteractive Transcript
0:00
These are images of a 71-year-old male
0:02
who had right-sided hemiparesis.
0:04
This is the non-contrast CT.
0:06
You can see the dense MCA vessel sign.
0:09
There's some hypodensity in the insula
0:11
and the basal ganglia.
0:14
Cortex doesn't look too bad.
0:16
Maybe a little bit in cortex.
0:19
On CTA,
0:20
this is just the MIP,
0:21
you can see top of the ICA
0:23
going into MCA lesion,
0:25
and there's pretty bad collateralization.
0:28
So, almost malignant collaterals in that area.
0:32
So, we got an MR and diffusion-weighted images
0:38
show a pretty big infarct
0:39
involving the anterior temporal lobe, the insula,
0:42
basal ganglia, and the frontal lobe.
0:45
And when we look at the perfusion images
0:49
together with the diffusion images, we can see,
0:52
so these are the Tmax maps,
0:54
you can see there is a mismatch here.
0:57
There is tissue at risk.
0:59
There's quite a bit of tissue at risk
1:00
in the left temporal lobe,
1:01
where you don't see any DWI abnormality,
1:05
and then there's some risk in the parietal lobe.
1:08
This is artifact back here.
1:09
So, this is a core penumbra mismatched.
1:12
It's just that the core is already over 70 CCs,
1:15
and the patient has malignant collaterals,
1:18
and the infarct is growing really fast.
1:20
So the patient's unlikely to
1:22
do well with thrombolysis.
1:24
You might spare some tissue,
1:25
but the infarct's growing so fast,
1:27
it might be hard to spare that.
1:31
So, large infarct core
1:32
with a core penumbra mismatch.
1:34
This patient did not go to thrombolysis.
1:38
Here's the follow-up.
1:40
So, here's the initial DWI on the top
1:43
and the follow-up on the bottom.
1:45
And you can see that area that was at risk
1:47
on the perfusion maps,
1:50
now is infarcted.
1:52
So basically,
1:53
it extended into the mismatched area.
1:55
You can see the same thing at the vertex.
1:58
So, this is an example of a large core
2:01
with a core penumbra mismatch
2:03
but had malignant collateral
2:05
so it was growing too fast.
2:06
Did not go to thrombolysis,
2:07
and the infarct extended.
Report
Faculty
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
Tags
Vascular Imaging
Neuroradiology
Neuro
MRI
Head and Neck
CT
Brain
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