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index [2020/02/01 18:28] – icnaindex [2022/01/24 21:55] – Kristen Scheitler, MD @k_scheitler Via Twitter administrator@icnapedia.org
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 <nspages .:content -h1 -actualTitle -textPages="Index"  -exclude:index> <nspages .:content -h1 -actualTitle -textPages="Index"  -exclude:index>
 ~~AUTHORS:off~~ ~~AUTHORS:off~~
 +====== Quick yet systematic approach to MR imaging of brain lesions ======
 +
 +In general, there are 4 MR sequences that will tell you 99% of what you need to know:
 +
 +1. T2 FLAIR
 +2. T1 post-contrast 
 +3. DWI
 +4. GRE/SWI/SWAN/T2*
 +
 +1. T2 FLAIR: "What is grossly abnormal?"
 +anything abnormal = bright on T2 FLAIR
 +2. T1+gadolinium*: "Where is the BBB disrupted?"
 +
 +Also:
 +-"What is the vascular composition?" 
 +always compare T1+gad sequences to pure T1 without contrast (if also bright on pure T1, then BBB not necessarily disrupted)
 +{{::fj1ehv3x0aykaij.jpg?200|}}
 +3. DWI*:
 +bright = abnormal = "diffusion-restricting" = could be hypercellularity, ischemia, demyelination, abscess, &c
 +**the above applies only if the corresponding area is dark on ADC sequence (if also bright on ADC, then just T2 shine-through)**
 +{{::fj1eh_ixsay4td-.jpg?200|}}
 +4. GRE/SWI/SWAN/T2*: helps to distinguish nuances among entities on your differential.
 +in general, abnormal = dark (blood, vascularity, &c; abscesses tend to have dark rims on SWI)
 +{{::fj1eipkx0aihgp_.jpg?200|}}
  
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