Case

STUDY
MRI Brain
TABLE OF CONTENTS

01 Patient 02 Clinical
Information History

Exam Procedure,
03 Clinical 04 technique and
Diagnosis
views
05 Pathology
 PATIENT01
IINFORMATION

An 8-year-old boy
 02
Clinical
History
He presented with 3 days of headache, emesis, lethargy, and
right eye pain. The headaches began 6 weeks earlier and
initially occurred once a week, and since increased in
frequency
No significant past medical history presented
 03
Clinical
Diagnosis
He showed no changes in gait or speech, no numbness or tingling, and no
abnormal gaze or nystagmus. He denied photophobia and dizziness.
Clinical diagnosis was uncertain. After initial work-up including CT, a brain
lesion was discovered. The patient underwent (MRI) of the with and without
gadolinium-based contrast.
 04
Exam Procedure, technique and
views
PATIENT PREPARATION :
1. Check patient identification and a written consent must be done by the
parents.
2. Patient have to go to toilet before examination.
3. Explain the procedure to the child and the parents. Instruct the patient
to keep still.
4. Offer ear plug or ear protector.
5. Intravenous line placement if necessary.
6. Contrast injection risk and benefits must be explained to the parents

before the scan, and make sure if the child has a known allergy to contrast

material.

7. Ensure if the child has any implanted medical, electronic device and

remove anything contain metal.

8. Fasting 4-6 hours for contrast material.

PROCEDURE :
Positioning :
* The patient lies supine on the examination couch with their head
within the head coil. Head first.
* Adjust the head so that the interpupillary line is parallel to the couch,
head is straight.
* The longitudinal alignment light lies in the midline, horizontal
alignment light passes through the nasion.
* For immobilization use straps and foam pads.
Contrast Usage :
*IV Gadolinium . Contrast material magnivest 0.1 – 0.2 mmol/kg.
* “NOTE the patient weight”.
* Scans are obtained a few minutes after administration.

Technique :
*Scout three plans or sagittal and axial. Normally less than 25 sec.
- Sagittal T1 : Plan the sagittal slices on the axial plane. Medium
slices/gap are prescribed on each side of the longitudinal alignment light from
one temporal lobe to the other. Angle the position block parallel to midline of
the brain.
The area from the foramen magnum to the top of the head is included in the
image.
- Coronal T1: Plan the coronal slices on the sagittal plane. Angle the
position block parallel to the brain stem. An appropriate angle must be
given in the axial plane on a tilted head (perpendicular to midline of the
brain).
Slices must be sufficient to cover the whole brain from the frontal sinus to
the line of the occipital protubernce .
Axial T1: Plan the axial slices on the sagittal plane. Angle the Position
block parallel to the genu and splenium of the corpus callosum. An
appropriate angle must be given in the coronal plane on a tilted head
(perpendicular to the line of 3rd ventricle and brain stem). Slices must be
sufficient to cover the whole brain from the foramen magnum to the
superior surface of the brain.
 Views :
- Sagittal T1 pre-contrast sequence; ( A )
- Sagittal T1 post-contrast; ( B )
- Coronal T1 post-contrast sequences ;( C )
- Axial T1 pre-contrast; (D)
- Axial T1 post-contrast; (E)
A B C
D E
 05
Pathology
- Pineoblast
- MRI with and without contrast
demonstrated a 2.4 x 2.0 x 1.9 cm
lesion in the pineal region (red arrow)
that is heterogeneously enhancing,
consistent with pineoblastoma.
 REFERENCES

● Jad El Bulbul, MD and Ari Goldberg, MD, PhD (2021).

Pediatric Pineoblastoma. Department of Radiology, Loyola
University Medical Center AUTHOR (2005).
● MRI brain protocols, planning, positioning and indications.
MRImaster
Thank
you
Wejdan Hakami

201808688