Forensic radiology is a developing field that ideally integrates the expertise of a trained radiologist and a forensic pathologist. Forensic imaging involves imaging the deceased with conventional radiography, CT, or MR imaging. Although forensic pathologists often interpret postmortem imaging, radiologists with cross-sectional skills can provide synergistic assistance. Additional radiologic training is necessary to be competent in this field because specific knowledge of normal postmortem findings is required. This article focuses on unenhanced postmortem CT depicting a variety of neuroradiologic pathologies.Learning Objective: To review the benefits and limitations of postmortem CT and describe normal postmortem changes and mimics on postmortem CT that can impact clinical outcome.
Silicone oil is commonly used for intraocular tamponade to treat vitreoretinal diseases. A rare complication of intraocular silicone oil injection is intracranial migration mimicking other pathologies. In this report, we describe 2 cases of intracranial silicone oil migration and the salient CT and MR imaging characteristics of intracranial silicone oil migration.
A subset of glioneuronal tumors that histologically resembled dysembryoplastic neuroepithelial tumors and rosette-forming glioneuronal tumors were found to have a recurrent dinucleotide variant in the PDGFRA gene, which encodes platelet-derived growth factor receptor α. On the basis of the morphology, molecular features, and common location of the septum pellucidum, these tumors were designated myxoid glioneuronal tumors and incorporated into the 5th edition of World Health Organization (WHO) Classification of CNS tumors (CNS WHO 2021). At our institution, there have been 4 cases in which the characteristic PDGFRA mutation has been identified. The clinical presentations, neuroimaging findings, differential diagnoses, pathology, and short-term outcomes will be discussed and compared with the recent literature. Patients were all young adults with a mean age of 29.75 years. Headache was the most common presenting symptom and correlated with obstructive hydrocephalus. All 4 cases were located along the septum pellucidum. One case was multifocal with an additional mass in the cerebral aqueduct. MR signal characteristics were similar to those of CSF on T1- and T2-weighted imaging. FLAIR showed more unique features of partial suppression except for a rim of bright signal. All patients had an indolent clinical course without recurrence or progression following resection. Myxoid glioneuronal tumors are rare, slow-growing tumors distinguished by their unique PDGFRA variants. The cases included in this study demonstrate the characteristic location and imaging appearances of the tumor type. Familiarity with these tumors and their imaging characteristics is critical to an accurate diagnosis, which may influence treatment.Learning Objective: To improve understanding and enhance the diagnostic accuracy of the recently described myxoid glioneuronal tumors.
The lacrimal fossa, located in the superolateral orbit, is a shallow depression in the orbital plate of the frontal bone. It primarily houses the orbital lobe of the lacrimal gland but also contains other tissues such as fat, blood vessels, and nerves. Lacrimal fossa lesions constitute a diverse spectrum of pathologies, originating from the frontal bone and adjacent soft tissues or from the resident lacrimal gland itself. We present a 42-year-old woman with slowly progressive right superolateral orbital swelling. Subsequent resection of a mass lesion demonstrated a solitary fibrous tumor (SFT) with a Demicco risk of two. We use SFT as a springboard to review the differential diagnosis of unilateral lesions of the lacrimal fossa and lacrimal gland. Nonglandular lesions of the lacrimal fossa primarily arise from its bony superstructure, neurovascular supply, and/or connective tissues. In contrast, lacrimal gland pathologies are like those of the salivary glands, being primarily neoplastic or infectious/inflammatory. Neoplastic lacrimal gland lesions can be of epithelial origin or nonepithelial origin, with lymphoma being the most common of the latter. While inflammatory lesions are often bilateral, unilateral involvement can occur. The clinical and imaging characteristics of multiple unilateral lacrimal fossa and lacrimal gland pathologies are explored herein.
Noncompressive myelopathies are intrinsic diseases of the spinal cord leading to neurologic dysfunction. Unlike compressive myelopathies, which are typically not a diagnostic dilemma and are managed operatively, noncompressive myelopathies can be more challenging to diagnose, and treatment addresses the specific underlying or precipitating condition. The cornerstones of diagnosis include the history and physical examination as well as paraclinical tests including laboratory analysis and MRI. Thus, radiologists play an important role in the timely and accurate diagnosis of noncompressive myelopathy. The purpose of this review is to describe the MRI findings of the most common causes of noncompressive myelopathy. Mimics and interpretation pearls will also be presented to further emphasize diagnostic accuracy.Learning Objective: To describe the broad differential diagnosis for noncompressive myelopathy and recognize key clinical and imaging features of each entity.
