0:01

So this was a 64 year old woman, um,

0:04

and they had pain and fullness in their forearm and their digits.

0:10

So just scrolling through a couple of axial sequences in this case,

0:16

again with our T one weighted sequence on the left,

0:19

our fluid sensitive sequence on the right. And I've got a couple more,

0:24

uh, imaging, imaging sequences for you here as well.

0:28

Maybe just one more. And this is a post contrast T one weighted sequence.

0:33

Give you an idea of what's going on here.

0:40

All right. Uh, so for question number seven, I wrote this,

0:45

uh, the way you're not supposed to write questions.

0:47

So which of the following is not a described sign of a peripheral nerve sheath

0:52

tumor? So what is not a sign of peripheral nerve sheath tumor?

0:58

All right. Your options are split. Fat, vesicular target, or bowl of grapes.

1:01

Very good. Everybody got this one? Uh,

1:03

the bowl of grape sign is associated with synovial sarcomas and so you've

1:08

probably seen some instances of this.

1:10

Peripheral nerve sheath tumors are fairly common. Uh,

1:13

fre more frequently encountered.

1:14

Obviously if you have some sort of nerve she tumor genetic susceptibility, uh,

1:19

but can occur, um, just sporadically in the general population as well.

1:23

So examples of the split fat sign you get kind of this,

1:26

this area where the fat is split by the tumor itself.

1:30

The fas particular sign is where you see this kind of heterogeneous appearance

1:33

of the nerve.

1:34

We have these foci of hyperintensity within the hyperintense tumor and the

1:39

target sign,

1:40

probably the most classic of the peripheral nerve sheath tumor signs where we

1:43

have peripheral hyperintensity, central hypo intensity.

1:48

And hopefully you get to see some of those findings in this case. Uh,

1:52

I picked this not because it's the world's best, um,

1:54

peripheral nerve sheath tumor,

1:56

but more because of the nerve that had involved in this case.

1:59

So not any denervation edema associated with this, uh,

2:03

peripheral nerve sheath tumor to help guide you.

2:06

But hopefully based on the location alone,

2:08

you picked up that this was the deep branch of that median nerve.

2:12

You can see kind of as it courses along that perineural fat and just anterior to

2:16

that interosseous membrane. We have this large tumor associated.

2:21

Um,

2:21

and this was thought to be arising from that anterior intraosseous nerve branch.

2:26

So that deep branch of the median nerve, the anterior interosseous nerve,

2:30

we have some heterogeneity just predominantly homogeneous T two or um,

2:35

PD fat sat hyperintensity. Um,

2:38

and the associated enhancement characteristic of a peripheral nerve she tumor.