0:00

This is a 13-month-old child

0:03

with tuberous sclerosis complex

0:04

receiving an MRI for routine surveillance.

0:06

And we can see on this FLAIR image,

0:08

multiple subependymal nodules.

0:11

You can see better on the T2-weighted imaging,

0:14

the relatively confluent areas of dysplasia

0:17

in the right parietal lobe,

0:18

an additional conglomeration of

0:21

relatively confluent dysplasia

0:23

in the left frontal pole.

0:25

Several other areas,

0:27

you can see this gyrus is rather enlarged,

0:31

doesn't maintain the normal typical morphology

0:35

of the sulcation pattern expected there.

0:38

So, one thing that was noted is this lesion here

0:44

and this caught people's attention.

0:50

But if we look closely,

0:52

we're not seeing a correlate on T2-weighted imaging.

0:58

While some of these nodules enhance,

1:00

there is nothing enhancing in this location

1:04

in the anterior body of the

1:06

left lateral ventricle.

1:08

And I'm not seeing anything on STIR either,

1:12

except I'm seeing a slightly ill-defined

1:16

area of hypointense signal.

1:19

So, this is a fake out.

1:21

This is not a subependymal giant astrocytoma.

1:24

This is something that we can see in many

1:26

MRIs of the brain,

1:27

and our eyes may end up ignoring it,

1:29

or sometimes maybe we may get concerned.

1:32

This is a CSF pulsation flow void.

1:35

CSF is coming through

1:36

the foramen of Monroe.

1:38

And at the time that the inversion pulse know

1:41

the signal of water here, between the time

1:44

of that inversion pulse and the readout,

1:46

this fluid comes in with protons that

1:50

had not received the inversion pulse.

1:52

And so, we're seeing this bright signal here

1:56

and we're seeing a subtle little, you know,

1:58

flow anomaly here, flow void really

2:01

to CSF pulsation.

2:03

So, this is normal.

2:04

This is a physiologic finding.

2:06

This is not a subependymal giant cell astrocytoma.

2:09

This is just a good example that even in

2:13

patients with a known disease process,

2:15

those scans are prone to all the normal

2:18

artifacts that we see in other imaging

2:21

sequences in other patients.

2:23

So, we see another CSF pulsation

2:26

flow void in the fourth ventricle here.

2:30

But so, this is a patient with

2:33

tuberous sclerosis complex,

2:34

moderately severe burden of dysplasia,

2:37

multiple subependymal nodules and a CSF

2:40

pulsation flow void that could

2:42

be mistaken for a sega.