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Brain computed tomography (CT) is inconsistently recommended worldwide in the investigative algorithm of patients presenting with first episode psychosis (FEP). The objective of this study is to investigate the clinical efficacy of brain CT in patients presenting with FEP without neurological signs in a major metropolitan teaching hospital.The CT brain scan reports of 237 consecutive patients, for which the imaging requests or reports provided a history of FEP but no focal neurological signs, were retrospectively identified within a 6-year period in a 750-bed tertiary referral teaching hospital using the radiology information system text-search function (170 male, 67 female; mean age, 28.3 years). All reports were authored or approved by consultant radiologist. They were reviewed for the presence of any lesion that could cause psychosis and hence alter clinical management. Minor neuroradiological abnormalities were also noted. Hospital Ethics Committee registration and approval were obtained and patient informed consent was not required.No focal brain lesion potentially responsible for the psychosis or focal lesion requiring surgical intervention was identified in any patient. Findings unable to be directly linked to the psychosis such as evidence of small vessel ischaemic disease, arachnoid cysts, cerebral atrophy, and normal variants were present in 17.6% of patients (45 of 237 studies), none of which led to an alteration of clinical management.The results of this study postulate that brain CT should not be universally performed in the initial assessment of patients with first episode psychosis without neurological signs.

Susceptibility weighted imaging (SWI) is a valuable technique in the evaluation of a wide variety of intracranial pathologies. SWI is a gradient echo sequence utilising both phase and magnitude data to achieve exquisite sensitivity to tissue magnetic susceptibility effects. Normal SWI appearances and common artefacts are illustrated. Examples of SWI in common intracranial pathologies such as subarachnoid, intraventricular and intraparenchymal haemorrhage, intra-axial and extra-axial tumours, pyogenic and non-pyogenic infections, trauma, neurodegenerative diseases and vascular disease including aneurysms, vascular malformations are illustrated and discussed. This pictorial essay will enable radiologists to recognise the normal, artefactual and common intracranial pathological appearances of SWI.

Summary: We present the case of a 64-year-old man with a presumed diagnosis of extracerebral cavernous hemangioma involving the cavernous sinus. The diagnosis was made on the basis of labeled red cell blood pool scintigraphy findings in conjunction with those of MR imaging. This lesion was not altered in appearance at 6-year follow-up MR imaging. We also present the labeled red cell blood pool scintigraphy findings obtained in three other patients with similar-appearing cavernous sinus lesions at MR imaging who underwent subsequent biopsy; histologic findings confirmed chondrosarcoma, chordoma, and meningioma, respectively.

A case of spontaneous internal carotid artery (ICA) dissection confined to the intrapetrous carotid canal that was confirmed by angiography and magnetic resonance imaging is presented. Isolated dissection involving the intrapetrous ICA is rare; however, whenever arterial dissection is a consideration, specific review of imaging in this region is warranted.