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PCNSL (primary central nervous system lymphoma) is a chemosensitive and radiosensitive tumor, and early diagnosis has a significant impact on management. Unlike many other brain tumors, radical surgical excision of PCNSLs is not indicated because these lesions are highly infiltrative and even partial resection leads to a bad prognosis. The goal of this study is to highlight the unusual radiological presentation of PCNSLs and increase the awareness, familiarity, and global database of our observations that pose a challenge on management.

Intracranial dermoids are rare congenital lesions of the brain that account for < 1% of all intracranial tumors. Even though they are rare, typical computed tomography (CT) scan and magnetic resonance imaging (MRI) features along with location allow radiological diagnosis in the majority of patients. Radiologically, dermoid cysts typically appear as nonenhancing low-density masses on CT scan and are hyperintense on T1-weighted (T1-W) MRI sequences with variable signal on T2-W sequences. We describe two cases of dermoid with unusual imaging appearance with the presence of mural nodule in both the cases. The recognition of atypical radiological features can avoid diagnostic pitfalls and is clinically relevant for overall surgical management.

Although MRI has a spectrum of findings which help in the diagnosis of tuberculosis (TB) spine, a broad spectrum of spine pathologies resemble Pott's spine on MRI and are often missed due to inadequate clinical details. As a result, patients are often subject to unnecessary biopsy. A blinded radiologist may misdiagnose such mimic cases as TB. Our aim is to enable the reader to learn the main criteria that differentiate spine TB from other spine etiologies that mimic TB. A retrospective search was done and authors collected only MRI spine reports that showed a differential diagnosis or diagnosis of TB spine from the computer-based data records of the institution over a four-year period. This revealed 306 cases of TB spine out of which 78 cases with an alternate diagnosis that resembled TB spine were included. We describe a single institute review of 78 such cases that resemble and mimic Pott's spine on MRI. The cases being: (n = 15) pyogenic spondylitis, (n = 1) brucellar spondylodiscitis, (n = 12) rheumatoid arthritis, (n = 12) metastases, (n = 8) lymphoma, (n = 5) post-trauma fractures, (n = 10) degenerative disc disease, (n = 2) Baastrup's disease, (n = 9) osteoporotic fracture, (n = 3) spinal neuropathic arthritis, and (n = 1) case of Rosai-Dorfman disease. The clinical and radiological findings of all these cases were correlated with lab findings and histopathology wherever necessary. Appropriate recognition of these entities that resemble and mimic TB spine on MRI is important for optimal patient care. This paper exposes radiologists to a variety of spine pathologies for which biopsy is not indicated, and highlights key imaging findings of these entities to facilitate greater diagnostic accuracy in clinical practice.

When surgical decompression of cervical spine is considered, multilevel cervical corpectomy with long strut grafts is the preferred treatment. This procedure is used in a variety of pathologies including degenerative disease, tumors, trauma and infection. Corpectomy with interbody grafting helps in adequate spinal canal and neural decompression compared to multilevel discectomy, which could be difficult as well as inadequate. Fibular/iliac strut grafts are used for reconstruction along with a stabilizing hardware in this procedure. So far, complete imaging spectrum of complications exclusive to strut graft has not been reported in the literature. This pictorial essay presents complications exclusive to the strut graft, utility of advanced imaging in diagnosis and a brief note on the clinical management of complications.

We describe a case of dural-based homogenously enhancing fungal granuloma in a 29-year-old male who presented with 3 months history of headache. The peculiarity of the case was that there were streaky areas of enhancement around the lesion in the brain parenchyma which resembled tree-in-bud like appearance. The patient underwent surgery and histopathological analysis revealed numerous Aspergillus hyphae. To the best of our knowledge, this is the first case report of a fungal granuloma with atypical parenchymal enhancement pattern.

We describe a case report where the diagnosis of sporadic Creutzfeldt-Jakob disease(CJD) was suspected by the magnetic resonance imaging (MRI) radiologist in a 75-year-old lady who presented with rapid cognitive decline. MRI revealed cortical T2 and FLAIR(fluid attenuation and inversion recovery) hyperintensities in bilateral fronto-parietal and temporo-occipital locations and showed significant restriction on diffusion-weighted images(DWI). In this case report, we discuss the role of MRI to suspect the diagnosis of CJD in appropriate clinical settings.

Arachnoiditis ossificans is a rare chronic disorder characterized by the presence of calcification/ ossification of the spinal arachnoid. We describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings of arachnoiditis ossificans as sequelae to trauma in a 30-year-old patient. This imaging diagnosis becomes important to alert the clinician as most of them can be treated by conservative management.

Intracranial epidermoid cysts are relatively rare congenital inclusion cysts. They are the third most common cerebellopontine angle cistern mass after vestibular schwannoma and meningioma. White epidermoid is a rare variant. We present the first case, to our knowledge, of a white epidermoid cyst anterior to the pontomedullary junction, emphasising its imaging appearance, location and the importance of pre-operative diagnosis, which may reduce operative complications.

We present 2 rare cases of mixed schwannoma with meningioma. The first case was sporadic, in a 38-year-old female in cervical spine (C₂). The second case was a 24-year-old female, associated with NF-2, involving bilateral cerebellopontine angle with extension into the left cavernous sinus, sellar region with erosion of the petrous ridge and multiple intradural extramedullary lesions in the spinal cord suggestive of neurofibromas. To date only 12 cases of such tumors are documented in the literature. To the best of our knowledge this is the first case of sporadic mixed schwannoma with meningioma in cervical spine (C₂).

We report a rare case of recurrent chordoid glioma in suprasellar region with extension into the third ventricle diagnosed peroperatively. On MRI, a brilliantly contrast enhancing lesion in the suprasellar region extending superiorly into the third ventricle and measuring 2.5 × 3 × 3.5 cm was identified. Patient had a previous history of subtotal removal of the tumor 8 months back and had received 56 Gy of postoperative radiotherapy. On smear preparation the tumor was composed of cells arranged in chords and rows in a myxoid background with sprinkling of lymphocytes. The individual cells were polygonal with moderate amount of faintly eosinophilic cytoplasm with cytoplasmic vacoules in few cells. The nuclei showed fine chromatin with small prominent nucleoli. Paraffin sections confirmed the diagnosis and on immunohistochemistry the tumor cells showed strong positivity for GFAP and focal weak positivity for EMA with low MIB-1 labeling index (

Spontaneous pneumorrhachis, non-traumatic, non-iatrogenic air within the spinal canal, is a very rare occurrence. We report a case of spontaneous pneumorrhachis, multiple air pockets in the epidural space, with vacuum discs and spndylolisthesis. Probably this is the first report of such case.