The value of neuroimaging team meetings for patients in a district general hospital

Examples of clinically important missed lesions and misinterpreted lesions. (a) CT scan of brain showing left Virchow Robin space, which was misinterpreted as a lacunar infarct. (b) MRI of brain with subdural collections (b1, which was identified in the initial report) and sagging of the brainstem (b2, not identified) suggesting intracranial hypotension. (c) MRI of brain right hemisphere gyrus with signal change of unclear significance (c1) that enlarged over 4 years (c2), making low-grade tumour the probable diagnosis. The enlargement had not been recognised. (d) MRI brain showing decussation of the superior cerebellar peduncles, which was misinterpreted as a midbrain infarct. (e) Right frontal low signal on gradient echo MRI of brain consistent with contusion but misinterpreted as a cavernoma. Clinically important lesions missed on initial reports included (f) right cerebellar stroke, (g) cerebral venous sinus thrombosis showing absence of contrast at the ­confluence of the venous sinuses, (h) torcula meningioma and (i) a spinal cord lesion at T1–2 consistent with demyelination. CT = computed tomography; MRI = magnetic resonance imaging