Evan Calabrese, MD PhD @ecalabr Twitter profile

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Evan Calabrese, MD PhD

@ecalabr

5 months

33 year old male presents with seizure. MRI reveals a brain tumor as shown. Can you make the WHO CNS 2021 diagnosis on this single image?

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Evan Calabrese, MD PhD

@ecalabr

10 months

59 year old with chronic headaches. What’s going on here?

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Evan Calabrese, MD PhD

@ecalabr

1 year

Arguably the most important sequence in a brain MRI. Sometimes you can make the diagnosis using DWI alone. History: fevers and seizure

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Evan Calabrese, MD PhD

@ecalabr

9 months

Sometimes its scary when a neuroradiologist tries to look inside the abdomen, but sometimes it can make the diagnosis! Whats going on here?

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Evan Calabrese, MD PhD

@ecalabr

9 months

Infant with left globe proptosis. What is the most likely diagnosis?

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Evan Calabrese, MD PhD

@ecalabr

7 months

Neuroradiologist calls this normal. Patient has facial squamous cell and right V1 symptoms. When questioned about this finding, they double down and say it’s just an enlarged superior ophthalmic vein… I’ve missed perineural spread before, but at least I’m not delusional…

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Evan Calabrese, MD PhD

@ecalabr

4 months

20s male patient presents with sx of hydrocephalus and this lesion is found on imaging. Original read suggested central neurocytoma. Biopsy non-diagnostic, revealing only mucin. CT C/A/P negative. What do you think?

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Evan Calabrese, MD PhD

@ecalabr

5 months

Patient presents with headache and seizure after a recent admission for TIA. MRI and CTA findings below. What's going on here and how can we treat it?

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Evan Calabrese, MD PhD

@ecalabr

7 months

Progressive myelopathy, concern for transverse myelitis. What's going on and what's the next step?

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Evan Calabrese, MD PhD

@ecalabr

30 days

30s patient with no significant PMH presents with progressive lower extremity weakness. Non-contrast CT and MRI findings shown. What's your ddx and what is most likely? Would contrast enhanced imaging change your ddx?

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Evan Calabrese, MD PhD

@ecalabr

9 months

Older patient with memory complaints. Tell me your diagnosis here or in person at #RSNA23

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Evan Calabrese, MD PhD

@ecalabr

10 months

This is a T1-weighted image of the brain at the level of the basal ganglia. It shows a large heterogeneously enhancing mass with surrounding edema centered in the left parietal lobe. The primary differential consideration is high-grade glioma. Biopsy or excision is recommended.

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Evan Calabrese, MD PhD

@ecalabr

10 months

Sometimes it helps to look at the PET. What do you think?

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Evan Calabrese, MD PhD

@ecalabr

2 months

Early 40s patient presents with acute onset right facial weakness. CT/CTA stroke protocol and non-contrast MRI shown. What's the most likely diagnosis/etiology?

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Evan Calabrese, MD PhD

@ecalabr

9 months

Images clockwise from top left are: TOF MRA, dynamic postcon MRA neck coronal MIP, and ASL perfusion. Patient presenting with transient hemibody numbness. What's going on here? What is the next step in the evaluation?

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Evan Calabrese, MD PhD

@ecalabr

11 months

Striking but ominous… What is your DWI diagnosis? #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

11 months

Regarding T2/FLAIR mismatch (incl. partial) in context of WHO2021: 1) it only applies to non-enhancing solid tumor components 2) it is specific for diffuse astrocytoma grade 2-4 versus oligodendroglioma/glioblastoma, NOT other tumors 3) it is NOT sensitive for IDH mutant status

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Evan Calabrese, MD PhD

@ecalabr

8 months

Patient with right eye pain and proptosis. What's going on here and what is the next step in diagnosis and management?

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Evan Calabrese, MD PhD

@ecalabr

8 months

7 year old with new lump on head. Subsequent FDG PET showed uptake in the lesions shown, but no other abnormality. What do you think?

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Evan Calabrese, MD PhD

@ecalabr

11 months

Another DWI diagnosis. Routine staging for patient with cancer. What’s going on here? Sometimes DWI is the best sequence for this… #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

18 days

Important to know that 🏒 sign is for variant CJD (aka mad cow), which has been confirmed in only 4 cases in the USA and none since 2012. Cortical T2/DWI abnormality is the dominant finding in the more common sporadic CJD.

WalidoNeuroPedia

@NeuroWalid

19 days

Hockey 🏒 stick sign: It refers to the hyperintense signal involving the pulvinar and dorsomedial thalamic nuclei bilaterally on FLAIR, in cases of variant Creutzfeldt-Jakob disease, which has the shape of a hockey stick. #neurotip #neuroradiology #neurocognitive @NeuroWalid

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Evan Calabrese, MD PhD

@ecalabr

2 months

Important case. These not infrequently get sent to tumor board. My rec is always the same: don’t touch!

Daniel Gewolb, MD

@daniel_gewolb

2 months

MRI obtained for further work up of a brain mass. What is the most likely diagnosis? 🧠 #neurosurgery #meded #ENT #Neurology #Medicine #FOAMed #radres #futureradres

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Evan Calabrese, MD PhD

@ecalabr

11 months

Last companion case for this recent series of 3 DWI diagnoses. History: found down at home. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

4 months

Neonate with left arm paralysis. What’s the cause and what scenario led to this?

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Evan Calabrese, MD PhD

@ecalabr

6 months

What do you think about these images? Any… inconsistencies? Source:

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Evan Calabrese, MD PhD

@ecalabr

7 months

Young patient referred for PICA aneurysm. What do you think? More images in the thread.

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Evan Calabrese, MD PhD

@ecalabr

9 months

Obstructive hydrocephalus from leptomeningeal disease (prior). Why did they bleed after shunting (current)?

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Evan Calabrese, MD PhD

@ecalabr

6 months

Baby with large birthmark on back. T1-weighted image of the brain and spine shows the following.

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Evan Calabrese, MD PhD

@ecalabr

3 months

Evaluate new sclerotic lesions in upper T-spine. Patient with history of lung cancer and staph epi bacteremia. What do you think?

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Evan Calabrese, MD PhD

@ecalabr

11 months

Three more DWI only diagnoses with abnormalities in proximity to the temporal bone. History: A) chronic headache; B) pediatric patient with fever, headache, AMS; C) chronic right conductive hearing loss. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

5 months

Workup of patient with myelopathy reveals a lesion at T12 with cord compression. Biopsy was non-diagnostic. Extensive imaging workup shown. Diagnosis? Dunk it. No diff.

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Evan Calabrese, MD PhD

@ecalabr

10 months

Another DWI diagnosis. 10 yo with tumor shown below. What is the tumor and subtype? Prognosis? #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

11 months

Very excited to share our work in @radiology_rsna on quantitative analysis of neonatal brain MRI and correlation with clinical outcomes at 2 years. Thanks to senior author @YiLiMD for inspiring and guiding this project.

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Evan Calabrese, MD PhD

@ecalabr

11 months

More DWI only diagnoses: three cases of abnormal hippocampal DWI, each with a different underlying cause. History: A) memory loss, B) tox screen positive for opioids, C) young patient with fever and AMS. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

11 months

Another DWI diagnosis. Behavioral changes. Requesting LP with radiology because patient is combative. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

3 months

We recently released a multi-sequence, multi-institution MRI dataset of over 1000 patients with intracranial meningiomas as part of the BraTS meningioma challenge. We also include tumor grade. AI model for predicting meningioma grade? You can build it!

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Evan Calabrese, MD PhD

@ecalabr

11 months

Two more DWI diagnoses for you, both with different underlying etiology but the same basic history: chronic EtOH, AMS. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

1 year

The @BraTS_challenge 2023 meningioma challenge page is live on Synapse! This is where you can learn about the challenge, register, and download the training data. Looking forward to an amazing competition!

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Evan Calabrese, MD PhD

@ecalabr

1 year

The BraTS 2023 meningioma segmentation challenge is in full swing with over 1000 training cases and 141 validation cases now publicly available. Participate and make meningioma great: @BraTS_challenge #ForgottenBrainTumor #MeningiomaRespect

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Evan Calabrese, MD PhD

@ecalabr

3 months

Calcified pineal gland. Another victim of big fluoride!

Neuromed

@Neuromed_

3 months

What's your diagnosis!!!

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Evan Calabrese, MD PhD

@ecalabr

10 months

Another DWI diagnosis. Young patient with epilepsy presenting confused after a seizure. What is the finding and how do you explain it? What is your opinion on coronal DWI? #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

11 months

Another great DWI only diagnosis. History: chronic EtOH, AMS. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

1 year

Getting excited for BraTS 2023 Meningioma Challenge! Thanks to all the data contributors and annotators who have participated so far. Are you a closet meningioma lover? If so, we should talk.

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Evan Calabrese, MD PhD

@ecalabr

2 months

Anyone out there routinely mentioning small cervicothoracic perineural cysts???

Neurology Journal

@GreenJournal

2 months

This #NeurologyRF Clinical Reasoning case delves into the differential diagnosis of hand weakness and atrophy, emphasizing the significance of myotomal innervation in intrinsic hand muscles:

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Evan Calabrese, MD PhD

@ecalabr

10 months

You thought I was done?? Another DWI diagnosis: Patient referred for incidental intraventricular tumor. What do you think it is? #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

3 months

+1 Don’t call unless you are willing to tell a surgeon why they should care.

Sameer Raniga

@samrad77

3 months

Cervical osteophyte fractures are extremely rare (they probably don’t exist in isolation). Almost unknown in the absence of rigid spine (AS or DISH) or prevertebral soft tissue swelling. Almost all of them are discal or annulus calcifications. Just ignore. --on-call wisdom

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Evan Calabrese, MD PhD

@ecalabr

10 months

Code stroke for diplopia…

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Evan Calabrese, MD PhD

@ecalabr

3 months

Very happy to announce the 2024 @BraTS_challenge Meningioma Radiotherapy Challenge! We just released 500 MRIs of patients who received radiotherapy for meningioma. Goal is to help improve/automate radiation planning! Info 👇

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Evan Calabrese, MD PhD

@ecalabr

9 months

This is a case of a high grade diffuse glioma that spread from the brain to the peritoneum via a ventriculoperitoneal shunt catheter. This is a rare complication of shunting in the setting of glioma with CSF dissemination. Not to be confused with gliomatosis peritonei!

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Evan Calabrese, MD PhD

@ecalabr

10 months

Very impressed with the great differential considerations given here. I think tumefactive perivascular spaces and tumor related cysts are great thoughts and could look identical. However, this is a case of racemos 🍇 neurocysticercosis!

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Evan Calabrese, MD PhD

@ecalabr

28 days

Dx: Chordoma was favored on noncontrast MRI and contrast enhanced imaging was deferred. Subsequent biopsy confirmed a chordoma. Good reminder that chordoma can occur throughout the spinal column, not just clivus/coccyx. Marked T2 hyper and relatively slow growth are typical.

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Evan Calabrese, MD PhD

@ecalabr

5 months

This was astrocytoma, IDH-mutant, WHO grade 4. Formerly IDH-mutant glioblastoma or 2ndary glioblastoma, though these are outdated terms. The key is a large amount of non-enhancing infiltrative tumor with central enhancing/cystic component, usually in a younger patient.

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Evan Calabrese, MD PhD

@ecalabr

10 months

I need your help. Teenage female no sig PMH presented w/ headaches and pan-hypopit. Imaging similar to below with central ⬇️diffusivity. Imaging findings essentially completely resolved in 1 mo without treatment. Still pan-hypopit. Thoughts?

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Evan Calabrese, MD PhD

@ecalabr

10 months

When in doubt, sprinkle a little SALT 🧂on your complex neuroimaging case: Sarcoid Amyloid Lymphoma and Tuberculosis can all have a highly variable imaging appearance. This is a case of neurosarcoidoisis!

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Evan Calabrese, MD PhD

@ecalabr

1 year

Reminder that we are hiring a medical imaging AI researcher! @KMagudia and I would love to have you join our team. See below for details.

Kirti Magudia, MD PhD

@KMagudia

1 year

🌟🌟🌟Hiring a postdoc candidate, research scientist or research assistant🌟🌟🌟 (retweets appreciated) Exciting times! @KMagudia and @ecalabr are recruiting a candidate to join us here at @DukeRadiology @duke_dair Apply here:

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Evan Calabrese, MD PhD

@ecalabr

3 months

@daniel_gewolb @AlbanyMedRadRes @TheASNR Left hemiatrophy, likely prior infarct or injury. Discharge home with no imaging or clinical follow up…. Wait a min. Did I already sign that one?

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Evan Calabrese, MD PhD

@ecalabr

10 months

The finding is abnormal cortical DWI signal in the right parietal lobe and left cerebellum. This was post-ictal change, and resolved rapidly. The contralateral cerebellar involvement is due to crossed cerebellar diaschisis.

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Evan Calabrese, MD PhD

@ecalabr

4 months

Pineal region mature cystic teratoma! Hard to make this diagnosis by imaging alone in the absence of gross fat, but the appearance, location, calcifications, and mucin are clues. MGT is a good ddx, but enhancement and calcifications are not typical.

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Evan Calabrese, MD PhD

@ecalabr

9 months

Imaging shows left sphenoid wing dysplasia and a homogeneously enhancing mass in the left cavernous sinus extending into multiple skull base foramina. Genetic testing was positive for NF1, and the mass is presumed to represent a plexiform neurofibroma.

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Evan Calabrese, MD PhD

@ecalabr

2 months

@Brandon_Beaber Hemosiderin cap. Suggests hemorrhagic intermedullary lesion such as ependymoma, cavernoma, hemangioblastoma. Would need more sequences to narrow much further. Was this before or after neck manipulation???

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Evan Calabrese, MD PhD

@ecalabr

9 months

@daniel_gewolb This was a young adult and the tumor was a diffuse midline glioma, but yes! This is peritoneal metastasis via a VP shunt.

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Evan Calabrese, MD PhD

@ecalabr

1 month

Is it possible to predict neurodevelopmental outcomes 2 years after neonatal HIE using brain MRI? We built an AI model to test this. AI Outcome Prediction in Neonatal Encephalopathy (AI-OPiNE) is now published in @Radiology_AI . @YiLiMD @DrDreMDPhD

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Evan Calabrese, MD PhD

@ecalabr

5 months

We found that reduced diffusivity in the parietal/occipital lobes was associated with poor neurologic outcome after cardiac arrest, even after adjusting for brain injury volume/severity. If you find this interesting, vote for us:

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Evan Calabrese, MD PhD

@ecalabr

5 months

Cerebral hyperperfusion syndrome is a rare complication following stenting or endarterectomy of chronic carotid stenosis. Findings are subcortical edema and increased vascularity in the carotid territory. Like PRES, disordered autoregulation is thought to be the cause.

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Evan Calabrese, MD PhD

@ecalabr

3 months

T2F mismatch, when present in grade 4 IDH mutant gliomas, is predictive of low grade molecular features. 🤓

Rajan Jain, MD

@CoolAsANeuroRad

3 months

A very important step forward understanding methylation basis of T2F mismatch sign in IDHmut gliomas, result of almost 6 years of discussions with excellent NYY neuropathology team led by Matija Snuderl. @NeuroOnc @TheASNR @RSNA @NYUImaging @DanOrringerMD

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Evan Calabrese, MD PhD

@ecalabr

4 months

I use this all the time. Can be very useful. Just don’t call it L6 🤢🤮

Dr. Ameya Kawthalkar, MD,DNB,FRCR,EDiR

@ASK_MSK

4 months

How to confirm lumbosacral transition vertebrae on MRI when you don't have cervicodorsal spine screening for vertebral counting? By looking at nerve root morphology anterior to sacral ala. ▶️Sacralization of L5: 3 small nerve roots (L4) ▶️Typical configuration (no lumbarization

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Evan Calabrese, MD PhD

@ecalabr

1 month

@DocNavarrow Ddx meningioma, hemangioblastoma, metastasis, or maybe something weird. Would want to see more imaging before going too deep down the weird diff.

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Evan Calabrese, MD PhD

@ecalabr

9 months

Images show asymmetric left anterior temporal lobe atrophy suggestive of semantic dementia AKA semantic variant primary progressive aphasia.

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Evan Calabrese, MD PhD

@ecalabr

8 months

Findings are asymmetric enlargement/enhancement of the right cavernous sinus and enlarged superior ophthalmic vein. Bone window images show evidence of prior facial fractures. This is a post-traumatic direct carotid-cavernous fistula. Catheter angiography can confirm and treat.

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Evan Calabrese, MD PhD

@ecalabr

4 months

@JavadAzadi @francisdeng No, but I have a couple that slow me down and annoy me…

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Evan Calabrese, MD PhD

@ecalabr

8 months

This was langerhans cell histocytosis. The key here is the age, multiplicity, punched out lytic calvarial lesions, and lack of another primary neoplasm.

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Evan Calabrese, MD PhD

@ecalabr

10 months

This is WNT activated medulloblastoma and has a relatively good prognosis!

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Evan Calabrese, MD PhD

@ecalabr

2 months

I’m impressed! 😧

William R. Blythe, MD

@WilliamRBlythe

2 months

This is a relatively unimpressive CT of orbital extension of the Black Mamba of sinus infections: Invasive Fungal Sinusitis. The ocular symptoms (afferent pupillary defect, light perception only, impaired EOM) were out of proportion to the radiographic findings. #ENTX

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Evan Calabrese, MD PhD

@ecalabr

6 months

If you do any neonatal brain MRI data processing, you may find this new tool useful! AI-based neonatal brain extraction for multi-sequence MRI data. @YiLiMD @DrDreMDPhD

Automated neonatal nnU-Net brain MRI extractor trained on a large multi-institutional dataset

Scientific Reports - Automated neonatal nnU-Net brain MRI extractor trained on a large multi-institutional dataset

www.nature.com

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Evan Calabrese, MD PhD

@ecalabr

9 days

@DocNavarrow Enhancing R middle cranial fossa extra axial mass with internal fat signal. Lipomatous meningioma would be best guess. Ddx teratoma or other brain tumor with fatty metaplasia.

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Evan Calabrese, MD PhD

@ecalabr

5 months

@mperezd90 The correct answer! But we can still try to infer it from the imaging.

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Evan Calabrese, MD PhD

@ecalabr

5 months

The partial T2-FLAIR mismatch sign can be helpful, but is not always present: Ddx includes other diffuse gliomas like diffuse hemispheric glioma, IDH-wildtype glioblastoma, and possibly embryonal tumors (usually younger patients).

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Evan Calabrese, MD PhD

@ecalabr

2 months

We already have a name for ARIA. It’s called brain bleeding and edema.

Alberto J Espay

@AlbertoEspay

2 months

Open letter to my dear Alzheimer's patients. @alzassociation

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Evan Calabrese, MD PhD

@ecalabr

11 months

Companion to my last DWI diagnosis case. History: young adult with type 1 diabetes presenting with coma. #DWIDx

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Evan Calabrese, MD PhD

@ecalabr

11 months

Abnormal DWI signal in the caudate and putamen bilaterally. Additional involvement of the dorsal thalami. Findings are concerning for prion disease, and CJD was the final diagnosis.

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Evan Calabrese, MD PhD

@ecalabr

7 months

Sometimes we need to put it all together. Multi-modal whole neuroaxis imaging workup reveals...

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Evan Calabrese, MD PhD

@ecalabr

5 months

@2thingsteam Important to let radiology know, but it’s not a contraindication. It just creates artifacts on some sequences. If your patient needs the MRI we will still do it!

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Evan Calabrese, MD PhD

@ecalabr

2 months

Right facial paralysis. 🔕🔕 What is your dx?

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Evan Calabrese, MD PhD

@ecalabr

5 months

Prognosis for astrocytoma IDH-muatant WHO grade 4 is much better than for IDH-wildtype glioblastoma. There is also evidence that maximal resection of nonenhancing tumor is beneficial (). See also:

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Evan Calabrese, MD PhD

@ecalabr

12 days

@Brandon_Beaber Good reminder to consult a rad if you are going to include radiology images and don’t know what you are looking at. The lung findings can’t be seen because the CT images are displayed with the wrong window. 🤦‍♂️

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Evan Calabrese, MD PhD

@ecalabr

1 year

Peep that lateral recess

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Evan Calabrese, MD PhD

@ecalabr

12 days

Don’t you dare…

Neuromed

@Neuromed_

13 days

Your diagnosis!!!!

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Evan Calabrese, MD PhD

@ecalabr

3 months

Benign venous enhancement. Few things to notice: 1) This is enhancement, not sclerosis. See MRI and subsequent non-con below. 2) Enhancement is dorsal/surrounding the basivertebral vein. 3) Note pacer and venous collaterals (arrows): low output and central venous stenosis.

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Evan Calabrese, MD PhD

@ecalabr

8 months

They separated out neurorads from “radiology” and found neurorads had higher fulfillment and less burnout. Curious… may require a deeper dive.

Abhimanyu Mahajan

@AMahajanMD

8 months

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Evan Calabrese, MD PhD

@ecalabr

2 months

Utox positive for cocaine. No other findings elsewhere to suggest GPA. Full stroke work up otherwise negative. Diagnosis of exclusion: cocaine vasculopathy with acute and chronic infarcts.

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Evan Calabrese, MD PhD

@ecalabr

11 months

Symmetric signal abnormality in the basal ganglia and patchy but symmetric cortical involvement. This was hypoglycemic encephalopathy following an insulin overdose.

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Evan Calabrese, MD PhD

@ecalabr

1 year

Real and important question: how do you number this L spine?

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Evan Calabrese, MD PhD

@ecalabr

2 months

Findings: Acute infarct left corona radiata. Age advanced white matter disease/chronic infarcts. Mild multifocal luminal irregularity of major intracranial arteries. Perforated nasal septum.

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Evan Calabrese, MD PhD

@ecalabr

7 months

The MRI findings of cervicomedullary edema and enhancement and dilated, tortuous perimedullary veins were caused by a dural arteriovenous fistula with connections from the right vert to the right transverse sinus. Notice early venous sinus filling on this right vert injection.

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Evan Calabrese, MD PhD

@ecalabr

9 months

This is artifact created by retrograde flow in the left jugular vein when laying supine, which can mimic posterior fossa dural AVF. Check out this great article on the subject by @traviscaton

Jugular Venous Reflux Can Mimic Posterior Fossa Dural Arteriovenous Fistulas on MRI-MRA | AJR

Dural arteriovenous fistulas (DAVFs) are high-flow acquired shunts that can carry high risk of intracranial hemorrhage. Because DAVFs can often be managed by endovascular means, early and accurate...

www.ajronline.org

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Evan Calabrese, MD PhD

@ecalabr

8 months

AI-based brain lesion segmentation shows a characteristic increase in enhancement after laser ablation of brain metastases. Can this be the basis for post-ablation progression criteria? Great work by @AdenMendoza_ in collaboration with me and @PeterFecci :

Automated segmentation of ablated lesions using deep convolutional neural networks: A basis for...

AbstractBackground. Laser interstitial thermal therapy (LITT) of intracranial tumors or radiation necrosis enables tissue diagnosis, cytoreduction, and rap

academic.oup.com

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Evan Calabrese, MD PhD

@ecalabr

2 months

@francisdeng @daniel_gewolb My take is: essentially all diffuse gliomas with T2F mismatch will be IDH mutant, but not all IDH mutant diffuse gliomas will have T2F mismatch. In fact, essentially none of IDH mutant oligos will have T2F mismatch. So the claim T2F mismatch is a marker for IDH is misleading.

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Evan Calabrese, MD PhD

@ecalabr

2 months

@nirmalregency A companion. Along with the external auditory canal enhancement, prompted diagnosis of zoster oticus. Easy for us rads to forget to 👀 in the 👂

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Evan Calabrese, MD PhD

@ecalabr

10 months

More SALT🧂(Sarcoid Amyloid Lymphoma Tuberculosis). This one ended up being TB.

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Evan Calabrese, MD PhD

@ecalabr

1 year

Great talk on image synthesis @GregZ_MD ! Thanks for showing some of our work. Looking forward to the really impressive spine STIR synthesis work from your group being presented Tues at AI & imaging methods session. #ASNR23

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