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AwaDRad — Advanced Radiology Solutions and Services

The imaging. The reasoning. The insight.

Cases that sharpen the way we see.

Explore image-led cases, diagnostic reasoning and practical teaching points for radiologists and the wider medical community.

19 cases

MSKCT

L1 Chance fracture following a road traffic collision

A horizontal fracture extending from the posterior elements through both pedicles into the vertebral body should prompt recognition of a Chance-type flexion-distraction injury. Multiplanar CT reformations help define its full osseous extent. Highlight associated kyphotic angulation and report additional transverse process fractures separately. Such injuries may be mechanically unstable; imaging morphology alone does not establish the patient's clinical stability or outcome. Review the remaining thoracoabdominal examination for associated injuries.

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Rectal cancer MRI staging — reading the mesorectal fascia for the CRM
BodyMRI

Rectal cancer MRI staging

In rectal MRI staging the single most surgically relevant measurement is the distance from tumour (or suspicious node) to the mesorectal fascia — the plane of total mesorectal excision. The mesorectal fascia is the anatomical landmark on MRI; the circumferential resection margin is the surgical margin, and the two are not interchangeable. A reported distance contributes to that assessment alongside extramural depth, nodal distribution and EMVI status — it does not by itself decide between upfront surgery and neoadjuvant therapy. High-resolution T2 in the correct oblique plane, not enhancement, defines the relationship.

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Diffuse thigh myositis with a rim-enhancing collection — when STIR and post-contrast rings settle the question
MSKMRI

Diffuse thigh myositis with a rim-enhancing collection

In a painful, swollen limb, STIR maps the extent of myofascial and intramuscular oedema, but it is the post-contrast pattern that discriminates: diffuse heterogeneous enhancement supports myositis, while a rim-enhancing focus with a non-enhancing centre raises an organising abscess. Reporting the discriminating pattern, the exact site and the measured volume gives the clinician what is needed to decide between antibiotics alone and drainage, and a normal femoral marrow reassuringly argues against contiguous osteomyelitis.

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Post-traumatic elbow hemarthrosis — when a lobulated posterior recess mass needs a follow-up plan
MSKMRI

Post-traumatic elbow hemarthrosis

Traumatic haemarthrosis can harbour a lobulated intra-articular mass that mimics — or masks — a true synovial proliferative process. On a non-contrast study, blood products and synovial lesions overlap in signal, so restraint is warranted: favour the benign post-traumatic explanation but recommend interval follow-up (or contrast-enhanced MRI) to ensure resolution and exclude an underlying lesion. Absence of fracture does not equal absence of significant injury — capsular disruption and hemarthrosis point to meaningful trauma.

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Diffuse intrinsic pontine glioma — the non-enhancing expansile pons that encases the basilar artery
NeuroMRI

Diffuse intrinsic pontine glioma

A diffusely expansile, T2-hyperintense, largely non-enhancing pontine mass in a child is the classic imaging phenotype of diffuse midline glioma (DIPG); lack of enhancement does not imply low grade. Look for basilar artery encasement with preserved flow void, effacement of the prepontine cistern, and secondary fourth-ventricular obstruction with transependymal seepage as markers of active hydrocephalus and raised ICP. Definitive classification, including H3 K27 alteration status, requires tissue/molecular characterisation when clinically undertaken.

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Bilateral active sacroiliitis — bone marrow oedema before structural damage
MSKMRI

Bilateral active sacroiliitis

Bone marrow oedema on fluid-sensitive sequences is the hallmark of active sacroiliitis and can precede structural change by years. Documenting active inflammation in the absence of erosions, sclerosis or ankylosis identifies early, potentially treatment-responsive disease and supports a diagnosis of axial spondyloarthritis in the correct clinical setting. Reporting both the active (oedema) and structural (erosion, fat metaplasia, ankylosis) domains gives the referring rheumatologist the fullest picture.

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Partial-thickness ACL tear with tibial traction cysts — the subtle intrasubstance signal that changes management
MSKMRI

Partial-thickness ACL tear with tibial traction cysts

A partial ACL tear can be subtle: preserved continuity with only increased intrasubstance signal and partial fibre disruption. Traction-related cystic change at the tibial insertion is a useful corroborating sign of ligament strain and should prompt careful scrutiny of fibre integrity rather than being dismissed as an incidental ganglion. Distinguishing a partial from a complete tear directly informs conservative versus surgical management.

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Aggressive T10 posterior-element lesion — recognising cord compression as an urgent MRI finding
NeuroMRI

Aggressive T10 posterior-element lesion

An expansile lesion of the posterior elements with costovertebral, rib and paraspinal extension plus an extraosseous soft-tissue mass has an aggressive appearance and should prompt consideration of primary or metastatic osseous neoplasm. The critical, time-sensitive observation is epidural extension with canal stenosis and intramedullary T2 hyperintensity — cord compression with cord signal change is an urgent finding. It mandates contrast-enhanced MRI, CT for osseous characterisation, tissue diagnosis, and immediate neurosurgical/orthopaedic-oncology involvement.

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