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Neuroscience - 4.1.1 - Neuroimaging (LG)
Neuroscience - 4.1.1 - Neuroimaging (LG)
4.1.1
Neuroimaging
Nov. 9, 2015
OUTLINE
A.
B.
C.
D.
E.
F.
G.
H.
Radiologic Techniques
Plain Radiographs
CT Scan
Magnetic Resonance Imaging
Cerebral Arteriography
Ultrasonography
Technique Selection
Venous System
NEUROIMAGING
A. RADIOLOGIC TECHNIQUES
Two major Radiologic modalities in brain (and
meninges/coverings) evaluation:
o Anatomic Modalities- provide information
mostly of structural nature
Include plain films of the skull, computed tomography
(CT), magnetic resonance imaging (MRI), cerebral
arteriography, ultrasonography
o Functional Modalities- Single photon emission
computed tomography (SPECT), PCT imaging,
Perfusion Weighted
MRI, Diffusion weighted MRI imaging, functional MRI
(fMRI), MRS
o Gives info about brain perfusion or metabolism
Some techniques provide both anatomic and functional
info such as:
o Cerebral arteriography- depicts blood vessels
supplying the brain but also allows us to estimate
brain circulation time.
Ultrasonography of the carotid bifurcation- routine
sonogram of the carotid bifurcation gives anatomic data
when combined with Doppler data, readily provides info
about blood flow.
B. PLAIN RADIOGRAPHS
Bones of skull can block a large number of x-rays thereby
casting a white "shadow" on the x-ray film
Soft tissues such as scalp or brain cast little, if any
shadow on the film
Info about bones of the skull, no direct info about
intracranial contents
Indirect info about intracranial abnormalities can
sometimes be obtained from the skull plain radiograph
Largely replaced by CT/MRI
C. CT SCAN
Show fracture, intracranial abnormality that might require
treatment, computer generated cross sectional images
obtained from a rotating x-ray beam and detector system
Depict and differentiate between soft tissues, thus allowing
direct visualization of intracranial contents and
abnormalities associated with neurologic disease.
Consist of images adjusted to emphasize soft tissue detail
as well as images adjusted to visualize bony detail.
Cortical bone = white (High attenuation value or
Hounsfield unit)
Air within paranasal sinuses appears black (low
attenuation value)
Cerebral white matter has a slightly lower Hounsfield
number than does cerebral gray matter and consequently
appears slightly darker than gray matter in a head CT
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scan.
Intracranial pathologic condition can be either dark (low
attenuation) or bright (high attenuation) depending on
abnormality
Acute intracranial hemorrhage typically very bright
Acute cerebral infarction - low attenuation (black)
compared to normal brain because of edema
"light up" normal blood vessels, dural sinus as well as
pituitary gland, choroid plexus, or pineal gland.
Pathologic conditions that interrupt BBB also demonstrate
enhancement after contrast material administration.
CT Angiography (CTA) implemented into developed
stroke protocol exam.; Identifies location and extent of
large vessel occlusions, predict response to reperfusion
therapies ; recent application in screening evaluation of
blunt cerebrovascular injury including head injuries, basilar
skull fracture and cervical vertebral fracture ; accurate for
ICA dissections a d assessing stenoses (difficult
evaluation due to surrounding dense bone).
CT venography - for dural sinuses and veins, evaluate
dural venous sinus thrombosis, distinguish partial sinus
destruction from venous occlusion
D. MAGNETIC RESONANCE IMAGING
Visual display of nuclear magnetic resonance
Data collected principally from nuclei within body tissues
esp. within fat and water molecules
Useful in demonstrating shear lesions within brain,
assessing brain in remote head trauma.
Intrinsic tissue relaxation occurs by two major pathway
Longitudinal / T1 - fluid very dark, fat is bright ;
Transverse / T2 - fluid is very bright, fat dark
BOTH cortical bone and air are very dark on all imaging
sequence; Brain tissue intermediate intensity
MR Angiogram - first line studies for evaluating arterial
occlusion and screening of intracranial aneurysms.
Perfusion MR imaging - measure CBF at capillary level of
organ or tissue region; measures brain function.
Perfusion Weighted MRI - applications in evaluation if
diseases such as cerebral ischemia, reperfusion, brain
tumor, epilepsy, blood flow deficits in Alzheimers.
Functional MRI - brain mapping techniques, uses fast
imaging to depict regional cortical blood flow changes in
space or time; based on CBF and neuronal activity; used
presurgically and for provision of spatial resolution.
MRI spectroscopy - qualitative and quantitative info
about
brain metabolism and tissue composition
E. CEREBRAL ARTERIOGRAPHY
Water soluble contrast injected in femoral or brachial artery
(carotid or vertebral artery)
Gold standard for assessing vascular stenosis,
atherosclerosis, vasculitis, cerebral aneurysms.
Used in gray scale imaging and Doppler Effect evaluation of
carotid artery in atherosclerosis, vasospasm in
subarachnoid hemorrhage
Used intraoperatively to demonstrate spinal cord and
surrounding structures.
F. ULTRASONOGRAPHY
Diagnostic application of UTZ in the human body
Intracranial abnormalities in newborn and young infants
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UTZ
Cerebral
Arteriography
PET Scan
X
X
X
Complex partial
seizure
Congenital
anomaly
Craniocerebral
trauma, with skull
fracture &
intracranial
hemorrhage
Intracranial
hemorrhage
CAROTIDS
RIGHT
o Aorta Right Innominate (Brachiocephalic) artery Right
common carotid artery right external and internal carotid
arteries
LEFT
o Aortic arch Left common carotid left external and
internal carotid arteries
Note: Left Carotid directly from aortic arch, Right Carotid
from brachiocephalic/innominate.
Neurologic deficits
unexplained by CT
X
X
Infarct , Acute
Vascular Stenosis
Tumor
Skull fracture
Aneurysms
Vascular
malformations
Infection
Cerebral
Angiogram
Intracranial
abnormality
Subarachnoid
headache
DW MRI
Nonfocal headache
CT
MRI
G. TECHNIQUE SELECTION
X
X
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H. VENOUS SYSTEM
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internal cerebral vein (drains blood from the diencephalon)
posteriorly as the great cerebral vein of Galen forms the
straight sinus Torcula herophili (confluence of sinuses)
transverse sinus sigmoid sinus jugular vein
MR VENOGRAM - AP AND LATERAL VIEW
MR
Venogram,
AP view
Cerebral
Veins Superior
Sagittal Sinus
confluence of
sinuses
transverse sinus
sigmoid
sinus jugular
vein
MR
Venogram
, Lateral
view
Sagittal
sinus
inferior cerebral
sinus
great
cerebral
vein of
Galen
straight
sinus
confluence
of
sinuses
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