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Neuroimaging (LG)
Neuroimaging (LG)
4.1.2
Neuroimaging
Nov. 9, 2015
OUTLINE
A.
B.
C.
B. RADIOLOGIC NEUROANATOMY
Neuroradiologic History
Radiologic Neuroanatomy
Diagnostic Tests
1. Roentogram
2. Cranial Ultrasound
3. Cranial CT
4. Cranial CT Angiography
5. Cranial CT Perfusion
NEUROIMAGING
A. NEURORADIOLOGIC HISTORY
Neuroimaging
o Use of various techniques to directly or indirectly
image the structure or function of the nervous system
o Indications:
It follows patient history and neurologic
examination to investigate a patient who may
have neurologic disorder.
History
o Before the advances in radiology, direct visualization
of intracranial compartment was norm
o Exploratory
burrholes
Indications:
1. Rapidly deteriorating neurologic exam
2. Lack of scanning facilities
3. Inaccesible remote area
4. Patients unfit for transfer
Pag naghahanap at mageextract ng tumor, drill a hole on one
side; pag wala sa isa, sa kabila naman. Pag wala pa
rin,tigil ka na. Hanggang dun lang ang pwede mong gawin
o 1895- German physics professor discovered Xray. He
referred to radiation as X, to indicate it as ann
unknown type of radiation. Xray was noted at that
time to pass through human tissue but it could not
pass thrugh bone or metal
o 1927- Portugese physician Egas Moniz provided
contrasted xray cerebral angiography in order to
diagnose several kinds of nervous diease such as
tumors, artery disease and AVM.
o 1950s- Ultrasound gained in popularity
o 1970s- Development of CT Scan
o Eary 1980s- Development of MRI
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C. DIAGNOSTIC TESTS
Neuroimaging
Indications:
o Rule out structural disorder
o Recurring progressive headaches
o Focal slowing on EEG
o Comorbid seizures
o Persistent unilateral headaches
o Assure anxious patient or his relatives
1.
Roentogram
SKULL X-RAY
CERVICAL X-RAY
Depressed fracture
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i. Prematurity
ii. Persistent large fontanel
iii. Synostosis ***
iv. Infection
v. Trauma
Limitations
i. Operator dependent-Di mo alam
view ng operator, mahirap i-orient
ang sarili
ii. Small acoustic window
iii. Cannot assess myelination
iv. Cerebellar lesions, infarcts
v. Small hemorrhages could be missed
vi. Deeper: blurred
ACOUSTIC WINDOWS
THORACIC X-RAY
2.
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Cranial Ultrasound
o Uses reflected sound waves to produce pictures
of the brain and the inner fluid chambers
(ventricles) through which the CSF flows.
o Indications
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Cheaper than MRI
Faster testing time
Angiography: Vascular anomaly or
aneurysm detection (To check for
Intracranial Pressure)
Disadvantages
Radiation exposure
Pregnancy
is
a
contraindication
(contraindicated because of radiation effect,
they could place a radiation shield but as
much as possible they do reduce the
radiation exposure of the patient).
Hemorrhage
Ischemia
Fractures
Calcifications
b. CONTRAST
o Iodinated contrast is injected to enhance imaging
o Indications
Neoplasms(TUMOR)
Vascular malformations(VASCULAR
ANOMALIES)
Meningitis(INFECTION)
**So you would see (the aforementioned) that would light up in
the scan.
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Cranial CT
a. PLAIN
o Advantages
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Sylvian fissure?
Temporal horn of lateral ventricle?
Normally you don't get to see your temporal horn of
lateral ventricle but once you see it, may hydrocephalus
ka na.
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HYPODENSE LESION?
The hypodense contains fluid so that's our 4th ventricle.
(doc also pointed out the 4th ventricle, cerebellum and
brainstem).
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Cranial CT Angiography
Blue is Bad
T1: Fluid (CSF) is black
T2: Fluid (CSF is white
Better images in swelling
In MRI:
Hypointense dark area
Hyperintense light area
REFERENCES
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Cranial CT Perfusion
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