Review of CT and MRI of Brain :

STROKE AND ANEURYSM

Pepi Budianto, dr., Sp.S(K), FINR
 ROLE OF CT AND MR IN PATIENTS WITH STROKE

The goal of imaging in a patient with acute stroke is :

• Exclude hemorrhage
• Differentiate between irreversible affected brain tissue and reversible
impaired tissue (dead tissue versus tissue at risk)
• Identify stenosis or occlusion of major extra- and intracranial arteries
 VASCULAR TERRITORIES
• CEREBRAL ARTERIAL TERRITORY:
• PICA
• SCA
• ACA
• Anterior choroidal artery
• Middle cerebral artery
• Lenticulostriate arteries
• PCA
• CEREBRAL VENOUS TERRITORY
CEREBRAL ARTERIAL TERRITORY (1)
CEREBRAL ARTERIAL TERRITORY (2)
CEREBRAL ARTERIAL TERRITORY (3)
CEREBRAL ARTERIAL TERRITORY (4)
CEREBRAL VENOUS TERRITORY
 CT EARLY SIGNS OF ISCHEMIA (1)

• Hypo attenuating brain tissue

• Obscuration of lentiform nucleus
• Dense MCA sign
• Insular ribbon sign
• Loss of sulcal effacement
 CT EARLY SIGNS OF ISCHEMIA (2)

Hypo attenuating brain tissue

 CT EARLY SIGNS OF ISCHEMIA (3)

Obscuration of lentiform nucleus

CT EARLY SIGNS OF ISCHEMIA (4)

Insular ribbon sign

 CT EARLY SIGNS OF ISCHEMIA (5)

Dense MCA sign

MRI : T2WI & FLAIR
MRI : DWI
DWI : MOST SENSITIVE SEQUENCE FOR STROKE
T2WI VS DWI VS ADC
PSEUDO-NORMAL DWI
PICA INFARCTION (CT)
PICA INFARCTION (MR)
SCA INFARCTION (MR)
ACA INFARCTION
ANT. CHOR. A INFARCTION
MCA INFARCTION
WHAT IS PENUMBRA ?
PENUMBRA : DIFFUSION – PERFUSION -MISMATCH
HEMORRHAGIC INFARCTION
LUXURY PERFUSION
PCA INFARCTION
PCA INFARCTION
WATERSHED AREA
DEEP WATERSHED INFARCTION
CORTICAL WATERSHED INFARCTION (1)
CORTICAL WATERSHED INFARCTION (2)
LACUNAR INFARCTION (1)
LACUNAR INFARCTION (2)
LACUNAR INFARCTION (3)
CEREBRAL VENOUS THROMBOSIS (1)
CEREBRAL VENOUS THROMBOSIS (2)
LOCALIZATION OF HEMORRHAGE
LOBAR HEMORRHAGE
BASAL GANGLIA HEMORRHAGE
THALAMUS HEMORRHAGE
CEREBELLAR HEMORRHAGE
S A H, ANEURYSM
ANEURYSM
S A H , ANEURYSM
S A H, ANEURYSM
S A H, ANEURYSM
S A H, ANEURYSM
S A H, ANEURYSM
THANK YOU