Applicable Neuroradiology For the Clinical Neurology Clerkship LSU Medical School New Orleans Stephen Deputy, MD Clerkship Director Applicable Neuroradiology Introduction The field of Radiology first developed following the
discovery of X-Rays by Wilhelm Roentgen in 1895. This resulted in widespread clinical use before the damaging effects of ionizing radiation were fully appreciated. Applicable Neuroradiology Plain Films of the Skull were the first application of
radiological techniques to the field of Neurology and became widespread beginning around 1905 Applicable Neuroradiology Plain Films of the Skull Good for detecting Ca++
Good for Skull Fxs Good for Foreign Bodies Quick way to look for pneumatization of cranial sinuses Plain Spine Films Good for vertebral fractures and dislocations Used in evaluation of scoliosis Does NOT image cord however Applicable
Neuroradiology Pneumoencephalogram o Air injected into thecal sac through LP o Reveals the ventricular system o Causes Headaches (pneumocephaly) o First use in 1918 parenchymal Ca++ and hydrocephalous due to congenital Toxoplasmosis
Applicable Neuroradiology Cerebral Angiography First used in 1927 via direct percutaneous internal carotid artery puncture Useful for defining cerebral vasculature
Was used to infer tumors or other mass lesions based on the displacement of vascular structures Applicable Neuroradiology Computed Axial Tomography o First developed in the 60s o Digital geometry is used to create a 3 dimensional image of the internal aspects from a large series
of 2 dimensional X-ray images taken around a single axis of rotation Applicable Neuroradiology o o o o o o
Computed Axial Tomography Has advantages of quick acquisition time Excellent for picking up acute intracranial blood Uses Houndsfield Units to determine the density of structures identified Contrast can be used to better define edema or any process where there is breakdown of the BBB Bolus contrast administration provides vascular anatomy (CT Angiogram) Contrast administration is contraindicated for use with renal insufficiency or prior allergy Applicable
Neuroradiology CT Angiogram showing a Large MCA aneurysm Contrast-enhanced CT showing brain abscess and edema Applicable Neuroradiology o Computed Axial Tomography 5 B things that are bright (hyperdense) on CT
o Blood o Bone (or Ca++) o Brain o Bullet (or foreign body) o Bontrast for Contrast Applicable Neuroradiology
Cranial Ultrasound Cranial U/S developed in the 70s Used in infancy as a non-invasive way to view ventricles and look for intraventricular hemorrhage using the anterior fontanelle as a portal Used in adults for carotid stenosis/dissection or for cerebral vasospasm Applicable Neuroradiology
Neonatal Head U/S with Grade III IVH Carotid Doppler Ultrasound showing ICA stenosis Cranial Doppler with MCA stenosis Applicable Neuroradiology
SPECT Single Photon Emission Computed Tomography Developed in 60s (along with CT) gamma ray-emitting long-acting isotope (Technetium-99m) shows regional CBF Can help localize seizure onset (Ictal-SPECT) Can be superimposed on CT or MRI More available than PET Applicable
Neuroradiology Ictal SPECT superimposed upon brain MRI Applicable Neuroradiology
PET Positron Emission Tomography Developed in the 70s Detects gamma rays released by a radionuclide tracer linked to a marker FDG (Fludeoxyglucose) most commonly used Other markers include specific neurotransmitters or their receptors Requires cyclotron to make short half-life tracers so not as available as PET Applicable Neuroradiology
PET showing loss of regional stores of Dopamine in patients with Parkinsons disease Applicable Neuroradiology Magnetic Resonance Imaging
Developed in the 80s Powerful magnetic fields cause water molecules to align along their dipoles Radiofrequency waves produce an electromagnetic field which transiently knocks the molecules out of alignment When water molecules re-align within the magnetic field they release energy (photons) which are detected by scanners and following a lot of computer mumbo-jumbo an image is produced Applicable
Neuroradiology Magnetic Resonance Imaging T-1 Imaging Water is dark. Fat (Myelin) is bright Gadolinium contrast used to show breakdown of BBB T-2 Imaging Water is bright. Fat is dark. FLAIR (same as T2 except water is blacked out)
Diffusion Imaging Shows restricted Diffusion of water suggesting cell death ADC Mapping takes into account brightness of background T2 signal Applicable Neuroradiology T1 MRI
Axial Plane T1 MRI with Gadolinium showing a brain tumor Applicable Neuroradiology T1 Saggital Plane T1 Coronal Plane Applicable
Neuroradiology T2 and FLAIR of Multiple Sclerosis T2 Axial image Applicable Neuroradiology Diffusion/Perfusion Mismatch L MCA Stroke Applicable Neuroradiology
T.O.F. MR Angiogram of The Cerebral Vessels Gadolinium Contrast Injected MR Angiogram of the Cervical Vessels Applicable Neuroradiology MR Venogram of the Cerebral Sinuses and Draining Veins
Applicable Neuroradiology Neuroanatomy CT Scan Name The Structures Applicable Neuroradiology Applicable Neuroradiology Applicable Neuroradiology Globe Ethm o
id S. C l i v u s Ma Fron
e Air C stoid lls ta l S . Sphe n
oid S . Int A co Mea ustic tus ir Ce A d i
to Mas lls Applicable Neuroradiology Applicable Neuroradiology To ns ils
Medulla Applicable Neuroradiology Applicable Neuroradiology Applicable Neuroradiology B a s i l
a r A r t e r y Temporal Lobe th
4 Cerebellar Hemisphere le ric t n Ve Pons Applicable Neuroradiology
Applicable Neuroradiology Applicable Neuroradiology lL Fronta Ca ud ate
He ad obe Lateral Ventricle Sylvian Fissure 3rd Ventricle Tem p
i M n ai r db Occipit al L obe oral
L obe Applicable Neuroradiology Applicable Neuroradiology Applicable Neuroradiology Falx Cerebri Frontal Lobe
Lateral Ventricle P ar ieta l Occipital Lobe L ob e Applicable Neuroradiology
T1 Saggital MRI Applicable Neuroradiology T1 Saggital MRI Applicable Neuroradiology T1 Saggital MRI
m riu o nt Te Frontal Sinus S phe
dS no i Tongue s inu P i t u i
t a r y Clivus C l be e er
li Applicable Neuroradiology T1 Saggital MRI Applicable Neuroradiology T1 Saggital MRI
Applicable Neuroradiology T1 Saggital MRI Bo d yo fC C Splenium of CC
Genu of CC Tegmentum of Midbrain Tectal Plate of Midbrain 4th Ventricle M ed ul la Pons
Tons ils Applicable Neuroradiology T2 Axial MRI e b o
l G Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology T2 Axial MRI
Temporal Lobe a Medull Cerebellar Hemisphere V e r m i s
Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology oid S Ethm
inus T2 Axial MRI dS enoi h p S Int rtery
A d i t Caro Temporal Lobe ilar A B as rtery
Pons 4 th V entr ical re Ce b r ella
m He h isp ere inus Applicable Neuroradiology
T2 Axial MRI Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology Frontal Sinus Fron
tal L o T2 Axial MRI Inte rn a l Ca be
roti d le entric V l a r e at ip o f L T
l a r o Temp Temporal Lobe M id b Occipital Lobe ra
in Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology T2 Axial MRI al Pe duncl
e Aqueduct of Sylvius Mi ck e Mi y M db ou r ai s e n Cereb r
Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology
n Fro T2 Axial MRI G tal n Fro Head
o f Cau date Anterior ta re y tte a
M hit W l att M e Horn of La
er t Ventric le Putame n s mu a l Tha
r Splenium of CC Applicable Neuroradiology T2 Axial MRI Applicable Neuroradiology T2 Axial
MRI Applicable Neuroradiology An t erio Ext r L im b In ern
tern al C aps ule al C aps u le Caudate Head
en Putam Genu of Inte rnal Capsule Globus Pallidus rio P o st e r Limb
le Capsu l a n r e o f In t Thalam T2 Axial MRI
us Applicable Neuroradiology T2 Cornoal MRI Applicable Neuroradiology T2 Cornoal MRI Applicable Neuroradiology
Superior Saggital Sinus T2 Cornoal MRI Ci ng ula te Gy
ru s Sylvian Fissure Hippocampus Temporal Lobe ry Arte r a
l i Bas Applicable Neuroradiology MR Angiogram of Cerebral Vessels Applicable Neuroradiology MR Angiogram
of Cerebral Vessels Applicable Neuroradiology An t C e r ebral Ar tery MR Angiogram of Cerebral y rter
A l ra Vessels r eb Ce dle Mid Basilar Artery Internal Carotid Artery
A bral e t r Ve rtery Applicable Neuroradiology MR Angiogram of Cerebral Vessels
Applicable Neuroradiology MR Angiogram of Cerebral Vessels Applicable Neuroradiology MR Angiogram of Cerebral Vessels AC A
MCA s A1 ICA PCA l Artery Vertebra nt
me g e A of M1s Su pe
ri o rC ere be lla r CA egm
ent o Ar ter y f MC A Applicable Neuroradiology
MR Venogram of Cerebral Vessels Applicable Neuroradiology MR Venogram of Cerebral Vessels Applicable Neuroradiology MR Venogram of Cerebral Vessels
Su S ital g g a ior S per .
s inu S t gh i a Str Tra ns ver
s eS . Tor cul a Internal Jugular Vein Applicable Neuroradiology
What is the Abnormality? Applicable Neuroradiology Applicable Neuroradiology Large MCA Stroke Applicable Neuroradiology Applicable Neuroradiology on
ersi v n Co agic h r r o Hem Applicable Neuroradiology
Applicable Neuroradiology r eas Dec T1 Axial MRI ed ed Increas signal
al Sign T2 Axial MRI Applicable Neuroradiology Applicable Neuroradiology DWI restriction ADC Map
Old Glio sis Applicable Neuroradiology Applicable Neuroradiology ffe Mass E ct
ral He Sub Du matoma Applicable Neuroradiology Applicable Neuroradiology Mass Effect u Epid
ra ma l he a t om Applicable Neuroradiology Applicable Neuroradiology
Subarachnoid Hemorrhage Applicable Neuroradiology Applicable Neuroradiology Gli om a Edema Applicable Neuroradiology
Applicable Neuroradiology Edema a Gliom Applicable Neuroradiology Applicable Neuroradiology Metastatic Brain Tumors
Applicable Neuroradiology Applicable Neuroradiology Tra Hydrocephalus pe ns e ndy
m d al E em a Applicable Neuroradiology Applicable Neuroradiology
i r a i h C
Syringomyelia Applicable Neuroradiology Bonus Round Applicable Neuroradiology T2 Axial MRI 4 y.o. with Gelastic Seizures
Applicable Neuroradiology T2 Axial MRI Hyp a rtom a am ic H m a la o th
4 y.o. with Gelastic Seizures Applicable Neuroradiology T2 Axial MRI 10 y.o. with Developmental Delay and Epilepsy Applicable Neuroradiology
T2 Axial MRI 10 y.o. with Developmental Delay and Epilepsy Sch iz Pol encep ymi cro haly/ gyr ia
Applicable Neuroradiology The End
