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
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Applicable Neuroradiology Applicable Neuroradiology lL Fronta Ca ud ate
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Lateral Ventricle P ar ieta l Occipital Lobe L ob e Applicable Neuroradiology
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