NEURORADIOLOGY
NEURORADIOLOGY
Dr. Ramirez
Imaging Examination:
Head:
1. Plain Radiographs
a. PA view
b. Lateral view
c. Towne’s view
d. Caldwell’s view
e. Water’s view
2. Contrast Examination
a. Arteriography
b. Pneumoencephalography- introducing an air
3. Ultrasound – fontanel, suture are fused; absence of window
4. CT Scan
5. MRI
6. Radioisotope studies
PA- frontal bones, frontal and ethmoid sinuses, nasal cavity cavity, superior orbital rims and mandible.
Lateral- frontal bone and paranasal sinuses
Towne’s- occipital bone, mastoid and inner ear region, foramen magnum and zygomatic arches
Submentovertical – basal structure of the skull including the major foramen.
PA View:
• Patient is in normal supine position
• Note outer and inner table (smooth)
• Vertex, temporal and partial area are of thinning density
Densities:
• Black- air (usually dark or loosen)
• White- bones, calcification
• Gray- soft tissue density
Lateral View:
• Ethmoid sinus beneath frontal or greater wing of sphenoid
• Frontal sinus
• Sphenoid sinus- beneath sella
• Maxillary sinus
Lobes (fossa)
Frontal lobe- anterior
Parietal lobe- middle
Cerebrum and pons- posterior
Petrous bone- ridge and anterior margin of posterior fossa
Lesser wing of sphenoid- anterior margin of the anterior fossa
Towne’s View:
• Foramen magnum
• Lambdoid (triangular)
Submentovertical View:
• Foramen magnum- lacerated
• Foramen ovale- round
Caldwells View:
• PA with little angulation
• Margin of orbit
• Temporal bone
AP View:
• Middle cerebral artery
Circle of Willis:
Anteriogram study:
Three phases of arteiography:
1. arterial
2. parenchymal
3. venous
Artery on left side
Anterior cerebral artery- midline; space occupying lesion
Displaced to the right- Focal hydrocephalus
Communicating- no obstruction; increase production of CSF
SKULL ABNORMALITIES:
1. Size
a. small (microcephaly)
• incomplete development
• craniostenosis
• pituitary abnormality
b. large (macrocephaly)
• hydrocephalus
• endocrine disorders (acromegaly)
• congenital or development (osteogenesis imperfecta)
• 2/4 skull- 1/3 face
2. Contour
• Craniostenosis
• Meningoencephalocoele
• Depressed fracture
Osteomas- benign, inc. density of bone
Platysbia- osteogenesis imperfecta
(paget’s disease, Arnold Chiari malformation)
3. Lucencies
• Fracture
• Infection (asteomyelitis)
• Neoplastic
• Metabolic/endocrine (hyperparathyroidism)
Fracture- dense
Margin is stenotic ordenser
4. Opacities or Densities
• Calcification- physiologic
• Congenital/development (osteoporosis, engelan’s dx)
• Teratoma- calcification, fat, air in soft tissue
HYDROCEPHALUS
• Posterior and anterior fontanel
• Wormians- vascular branching
Radiographic evidence of intracranial space occupying lesions:
1. increase convolutional impression
2. separation of sutures (up to about 14 to 15 years)
3. sella turcica changes
4. erosions of the bones of the skull
5. displacement of the physiologically calcified suture
• abnormal vascular grooves
• abnormal calcification within the lesion
Structures that are already calcified:
1. pineal gland- midline
2. choroids plexus- lateral
3. cerebral falx- midline
4. havinular commisure- midline
5. glenoid ligaments- area of sella
1-6 months old
• lukenchalden/lacunar skull
• hydrocephalus
caputsuccedaneum- cross behind suture lines
cephalhematoma- above calvareum; soft tissue
lytic- lucent lesion
blastic- sclerotic lesion
multiple densities:
-infant- osteocytosis
encephalocoele- brain and CSF
meningocoele- only brain parenchyma
havinular calcification- C calcification
pineal gland- round or ovoid calcification
Choroid plexus Calcification- “popcorn-like calcification”
Toxoplasmosis lesion in the parenchyma- parasitic
Frontal View of Sella:
• external auditory canal
• sphenoid
• dorsal sella
• 14 by 17- posterior sphenoid
• 1:17 cm
Radiographic evidence of sellar/ parasellar lesion:
Intrasellar lesion:
• thinning and deepening of sellar fossa
• thinning of backward bending of the dorsum sellae
• destruction of the bony walls of the sella (late stage)
Extracellular Lesion:
• sellar floor is thinned but not depressed
• dorsum sellae thinned out
CT Scan:
Dark: White:
1. fat- dark in CT scan 1. bone
2. fluid 2. calcification
3. air-dark 3. contrast
4.acute bleed
Magnetic Resonance Imaging (MRI)
Hydrogen Ion- align in the magnetic range
Two studies of CT Scan:
T1- on magnet- hydrogen ion synchronized
T2- off the magnet- measure how hydrogen ion is disoriented
Edema- lot of hydrogen ion
Trauma- plain study
Inflammatory- contrast study
TB meningitis- increase creatitine
Trauma patient:
Subdural hemorrhage- less dense than skull but denser than parenchyma
Epidural bleed- bulge toward parenchyma, do not follow the contour of brain
Subdural- follow the contour of the brain
Infarct- involving the basal ganglia
Internal capsule- divides external ganglia from thalamus
Abscess- ring enhancing lesion
Parenchyma and midline- middle blastoma
Spines:
1. AP
2. oblique
3. CT scan
4. MRI
5. arteriogram
6. Isotope studies
Intramedullary- spinal cord involved
Extramedullary and extradural- one side of the spinal cord
Contours:
Kyphosis- thoracic
Lordosis- lumbar
Spondylostasis- anterior displacement
Spondylosis- protruding in laminal parenchyma
Hemivertebra- one bone is undeveloped
Fused vertebra- intervertebral space absent
Scatty dog appearance:
Neck transverse process
Ear is pedicle and facet
Body is post vertebra
Legs inferior articulating artery
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