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Radiology 5th year, 1st & 2nd lectures (Dr. Ameer)
 

Radiology 5th year, 1st & 2nd lectures (Dr. Ameer)

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The lecture has been given on Feb. 10th & 17th, 2011 by Dr. Ameer.

The lecture has been given on Feb. 10th & 17th, 2011 by Dr. Ameer.

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    Radiology 5th year, 1st & 2nd lectures (Dr. Ameer) Radiology 5th year, 1st & 2nd lectures (Dr. Ameer) Presentation Transcript

    • Skull & Brain Imaging Techniques Plain……..trauma CT & MRI …standard investig. US Angiography….Limited to stenosis. aneurysm & AVM
    • Imaging Techniques
      • Plain ….
      • Normal….inner & outer tables (compact)
      • Diploic space ( spongy bone )
      • Sutures remain visible even
      • after fusion.
      • Metopic suture. Inconstant
      • vascular impressions
      • arachnoid granulations
      • position of calc. pineal body.
    • Plain film…..cont.
      • Abnormal plain films; look for
      • -intra-cranial calcifications
      • -pit. fossa…..pit. tumors
      • -bones for lytic, sclerotic, #
      • -calcifications & signs of raised ICP are
      • import. signs in the plain films.
    • Intracranial calcifications
      • Most intra-cranial calcif. is normal & of no significance.
      • Normal intra-cranial calcifications:
      • pineal, choroid, interclinoid, petroclinoid, falx, atheromatous calcification in carotid.
      • pathological calcifications:
      • primary tumors, meningioma, glioma, craniopharyngioma, AVM , aneurysm & old abscess.
    • Raised ICP
      • Plain film abnormality in prolonged cases.
      • Sutural diastasis.
      • Destruction of dorsum sellae.
    • Lytic & sclerotic lesions in the skull
      • Lytic lesions
      • Metast. & M.M.
      • Geographic skull in histiocytosis X.
      • Osteoporosis circumscripta …paget’s
      • Sclrotic lesions
      • Hyperostosis frontalis interna….commonest cause
      • Localized sclerosis…St. mixed with lytic in
      • meningioma, metastases, fibrous dysplasia
      • Paget’s ……cotton-wool app. (thickening of calvarum)
    • CT Brain
      • Normal CT
      • Abnormal CT cardinal signs
      • -abnormal tissue density
      • high density…recent hge, calcified and contrast enhancement
      • low density….neoplasm, infarct, oedema (surrounding neoplasm, infarcts, hge, inflammation)
    • Abnormal CT…cont.
      • Mass effect ..compressed or displaced
      • lateral ventricles
      • Midline shift
      • Dilatation of ventricular system
      • Obst. to CSF flow within the system ( non-communicating)
      • Obst. over the surface of brain (communicating)
      • Secondary to brain atrophy
      • -CT with contrast
    • MRI of brain
      • Multiplanar capability….extent of tumor.
      • esp. for post. Fossa & craniovertebral junction.
      • Disadvantage; inability to show calcification and bone details
      • long scan time
      • difficulty in monitoring critical patients
    • MRI Brain
      • Contrast
      • Gadolinium
      • MRA severe stenosis & aneurysm
      • MRV
    • MRI Brain
      • It is more often possible to make a specific diagnosis with MRI than CT.
      • Demyelinating plaques of MS
      • AVM
    • Neurosonography
      • Hydrocephalus
      • Hemorrhage
      • Congenital abnormalities.
    • Brain Tumors
      • Glioma
      • Solitary irregular mass
      • surrounded by edema
      • may compress or displace ventricle.
      • usually hypodense
      • may be hyper or mixed.
      • may calcify
      • most show partial enhancement.
      • may be ring enhancement.
      • Low in T1 , high in T2
      • Metastases
      • may be of high or low density.
      • surrounded by edema
      • typically multiple
      • a solitary metast. could not be diff. from
      • a primary neither by CT nor by MRI
      • Meningioma
      • arise from meninges of the vault, falx & tentorium.
      • commonest sites are parasagittal region over the cerebral convexities & sphenoid ridge.
      • Slightly hyperdense on native CT
      • marked enhancement
      • Sclerosis & thickening of adjacent bone.
      • Acoustic neuroma; in the CPA near IAM.
      • Pit. Tumors:
      • microadenoma < 10mm
      • macroadenoma.> 10mm
      • endocrine active 80%
      • endocrine inactive. 20%
      • Gd is better for demost. microadenomas
      • Cerebral infarction & hemorrhage
      • Clinically similar
      • CT is the initial exam.
      • Hge….high density surrounded by edema.
      • May be SAH or intraventricular.
      • In Infarction ….CT normal initially.
      • MRI diffusion Weighted Images.
      • SAH usually due to rupture aneurysm.
      • CT is the best initial exam.
      • The large aneurysms are seen by CT.
      • MRA can show smaller aneurysms.
      • Arteriography is the best.
      • AVM may present with Hge….CT can show the AVM esp. with contrast.
      • But MRI is better even without contrast.
      • Abscess
      • Low density with ring enhancement
      • Herpes encephalitis
      • enhancing low density areas in the
      • temporal lobes.
      • Head Injury:
      • Fractures
      • # more translucent
      • # may branch abruptly
      • # have straight or jagged edge that fit together. While venous channels have undulating irregular edges which cannot be fitted together.
      • Arterial grooves have parallel sides (more easily confused with #)..but present in known anatomical positions.
      • Suture in known anatomical positions & show regular interdigitations. Widening of a suture has the same significance as a #
      • Depressed #....dense
      • EDH can result from # through MMA groove.
    • CT in head injury
      • CT should be done when there is:
      • -deterioration in the conscious level.
      • -worsening of neurological deficits.
      • Extracerebral lesions
      • -EDH.. biconvex. Associated with #
      • High density for 2Wks.
      • After 3-4Wks…..hypodense
      • Isodense in between.
      • -SDH …….concavoconvex
      • Fractures of the base & vault are easily
      • seen in bone window
      • Intracerbral lesions:
      • -Edema- homogenous low density.
      • -Contusions- patchy low density areas
      • -Intracerebral hematoma
      • Severe head injury can exist with no abnormal CT