CT&MRI of Central nervous system Dept. Radiology, the 2nd affiliated hospital, Sun Yat-Sen University Huang Sui Qiao
CT Scanning <ul><li>Plain CT </li></ul><ul><li>Contrast CT </li></ul>
CT scanner
CT characteristics    of pictures <ul><li>CT value : depending on different organ and tissues to X ray. </li></ul><ul><li>...
Magnetic Resonance Imaging
MRI----conventional sequences <ul><li>SE sequence ( spin echo ) </li></ul><ul><ul><li>T1-weighted,T1-WI </li></ul></ul><ul...
MR signal characteristics <ul><li>SE sequences : </li></ul><ul><ul><li>T1-WI: highist signal on fat tissue ,better for sho...
MR signal charateristics T2WI T1WI
MR signal charateristics Fat supression Liquid supression
Normal anatomical structure of  head on CT Brain stem; cerebellum;suprasellar cistern; lateral sulcus; quadrigeminal ciste...
Normal anatomical structure of  head on CT Gray matter; white matter; cortex; frontal lobe; occipital lobe; parietal lobe;...
Normal anatomical structure of  head on MRI
T2WI
T1WI
Flair sequence
T2WI(coronal section )
T1WI ( sagittal section ) Corpus callosum; optic chiasm; pituitary gland; medulla oblongata
Intracranial tumors <ul><li>٭   primary  (80%)   : originating  from cranial  bone,  </li></ul><ul><li>cranial meninges, b...
The types of intracranial tumors <ul><li>Intraaxial brain tumors : </li></ul><ul><li>1.glioma(astrocytoma and oligodendrog...
The types of intracranial tumors <ul><li>Extraaxial brain tumors </li></ul><ul><li>1.meningioma </li></ul><ul><li>2.cranio...
The rule for diagnosis of intracranial tumors <ul><li>There are or not a tumor </li></ul><ul><li>The position of a tumor :...
一、  Direct signs   1. tumor or occupying lesion.   2. abnormal density or signal.   3. enhancement in different    degree ...
二、 indirect signs     1. shift of near structures   2. edema in brain tissue near tumor   3. intratumoral bleed   4. intra...
astrocytoma lower grading of astrocytoma , grading I or II . <ul><li>Often in adult  (20~40 years ) -- more occult in cere...
astrocytoma <ul><li>CT : low or slightly low density  lesion , no or </li></ul><ul><li>slight occupying effect , no or sli...
Grading  I  astrocytoma   Plain CT
Grading  I  astrocytoma T 1 WI T 2 WI
Grading  I  astrocytoma T2W  Gd+  Gd+ MR:39547
  astrocytoma high grading ( grading III or IV) <ul><li>Fast growing  </li></ul><ul><li>Occur in any age </li></ul>
Imaging appearances of  high grading  astrocytoma <ul><li>Obvious occupying effects ,infiltrating growing with unclear mar...
Grading IV  astrocytoma MR:39985 T2W  T1W  Gd+
Grading IV  astrocytoma MR:39985 T2W  Gd+ T2W  Gd+
MR : 53847 Grading IV astrocytoma
Brain metastasis <ul><li>Old age </li></ul><ul><li>Single or multiple  </li></ul><ul><li>Multiple appearances on CT or MR,...
Multiple metastases
Metastasis from lung cancer uncontrast contrast
Metastasis from lung cancer uncontrast contrast
Lung cancer and brain metastases MR:39491
The types of intracranial tumors <ul><li>Extraaxial brain tumors </li></ul><ul><li>1.meningioma </li></ul><ul><li>2.cranio...
meningioma <ul><li>Most common nanglial intracranial tumor. </li></ul><ul><li>Mostly affect 40-70 adults. </li></ul><ul><l...
Imaging of meningioma <ul><li>Round or hemishere mass occur mostly in convexity of brain , especially sagittal sinus. </li...
Left parietal meningioma  Plain CT Contrast CT Round high density mass Obviously and evenly enhanced
Right parietal meningioma Plain T1WI Contrast T1WI
T2WI AND contrast T1WI
meningioma T2WI T1WI Gd-T1W
Acoustic schwannoma <ul><li>Benign tumor, occur mostly at middle age people, approximately 7﹪~8﹪ of all primary intracrani...
Left acoustic schwannoma
Left acoustic schwannoma T2WI T1WI Contrast T1WI
Left acoustic schwannoma
Right acoustic schwannoma T1WI Contrast T1WI
Right acoustic schwannoma Contrast T1WI
CT and MRI diagnosis of brain vascular diseases <ul><li>Bleed in high pressure patients </li></ul><ul><li>Intracranial ane...
Brain bleed (hemorrhage) <ul><li>Causes : high blood pressure, vascular malformation and tumor </li></ul><ul><li>Stage : a...
CT&MRI appearances of hemorrhage at different stage <ul><li>CT was more sensitive for acute hemorrhage </li></ul><ul><li>C...
Acute hemorrhage ( high density on CT )
Acute hemorrhage ( high density on CT )
Subacute hemorrhage Density lower than acute  stage with unclear margin
acute/subacute hemorrhage acute subacute T2WI T1WI
Change from acute to subacute stage   ( CT  low density hemorrhage ) CT  after bleed  CT 2W latter  MRI  2W latter
Chronic intracranial hemorrhage
Intracranial aneurysm <ul><li>causes : congenital ; acquired (often high blood pressure )  </li></ul><ul><li>type : accord...
Aneurysm <ul><li>● Incidence : 0.2~1%. </li></ul><ul><li>●   Distribution of age: mid-old age(30~60years),seldon in youth....
CT appearances <ul><li>Showing aneurysm directly, filing defect in large one ( thrombus ) </li></ul><ul><li>Subarachnoid h...
MR appearance <ul><li>1. aneurysm without thrombus: round or oval homogeneous  </li></ul><ul><li>very low signal lesion bo...
 
Aneurysm at left internal carotid A
Aneurysm at left internal carotid A
T1WI-contrast T1WI-contrast
Aneurysm at left internal carotid A
Aneurysm at left middle cerebral A
CT&MRI diagnosis of cerebral infarction
CT appearances of  cerebral infarction <ul><li>Acute stage - onset within 4 - 6h. </li></ul><ul><li>normal/slightly low de...
MR appearances of  cerebral infarction <ul><li>High signal intensity at Acute , subacute  and chronic stage on T2WI becaus...
MR:44396 Within 24h After 3 days After 2 weeks Acute cerebral  infarction
MR:44396 MR&CT appearances of acute cerebral infarction Within 24h  after 3 days  after 2 weeks
MR:44396 MR&CT appearances of acute cerebral infarction T2WI T1WI Flair
MR:44396 MR&CT appearances of acute cerebral infarction Flair   T1WI T2WI
Acute infarction MR : 66335  CT : 122740  M 39 , CT (-)
Acute infarction MR : 66335  CT : 122740 M 39 , CT (-)
Acute  infarction MR : 66335  CT : 122740
Acute infarction  DWI MR : 66335  CT : 122740
Subacute/chronic infarction—T2WI
T2WI--Cor
Chronic infarction at brain stem and cerebellum—T2WI
Chronic infarction at brain stem and cerebellum—T1WI
CT&MRI diagnosis of head trauma
The types of head trauma <ul><li>一、 Skull fracture </li></ul><ul><li>二、 traumatic cerebral swelling </li></ul><ul><li>三、 b...
CT&MR diagnosis of cranial trauma <ul><li>Epidural hematoma : </li></ul><ul><li>٭   direct   violence on skull </li></ul><...
CT appearances <ul><li>٭   local  duple convex mirror with high density, CT value at 40~100Hu. </li></ul><ul><li>٭   there...
acute epidural hematoma at left frontal lobe
acute epidural hematoma at right frontal lobe
Acute epidural hematoma at  temporal-parietal  lobe
MR appearances   <ul><li>٭   shape of hematoma is seen like CT </li></ul><ul><li>٭   signal intensity of hematoma varies g...
Subacute hematoma at  left frontal lobe
Subacute hematoma at  left frontal lobe
Subacute hematoma at  left frontal lobe
Subdural hematoma <ul><li>٭ location: supratentorial convexity. </li></ul><ul><li>٭   caused by stretching and tearing of ...
Acute subdural hematoma at right frontal-temporal area
Subacute subdural hematoma at left frontal-temporal area
Subacute subdural hematoma at left frontal-temporal area
Subacute subdural hematoma at left frontal-temporal area
Subacute subdural hematoma at left frontal-temporal area
Chronic subdural hematoma at left frontal lobe
CT&MR diagnosis of brain contusion <ul><li>٭   Often   involve the temporal and frontal lobe. Temporal lobe lesions tend t...
Contusion  at frontal lobe
Contusion at both sides of frontal base
Contusion at temporal lobe
MR appearances <ul><li>٭   MR is more sensitive than CT to find small contusion because of easy to find edema caused by co...
Contusion and epidural hemorrhage at both temporal lobe and frontal lobe
Contusion and epidural hemorrhage at both temporal lobe and frontal lobe
Multiple contusions at both sides of frontal and temporal lobes
Multiple contusions at both sides of frontal and temporal lobes
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Ct & mri of central nervous system

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Ct & mri of central nervous system

  1. 1. CT&MRI of Central nervous system Dept. Radiology, the 2nd affiliated hospital, Sun Yat-Sen University Huang Sui Qiao
  2. 2. CT Scanning <ul><li>Plain CT </li></ul><ul><li>Contrast CT </li></ul>
  3. 3. CT scanner
  4. 4. CT characteristics of pictures <ul><li>CT value : depending on different organ and tissues to X ray. </li></ul><ul><li>call HU ( Hounsfield Unit ) . </li></ul>Bone Soft tissue Water Fat Air
  5. 5. Magnetic Resonance Imaging
  6. 6. MRI----conventional sequences <ul><li>SE sequence ( spin echo ) </li></ul><ul><ul><li>T1-weighted,T1-WI </li></ul></ul><ul><ul><li>TR: 200-800ms TE:15-30ms </li></ul></ul><ul><ul><li>T2-weighted,T2-WI </li></ul></ul><ul><ul><li>TR:1500-2000ms TE:60-150ms </li></ul></ul><ul><ul><li>Proton Density,N(H) ) </li></ul></ul><ul><ul><li>TR:1500-2500ms TE:15-30ms </li></ul></ul><ul><li>IR sequence ( inversion recovery sequence ) </li></ul><ul><ul><li>TR ( short ) TE ( short ) TI ( short ) </li></ul></ul>
  7. 7. MR signal characteristics <ul><li>SE sequences : </li></ul><ul><ul><li>T1-WI: highist signal on fat tissue ,better for showing anatomical structures </li></ul></ul><ul><ul><li>T2-WI: highist signal in liquid, better for detecting lesions </li></ul></ul><ul><ul><li>N ( H ) Density,N(H): for characteristics of lesions </li></ul></ul><ul><li>GRE sequence : flip angle , fast scan </li></ul><ul><li>IR sequence : separation between of fat and liquid </li></ul>
  8. 8. MR signal charateristics T2WI T1WI
  9. 9. MR signal charateristics Fat supression Liquid supression
  10. 10. Normal anatomical structure of head on CT Brain stem; cerebellum;suprasellar cistern; lateral sulcus; quadrigeminal cistern; lateral ventricle; basilar ganglion
  11. 11. Normal anatomical structure of head on CT Gray matter; white matter; cortex; frontal lobe; occipital lobe; parietal lobe; temporal lobe; internal capsule ; thalamus; falx
  12. 12. Normal anatomical structure of head on MRI
  13. 13. T2WI
  14. 14. T1WI
  15. 15. Flair sequence
  16. 16. T2WI(coronal section )
  17. 17. T1WI ( sagittal section ) Corpus callosum; optic chiasm; pituitary gland; medulla oblongata
  18. 18. Intracranial tumors <ul><li>٭ primary (80%) : originating from cranial bone, </li></ul><ul><li>cranial meninges, brain tissues, </li></ul><ul><li>vessels, cranial nerves, pituitary </li></ul><ul><li>gland, etc. </li></ul><ul><li>glioma (50%) , mingioma(14%) , pituitary </li></ul><ul><li>tumor (11%) , acoustic neuroma(7%) </li></ul><ul><li>٭ secondary (20%) : metastasis , involved by tumor </li></ul><ul><li>from near structures. </li></ul>
  19. 19. The types of intracranial tumors <ul><li>Intraaxial brain tumors : </li></ul><ul><li>1.glioma(astrocytoma and oligodendroglioma) </li></ul><ul><li>2.ependymoma </li></ul><ul><li>3.medulloblastoma </li></ul><ul><li>4.hemangioblastoma </li></ul><ul><li>5.papilloma choroideum </li></ul><ul><li>6.metastases </li></ul>
  20. 20. The types of intracranial tumors <ul><li>Extraaxial brain tumors </li></ul><ul><li>1.meningioma </li></ul><ul><li>2.craniopharyngioma </li></ul><ul><li>3.pituitary tumor </li></ul><ul><li>4.nerve sheath tumors-acoustic </li></ul><ul><li>schwannoma </li></ul><ul><li>5.epidermorid cyst, dermoid cyst and </li></ul><ul><li>hamartomas </li></ul>
  21. 21. The rule for diagnosis of intracranial tumors <ul><li>There are or not a tumor </li></ul><ul><li>The position of a tumor : intraaxial or </li></ul><ul><li>extraaxial </li></ul><ul><li>The type of a tumor </li></ul>
  22. 22. 一、 Direct signs 1. tumor or occupying lesion. 2. abnormal density or signal. 3. enhancement in different degree on enhanced scan. CT and MRI Signs for diagnosis of intracranial tumors 、
  23. 23. 二、 indirect signs 1. shift of near structures 2. edema in brain tissue near tumor 3. intratumoral bleed 4. intratumoral calcification 5. bone changes
  24. 24. astrocytoma lower grading of astrocytoma , grading I or II . <ul><li>Often in adult (20~40 years ) -- more occult in cerebral hemisphere , grading II , solid </li></ul><ul><li>child– less see , more in cerebellum , grading I, cyst </li></ul>
  25. 25. astrocytoma <ul><li>CT : low or slightly low density lesion , no or </li></ul><ul><li>slight occupying effect , no or slight </li></ul><ul><li>enhancement. </li></ul><ul><li>MR : Isointensity on T1WI , unclear border , </li></ul><ul><li>high or slightly high signal intensity on T2WI </li></ul><ul><li>no or slight occupying effect , no or slight </li></ul><ul><li>enhancement. </li></ul>
  26. 26. Grading I astrocytoma Plain CT
  27. 27. Grading I astrocytoma T 1 WI T 2 WI
  28. 28. Grading I astrocytoma T2W Gd+ Gd+ MR:39547
  29. 29. astrocytoma high grading ( grading III or IV) <ul><li>Fast growing </li></ul><ul><li>Occur in any age </li></ul>
  30. 30. Imaging appearances of high grading astrocytoma <ul><li>Obvious occupying effects ,infiltrating growing with unclear margin , growing across lobe and hemisphere. </li></ul><ul><li>Necrosis, cyst , bleed. </li></ul><ul><li>Obvious brain edema around tumor. </li></ul><ul><li>Obvious uneven or ring-like enhancement. </li></ul>
  31. 31. Grading IV astrocytoma MR:39985 T2W T1W Gd+
  32. 32. Grading IV astrocytoma MR:39985 T2W Gd+ T2W Gd+
  33. 33. MR : 53847 Grading IV astrocytoma
  34. 34. Brain metastasis <ul><li>Old age </li></ul><ul><li>Single or multiple </li></ul><ul><li>Multiple appearances on CT or MR, but often shown in nodule </li></ul><ul><li>Heterogeneous density or signal, central necrosis with lower density or signal on T1WI. </li></ul><ul><li>Ring-like or even enhancement </li></ul><ul><li>Obviously finger-like peritumoral edema </li></ul>
  35. 35. Multiple metastases
  36. 36. Metastasis from lung cancer uncontrast contrast
  37. 37. Metastasis from lung cancer uncontrast contrast
  38. 38. Lung cancer and brain metastases MR:39491
  39. 39. The types of intracranial tumors <ul><li>Extraaxial brain tumors </li></ul><ul><li>1.meningioma </li></ul><ul><li>2.craniopharyngioma </li></ul><ul><li>3.pituitary tumor </li></ul><ul><li>4.nerve sheath tumors-acoustic </li></ul><ul><li>schwannoma </li></ul><ul><li>5.epidermorid cyst, dermoid cyst and </li></ul><ul><li>hamartomas </li></ul>
  40. 40. meningioma <ul><li>Most common nanglial intracranial tumor. </li></ul><ul><li>Mostly affect 40-70 adults. </li></ul><ul><li>Extraaxial mass attaching dura matter,about 90% occult on suppratentorium of cerebellum, few of them can occult in ventricles </li></ul>
  41. 41. Imaging of meningioma <ul><li>Round or hemishere mass occur mostly in convexity of brain , especially sagittal sinus. </li></ul><ul><li>Mass with clear margin which was encysted with cerebral spinal fluid and/or vessels. </li></ul><ul><li>Iso- or slightly high density on plain CT and low signal on T1WI, iso- or slightly high signal on T2WI, which was enhanced obviously and evenly. </li></ul><ul><li>A broad thickened dural-based margin which was called “tail sign” . </li></ul><ul><li>Edema may be not or obvious. </li></ul><ul><li>Local bone changes including destruction, thin or thickness. </li></ul>
  42. 42. Left parietal meningioma Plain CT Contrast CT Round high density mass Obviously and evenly enhanced
  43. 43. Right parietal meningioma Plain T1WI Contrast T1WI
  44. 44. T2WI AND contrast T1WI
  45. 45. meningioma T2WI T1WI Gd-T1W
  46. 46. Acoustic schwannoma <ul><li>Benign tumor, occur mostly at middle age people, approximately 7﹪~8﹪ of all primary intracranial neoplasms. </li></ul><ul><li>Ovoid or tubular tumors may occur in the internal auditory canal and cerebellopontine angle cistern . </li></ul><ul><li>Tumor may be part of solid and cystic . </li></ul><ul><li>On Plain CT, solid part of tumor was iso-density ,and cystic part was low density. </li></ul><ul><li>Iso-intensity or low signal intensity were seen in solid or cystic part of tumor on T1WI, but high or very high signal intensity on T2WI,. </li></ul><ul><li>Obvious enhancement was seen on solid tumor. </li></ul><ul><li>Enlargement of internal auditory canal. </li></ul>
  47. 47. Left acoustic schwannoma
  48. 48. Left acoustic schwannoma T2WI T1WI Contrast T1WI
  49. 49. Left acoustic schwannoma
  50. 50. Right acoustic schwannoma T1WI Contrast T1WI
  51. 51. Right acoustic schwannoma Contrast T1WI
  52. 52. CT and MRI diagnosis of brain vascular diseases <ul><li>Bleed in high pressure patients </li></ul><ul><li>Intracranial aneurysm </li></ul><ul><li>Cerebral infarction </li></ul>
  53. 53. Brain bleed (hemorrhage) <ul><li>Causes : high blood pressure, vascular malformation and tumor </li></ul><ul><li>Stage : acute, subacute, chronic </li></ul>
  54. 54. CT&MRI appearances of hemorrhage at different stage <ul><li>CT was more sensitive for acute hemorrhage </li></ul><ul><li>CT - high density, CT value about 60 - 80Hu </li></ul><ul><li>MRI - iso-intensity on T1WI, slightly low or low </li></ul><ul><li>intensity on T2WI. </li></ul><ul><li>Subacute hemorrhage </li></ul><ul><li>CT - iso- or slightly high density. </li></ul><ul><li>MRI - iso- or high signal intensity on T1WI, iso- or </li></ul><ul><li>slightly high signal intensity on T2WI. </li></ul><ul><li>chronic hemorrhage </li></ul><ul><li>CT - iso- or low density </li></ul><ul><li>MRI - high signal intensity both on T1WI/T2WI. </li></ul>
  55. 55. Acute hemorrhage ( high density on CT )
  56. 56. Acute hemorrhage ( high density on CT )
  57. 57. Subacute hemorrhage Density lower than acute stage with unclear margin
  58. 58. acute/subacute hemorrhage acute subacute T2WI T1WI
  59. 59. Change from acute to subacute stage ( CT low density hemorrhage ) CT after bleed CT 2W latter MRI 2W latter
  60. 60. Chronic intracranial hemorrhage
  61. 61. Intracranial aneurysm <ul><li>causes : congenital ; acquired (often high blood pressure ) </li></ul><ul><li>type : according to morphology (saccular ,fusiform), size and location etc . </li></ul>
  62. 62. Aneurysm <ul><li>● Incidence : 0.2~1%. </li></ul><ul><li>● Distribution of age: mid-old age(30~60years),seldon in youth. </li></ul><ul><li>● morphology : saccular ( 95% ) ,fusiform . </li></ul><ul><li>● size : <0.5cm small; 0.5~1.5cm middle;1.5~2.5 large </li></ul><ul><li>; >2.5 huge </li></ul><ul><li>● position : internal carotid A--41.3%; anterior communicating A--24.4%; middle cerebral A—20.8%; anterior cerebral A—9%; vertebral-basilar A--4.5% 。 </li></ul>
  63. 63. CT appearances <ul><li>Showing aneurysm directly, filing defect in large one ( thrombus ) </li></ul><ul><li>Subarachnoid hemorrhage in ruptured aneurysm. </li></ul>
  64. 64. MR appearance <ul><li>1. aneurysm without thrombus: round or oval homogeneous </li></ul><ul><li>very low signal lesion both on T1 and T2WI. </li></ul><ul><li>2. aneurysm with thrombus : heterogeneous both on T1 </li></ul><ul><li>and T2WI , high signal in some area. </li></ul><ul><li>3. enhanced scan : may be heterogeneously enhanced </li></ul>
  65. 66. Aneurysm at left internal carotid A
  66. 67. Aneurysm at left internal carotid A
  67. 68. T1WI-contrast T1WI-contrast
  68. 69. Aneurysm at left internal carotid A
  69. 70. Aneurysm at left middle cerebral A
  70. 71. CT&MRI diagnosis of cerebral infarction
  71. 72. CT appearances of cerebral infarction <ul><li>Acute stage - onset within 4 - 6h. </li></ul><ul><li>normal/slightly low density and narrowing of sulcus on infarction area because of edema; low density after 12 - 24h , but no any abnormal finding within 24h. </li></ul><ul><li>Subacute stage - within 1 week , typical CT </li></ul><ul><li>appearance. </li></ul><ul><li>Low density on infarction area with mass effect. </li></ul><ul><li>After 2 - 3 weeks , iso- or slightly low density with unclear margin, enhancement at border area in contrast scan. </li></ul><ul><li>Chronic stage - even low density with clear margin. Atrophy of local brain. </li></ul>
  72. 73. MR appearances of cerebral infarction <ul><li>High signal intensity at Acute , subacute and chronic stage on T2WI because of increment of fluid at infarction. </li></ul><ul><li>Iso-intensity at acute stage , iso- or slightly low intensity at subacte stage, low intensity at chronic stage on T1WI. </li></ul><ul><li>Flair and DWI sequences are more sensitive for detecting acute infarction. </li></ul>
  73. 74. MR:44396 Within 24h After 3 days After 2 weeks Acute cerebral infarction
  74. 75. MR:44396 MR&CT appearances of acute cerebral infarction Within 24h after 3 days after 2 weeks
  75. 76. MR:44396 MR&CT appearances of acute cerebral infarction T2WI T1WI Flair
  76. 77. MR:44396 MR&CT appearances of acute cerebral infarction Flair T1WI T2WI
  77. 78. Acute infarction MR : 66335 CT : 122740 M 39 , CT (-)
  78. 79. Acute infarction MR : 66335 CT : 122740 M 39 , CT (-)
  79. 80. Acute infarction MR : 66335 CT : 122740
  80. 81. Acute infarction DWI MR : 66335 CT : 122740
  81. 82. Subacute/chronic infarction—T2WI
  82. 83. T2WI--Cor
  83. 84. Chronic infarction at brain stem and cerebellum—T2WI
  84. 85. Chronic infarction at brain stem and cerebellum—T1WI
  85. 86. CT&MRI diagnosis of head trauma
  86. 87. The types of head trauma <ul><li>一、 Skull fracture </li></ul><ul><li>二、 traumatic cerebral swelling </li></ul><ul><li>三、 brain contusions </li></ul><ul><li>四、 Intracranial bleed of trauma </li></ul><ul><li>( 一 ) Epidural hematoma </li></ul><ul><li>( 二 ) Subdural hematoma </li></ul><ul><li>( 三 ) Subarachnoid hemorrhage </li></ul><ul><li>( 四 ) intracerebral hematoma </li></ul>
  87. 88. CT&MR diagnosis of cranial trauma <ul><li>Epidural hematoma : </li></ul><ul><li>٭ direct violence on skull </li></ul><ul><li>٭ skull fracture and deformation </li></ul><ul><li>٭ direct laceration or tearing of meningeal arteries </li></ul><ul><li>٭ local hematoma ,not across cranial suture </li></ul><ul><li>٭ shape of duple convex mirror </li></ul>
  88. 89. CT appearances <ul><li>٭ local duple convex mirror with high density, CT value at 40~100Hu. </li></ul><ul><li>٭ there are or not mass effect according the size of hematoma which compress gyri , ventricles. Midline is shifted to contralateral side. </li></ul><ul><li>٭ the density of hematoma decrease during the time, become isodesity at about 2 weeks (subacute stage) and low density at about 1 month (chronic stage) . </li></ul>
  89. 90. acute epidural hematoma at left frontal lobe
  90. 91. acute epidural hematoma at right frontal lobe
  91. 92. Acute epidural hematoma at temporal-parietal lobe
  92. 93. MR appearances <ul><li>٭ shape of hematoma is seen like CT </li></ul><ul><li>٭ signal intensity of hematoma varies greatly depending on times. </li></ul><ul><li>٭ at acute stage ( 0~2 days ), iso-intensity on T1WI , low intensity on T2WI. </li></ul><ul><li>٭ at subacute stage ( 3~14 days ), becoming high signal intensity from rim to center on T1WI, still low signal intensity at 6~8 days and high signal intensity after 8 day on T2WI. </li></ul><ul><li>٭ at chronic stage (14 days later) , high signal intensity on both T1WI and T2WI for quite long times (may be several months) </li></ul>
  93. 94. Subacute hematoma at left frontal lobe
  94. 95. Subacute hematoma at left frontal lobe
  95. 96. Subacute hematoma at left frontal lobe
  96. 97. Subdural hematoma <ul><li>٭ location: supratentorial convexity. </li></ul><ul><li>٭ caused by stretching and tearing of bridging veins. </li></ul><ul><li>٭ hematoma is located between dura mater and arachnoid. Often quite large extent , across cranial suture. </li></ul><ul><li>٭ CT appearances : crescentic high density. Dividing into acute, subacte and chronic stages . Density changes of hematoma at different stages similar to epidural hematoma. </li></ul><ul><li>٭ MR appearances : shape of hematoma seen as CT , signal changes of hematoma similar to epidural hematoma at different stages. </li></ul>
  97. 98. Acute subdural hematoma at right frontal-temporal area
  98. 99. Subacute subdural hematoma at left frontal-temporal area
  99. 100. Subacute subdural hematoma at left frontal-temporal area
  100. 101. Subacute subdural hematoma at left frontal-temporal area
  101. 102. Subacute subdural hematoma at left frontal-temporal area
  102. 103. Chronic subdural hematoma at left frontal lobe
  103. 104. CT&MR diagnosis of brain contusion <ul><li>٭ Often involve the temporal and frontal lobe. Temporal lobe lesions tend to lie just above the petrous bone or posterior to the greater sphenoid wing. Frontal lobe lesions occur just above the cribriform plate, orbit, planum sphnoidale, and lesser sphenoid wing. </li></ul><ul><li>٭ CT appearances : high density of hemorrhagic foci (vary in size ) scattered throughout the larger nonhemorrhagic </li></ul><ul><li>zone or lower density area (edema). May be or may not be mass effect. </li></ul>
  104. 105. Contusion at frontal lobe
  105. 106. Contusion at both sides of frontal base
  106. 107. Contusion at temporal lobe
  107. 108. MR appearances <ul><li>٭ MR is more sensitive than CT to find small contusion because of easy to find edema caused by contusion. </li></ul><ul><li>٭ hemorrhagic foci appear petechia or multiple confluent regions with high signal intensity. </li></ul><ul><li>٭ easy to find contusion at brain stem. </li></ul>
  108. 109. Contusion and epidural hemorrhage at both temporal lobe and frontal lobe
  109. 110. Contusion and epidural hemorrhage at both temporal lobe and frontal lobe
  110. 111. Multiple contusions at both sides of frontal and temporal lobes
  111. 112. Multiple contusions at both sides of frontal and temporal lobes
  112. 113. THANK YOU
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