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Anatomía radiológica del cerebro

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  • 1. Basic Neuroimagingsรศ. พ.ญ. จิรพร เหล่าธรรมทัศน์ Advanced Diagnostic and Image-Guided Minimal Invasive Therapy Center (AIMC) Ramathibodi Hospital Mahidol University
  • 2. AIMC
  • 3. Learning Objectives The main purpose of this lesson is to stimulate thestudents to recognize the value of gross anatomy andphysiology of the CNS as major foundations in clinicalpractice. The students will be able to   1.   Understand the principles of CT, MRI,Angiography PET and SPECT 2.     Recognize the multiplanar normal neuroimaginganatomy   3. Recognize the imaging of the CSF pathway,intracranial arteries and venous system
  • 4. Content Outlines1.     Basic knowledge of CT, MRI, Angiography, PET and SPECT2.     CT scan of the nervous system3.     MRI of the nervous system4.     Vascular imaging of the CNS: angiography, CT angiogram and venogram and MRA/MRV
  • 5. Learning Organization1.     Study the learning materials provided in advanced2.     Lecture 40 minutes3.     Questions and answers 10 minutes
  • 6.     Self study of the following topics 1. Meninges and intracranial spaces 2.  Intracranial vascular circulation 2.1 Cervical and intracranial carotid and vertebrobasilar system 2.2       Circle of Willis 2.3       Deep and superficial cerebral veins 2.4       Dural venous sinuses  3. Structural and functional correlation of the nervous sys. 3.1       Visual pathway and cortex 3.2       Language center: Broca’s and Wernicke’s 3.3       Auditory cortex 3.4       Motor and sensory cortex 3.5       Brain stem 3.6       Pituitary gland
  • 7. Imaging Modalities1. Plain films/ Tomogram2. Ultrasonogram3. CT4. MRI5. Myelogram6. Angiogram7. Venogram8. Nuclear SPECT/ PET
  • 8. Imaging Modalities UltrasonogramComputed Tomography(CT) Magnetic Rasonance Imaging(MRI) Digital C-arm Digital Angiography Computed Radiography
  • 9. Metabolic Imaging PET Scan Images in Mices: Differences in Thymidine kinase gene expression
  • 10. The brain1. The cerebral hemispheres2. The posterior fossa3. The deep gray nuclei4. White matter tracts5. The ventricular system6. The meningies7. Vascular supply8. Venous drainage
  • 11. Normal CT Anatomy
  • 12. Normal CT Anatomy
  • 13. Basal Ganglion
  • 14. Normal gray-white matter
  • 15. The posterior fossa Foramen Magnum Base of Skull
  • 16. C1-2Foramen Magnum
  • 17. Cervicomedullary JunctionHypoglossalnerve canal
  • 18. Brain Stem
  • 19. Sagittal Midline MRI
  • 20. Brain stem temporal lobe ponscerebellar peduncle: middle cerebellum
  • 21. Medulla
  • 22. Pons- CPA - IAC Middle Cerebellar Peduncle
  • 23. Cerebellum
  • 24. Cerebellar hemisphereCerebellar vermis
  • 25. Pons- CerebellumInfundibulum
  • 26. Mid Brain
  • 27. Third Ventricle Tectal Plate
  • 28. Brain Parenchymal Anatomy
  • 29. The cerebral hemispheres1. Frontal lobes2. Parietal lobes3. Temporal lobes4. Occipital lobes5. Insular lobes6. Limbic lobes
  • 30. frontal Occipital lobe
  • 31. Posterior FossaTemporal Lobes
  • 32. Uncus: Temporal Horn
  • 33. HypothalamusMidbrain- Aqueduct
  • 34. Frontal -Temporal Occipital Lobes
  • 35. Frontal and Parietal Lobes
  • 36. No C Concept of Blood Brain Barrier+C Centrum Semiovale Fronto- parietal lobes
  • 37. Central Sulcus: The Fronto-Parietal Boundary No C+C
  • 38. BG- Pineal- Thalamus
  • 39. Higher Sensitivity: fMRIFinger tapping fMRI
  • 40. Functional Brain Anatomy1. Primary Motor cortex2. Primary Sensory Cortex3. Primary Visual Cortex4. Primary Auditory Cortex5. Language 1. Broca’s area 2. Wernicke’s area
  • 41. Functional Cortical Brain Mapping Blood Oxygen Level Dectection :Bold Effect
  • 42. Combined visualization of fMRI maps and EEG/MEG multiple dipole models
  • 43. Central sulcus Hand motor areaPrecentral gyrus central sulcusPostcentral gyrus * ** Cingulate sulcus
  • 44. Motor Cortical brain mapping:Glioma
  • 45. Cognitive - Picture Encoding Picture Encoding
  • 46. Auditory cortex
  • 47. Internal Medicine Review November 11,2001
  • 48. The Ventricular System
  • 49. The ventricular system• Lateral ventricles – Frontal horn – Body – Temporal horn – Trigone – Occipital horn• Third ventricle• Aqueduct of Sylvius• Forth ventricle• The Foramina of Magendie and Luschka
  • 50. Concept of CSF- Brain Barrier
  • 51. f The Lateral Ventricle: frontal horn, body,t occipital horn, trigone & temporal horn b tr t b f o f tr tr t b o o
  • 52. The Foramen of Monro
  • 53. The Third Ventricle3rd 3rd 3rd
  • 54. Basal Ganglion Frontal Horn Pulvinar
  • 55. The aqueduct of Sylvius
  • 56. Suprasellar Cistern Temporal hornsAqueduct of Sylvius
  • 57. The Forth Ventricle 4th 4th 4th 4th 4th 4th
  • 58. The Foramina of Magendie and Luschka 4th FM 4th FL FL FM
  • 59. Foramen of Lushka and Magendie
  • 60. Fourth Ventricle
  • 61. Frontal Horns Foramen of Monroe Third VentricleGlomus of the choroid Plexus Aqueduct of Sylvius Pineal Gland
  • 62. Third Ventricle Aqueduct of SylviusPerimesencephalic Cistern
  • 63. Frontal Horns TrigoneOccipital Horns
  • 64. Body of The Lateral Ventricle Corona Radiata
  • 65. Centrum Semiovale
  • 66. Pituitary FossaVisual Pathway
  • 67. Sellar-suprasellar Region Infundibulum Suprasellar cistern Hypothalamus Sellar tursica Infundibulum Suprasellar cistern Sellar tursica Hypothalamus
  • 68. Normal CT Anatomy
  • 69. Pituitary Fossa
  • 70. Suprasellar Cistern Optic Apparati
  • 71. HypothalamusopticTracts-Radiations
  • 72. Optic RadiationCalcarine cortex
  • 73. White Matter Tracts
  • 74. Fiber tracking: DTI Commisure fibers (corpus callosum) Projection fibers (internal capsule) Cortico-cortical association fibers (IFO)
  • 75. Central sulcus Hand motor areaPrecentral gyrus central sulcusPostcentral gyrus * ** Cingulate sulcus
  • 76. CentralSulcus
  • 77. Centrum Semiovale
  • 78. Body of the Lateral Ventricle Coronal Radiata
  • 79. The Corpus Callosum
  • 80. ThalamusBasal Ganglion Frontal Horn Pulvinar
  • 81. Suprasellar Cistern- Optic Chiasm
  • 82. Mid pons
  • 83. Pons
  • 84. Medulla
  • 85. Cervicomedullary Junction
  • 86. Fornix
  • 87. Meningies
  • 88. Intracranial spaces
  • 89. Normal Meningeal Enhancement: CT
  • 90. NORMAL DURAL ENHANCEMENT: MRI
  • 91. EXTENSIVE DURAL ENHANCEMENT History:A 45 y.o. F presented with sudden onset of thunderclap headche for 1 week starting from bil. temporal areas progressing to the occiput with recent posterior right sided neck and occiput pain.
  • 92. Vascular Supply AndVenous Drainage
  • 93. Circle Of Willis
  • 94. Cerebral Angiogram
  • 95. CT Angiogram of the Brain and Neck
  • 96. MRA: Pipe2DTOF MRA: Neck 3DTOF MRA: Brain
  • 97. Suprasellar Cistern Circle of willis
  • 98. Sylvian Fissure
  • 99. Examples of“CE-TOFMRA”
  • 100. Routine 2DTOFMRA of Contrasted TOFMRA of the neck: inplane flow the neck demonstratingartifact is demonstrated. no inplane flow artifact
  • 101. 2DPCMRA with all directions encoded 2DTOFMRA with superior(VENC 50 cm/sec) showed bilateral VA saturation band showed only RVA
  • 102. RVA LVA2DPCMRA with SIencoding direction showed bilateralVA with different flow directions VENC
  • 103. contrasted3DTOFMRA showedbilateral VA,completeocclusion of the leftCCA and SCA originsbut well visualizedLVADIAGNOSISSUBCLAVIAN STEAL SYNDROME
  • 104. Takayasu’s arteritis: routine and contrasted MRA
  • 105. Dural Venous Sinuses
  • 106. Dural Venous sinuses
  • 107. MRV
  • 108. 3D PC MRV 2DPC2D PC MRV
  • 109. 2DTOFMRV: AVM
  • 110. Superior Sagittal Sinus
  • 111. SSS
  • 112. Third Ventricle Pineal GlandInternal Cerebral Vein
  • 113. Basal Vein of RosenthalStraight Sinus
  • 114. Transverse Sigmoid Sinuses
  • 115. Sigmoid SinusJugular foramen
  • 116. Ramathibodi Hospital

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