mri brain common intruduction and pathology

1. SHIVAPRASAD
CT/MRI TECHNOLOGIST
MRI BRAIN

2. History
 IMAGING GOES BACK TO 1895, W C ROENTGEN
DISCOVERED X-RAYS.
 NEXT MAJOR LEAPS IN IMAGING WERE
INTRODUCTION OF CT AND MRI IN 1970 .
HOUNSFIELD- 1972 CT SCAN, LAUTERBUR-1973 MRI

3.  CT & MR imaging modalities made significant
impact in diagnosis and evaluation of lesions
affecting cns.
 Provided almost clear diagnosis and extent of
disease process for first time noninvasively.

4. MRIMRI
 MRI – Magnetic Resonance imaging .MRI – Magnetic Resonance imaging .
 Images : Interaction between Body Protons,Images : Interaction between Body Protons,
Magnet & RF Coils.Magnet & RF Coils.

5. MRI - HeadMRI - Head
 Provides high resolution Anatomical Images.Provides high resolution Anatomical Images.
 Good Depiction of anatomical alterationsGood Depiction of anatomical alterations
(Pathology).(Pathology).
 Provides Physiological , Functional & BiochemicalProvides Physiological , Functional & Biochemical
information with advanced techniques.information with advanced techniques.

6. MR IMAGING
CONSIDERED AS ADVANCED MODALITY SINCE ITS
INTRODUCTION.
 SUPERIOR RESOLUTION.
 MULTIPLANAR CAPABILTY.
 NON-INVASIVE EVALUATION OF VESSELS, FUNCTION etc.

7. MR – ApproachMR – Approach
Basic :Basic :
 T1 , T2 & Flair Sequences.T1 , T2 & Flair Sequences.
 Multiplanar approach .Multiplanar approach .
Advanced : (MultiparametricAdvanced : (Multiparametric))
 Diffusion .Diffusion .
 MRA.MRA.
 MR Spectroscopy.MR Spectroscopy.
 MR PerfusionMR Perfusion
 MR Functional, DTI , CSF Flow etc.MR Functional, DTI , CSF Flow etc.

8. MR APPLICATIONS- TISSUE
CHARACTERSATION
 MR ANGIOGRAPHY - VESSELS.
 DIFFUSION IMAGING - CELLULARITY
DIFFUSION TENSOR IMAGING - WHITE MATTER INTEGRITY
 PERFUSION IMAGING - ANGIOGENESIS
 MR SPECTROSCOPY - BIOCHEMISTRY.
 SUSCEPTIBILITY WEIGHTED IMAGING - MICRO-HEMORRHAGE
 FUNCTIONAL MRI - PHYSIOLOGY.

9. MR - ContraindicationsMR - Contraindications
 Trauma ( Before CT ).Trauma ( Before CT ).
 Patients with Pacemaker & Mechanical Heart Valves.Patients with Pacemaker & Mechanical Heart Valves.
(Non MR Compatable)(Non MR Compatable)
 Ocular & Cochlear Implants.Ocular & Cochlear Implants.
 Recent surgical non MR Compatible Implants (< 4 WeeksRecent surgical non MR Compatible Implants (< 4 Weeks

10. MR ANGIOGRAPHY
NON INVASIVE STUDY
 NON CONTRAST .
TOF ANGIOGRAPHY (TOF) .
PHASE CONTRAST ANGIOGRAPHY(PC).
 CONTRAST ENHANCED MR ANGIO.

11. MRA – CEREBRAL ANGIO

12. MR- CAROTID ANGIO

13. MRA - STROKE
T2 W MRA

14. MR ANGIO- STROKE
H/O SEIZURES, POST PARTUM
T2 TSE
SWI
MRV
HAEMORRHAGIC INFARCT - CVT

15. AVM

16. DIFFUSION MRI
 DIFFUSION & ADC MAPS:
ANALYSES DIFFUSION PROCESS IN TISSUE.
STROKE AND HIGH CELLULAR TUMOURS .
 DIFFUSION TENSOR AND FIBER TRACTOGRAPHY:
ANALYSES THE ANISOTROPHY IN TISSUES.
GIVES ORIENTATION AND INTEGRITY DETAIL OF WHITE
MATTER TRACTS.

17. DIFFUSION MR
DW IMAGE ADC MAP
ABNORMAL BRIGHT DARK

18. DIFFUSION MR
T2 W DW ADC
INFARCT- LT MCA

19. STROKE
PLAIN CT DW ADC

20. FLAIR
CONTRAST
DWI
ADC
LYMPHOMA

21. DIFFUSION TENSOR AND FIBER TRACTOGRAPHY
FT IMAGING OF PONTINE FIBERS AND PL INTERNAL CAPSULE
CORPUS CALLOSUM

22. DTI AND FT
T2W FT
PARTIAL AGENISIS OF CORPUS CALLOSUM

23. DTI & FT MAP
CEREBRAL PALSY
THINNING OF SENORY AND THALMIC FIBRES

24. DTI AND FT
T2 W
FT
GLIOBLASTOMA-POST OP –FOLLOW UP

25. DIFFUSION-TENSOR IMAGING AND FIBER
TRACTOGRAPHY
ALLOW A BETTER UNDERSTANDING OF ABERRANT FIBER
CONNECTIONS AND DEARRANGEMENT OF WHITE MATTER
IN.
 DEVELOPMENTAL CNS DISEASES.
 TUMORS, DEMYELINATION AND INFARCTS.
 HELPS IN PRESURGICAL EVALUATION.

26. MR SPECTROSCOPY
 SPECTROSCOPY PROVIDES INFORMATION OF INTRACELLULAR
METABOLITES NONINVASIVELY.
 THESE METABOLITES ARE KNOWN TO CHANGE IN DIFFERENT
PATHOLOGIC CONDITIONS.
 ALWAYS INTERPRETATION OF MRS TO BE DONE WITH OF
OTHER IMAGING DATA.
 SINGLE VOXEL / MULTIVOXEL SPECTROSCOPY.

28. NAA (N-ACETYL ASPERTATE ) :
PRIMARY PEAK IS 2.02
PRESENCE AND LEVEL CORRELATE WITH NEURONAL INTEGRITY
CHOLINE :
PRIMARY PEAK 3.22PPM).
MARKER FOR MEMBRANE INTEGRITY AND MEMBRANE TURN OVER
TUMOURS
CREATINE & PHOSPHO CREATINE:
PRIMARY PEAK - 3.03
INVOLVED IN THE ENERGY METABOLISM .
A BASE LINE REFERENCE LEVEL.

29. MYO INOSITOL - 3.5 PPM
REGULATION OF CELLULAR TRANSPORT ACROSS CELL MEMBRANE.
DEMYELINATING.
LIPID : 0.8-1.4
BREAK DOWN OF TISSUE.
Necrosis
LACTATE – 1.32
ANEROBIC GLYCOSIS.
ISCHEMIA.

30. MR SPECTROSCOPY
INCREASED LACTATE

32. INCREASED LACTATE, LIPID, ALANINE AND SUCCINATE

33. MR SPECTROSCOPY
MR SPECTRO - LARGE CHOLINE, REDUCED NAA

34. LESION IN LEFT THALMUS – 50 YR MALE

35. MR SPECTROSCOPY
DECREASE IN NAA & INCREASE IN CHOLINE- LOW GRADE GLIOMA

36. T2 W
CONTRAST STUDY
CBV

37. MRS- HIGH CHOLINE – HIGH GRADE GLIOMA

38. POST OP GLIOMA, RADIATION
FLAIR
CONTRAST 1
PERFUSION

39. MRS- LIPID PEAK- NECROSIS, NO NAA / CHOLINE
RADIATION NECROSIS

40. POST OP GLIOBLASTOMA, RADIATION
FLAIR
POSTCONTRAST
PERFUSION

41. MR SPECTRO- INCREASED CHOLINE, REDUCED NAA- RECURRENT

42. MR PERFUSION
 EXPLOIT SIGNAL INTENSITY CHANGES OCCUR WITH PASSAGE OF
A TRACER SUCH AS GADO.
 BY APPLYING TRACER KINETICS , CBV , CBF , MTT & TTP ARE
CALCULATED .
 EVALUATION OF STROKE AND TUMOR.

43. DWI CBV CBF
MTT T2 WT
DIFFUSION – PERFUSION MISMATCH

44. PERFUSION
Perfusion Wt images
CBF MTT CBV

45. ISCHEMIC STROKE
CEREBROVASCULAR PATHOPHYSIOLOGY
CBF CBV MTT
Salvageable
Penumbra
↓ ↑ ↑
Nonviable Core
Infarct
↓ ↓ ↑ ↑

46. PERFUSION MR

47. PERFUSION MR
T2 CONTRAST CBV- PERF
GLIOMA

48. FUNCTIONAL MRI(fmri)
 IS AN ACTIVATION-BASED METHOD.
 BOLD RESPONSE APPEARS IN ALL AREAS THAT ARE
FUNCTIONALLY ACTIVE, BUT NOT NECESSARILY ESSENTIAL,
DURING THE EXECUTION OF A PARTICULAR TASK.
 MAPPING MAIN BRAIN FUNCTIONS—INCLUDING MOTOR,
SENSORY, AND LANGUAGE FUNCTIONS.

49. FMRI - LANGUAGE

50. SUSCEPTIBILITY-WEIGHTED IMAGING(SWI)
 EXPLOITS THE MAGNETIC SUSCEPTIBILITY DIFFERENCES
OF THE BLOOD, IRON AND CALCIFICATION IN VARIOUS
TISSUES.
 DETECTS MICROHAEMORRHAGE.
 CALCIFICATION / IRON DEPOSITION .

51. HAEMATOMA
HAEMORRHAGIC INFARCT
DAI VENOUS ANGIOMA

52. MOTION CORRECTION- BLADE
 Images not affected by flow and motion.
 By continuously acquiring low resolution images.

53. BLADE

54. CSF FLOW STUDY
NORMAL

55. MR HEAD - IndicationsMR HEAD - Indications
 Cerebral infarction & Ischemia 8.Cerebral infarction & Ischemia 8.
 Tumors 8.Tumors 8.
 Neuroinfections 8.Neuroinfections 8.
 White matter Diseases 9.White matter Diseases 9.
 Malformations 8.Malformations 8.
 Neurodegenerative Conditions 9.Neurodegenerative Conditions 9.
 Vascular Malformations 6.Vascular Malformations 6.
 Follow up Trauma , Presurgical & Post Surgical 7.Follow up Trauma , Presurgical & Post Surgical 7.
 HeadacheHeadache
 Focal neurological Deficit & SeizuresFocal neurological Deficit & Seizures

56. NEUROLOGICAL CONDITIONSNEUROLOGICAL CONDITIONS
 CONGENITAL AND DEVELOPMENTAL.CONGENITAL AND DEVELOPMENTAL.
 WHITE MATTER DISEASES - LEUKODYSTROPHY.WHITE MATTER DISEASES - LEUKODYSTROPHY.
 INFECTIVE.INFECTIVE.
 ISCHEMIC.ISCHEMIC.
 NEOPLASTIC .NEOPLASTIC .
 DEGENARATIVE CHANGES.DEGENARATIVE CHANGES.

57. CONGENITAL MALFORMATIONS

58. DANDY WALKER MALFORMATIONDANDY WALKER MALFORMATION
 ENLARGED POSTERIOR CRANIAL FOSSA.ENLARGED POSTERIOR CRANIAL FOSSA.
 HYPOPLASTIC VERMIAN FOSSA.HYPOPLASTIC VERMIAN FOSSA.
 DILATED 4DILATED 4THTH
VENTRICLE.VENTRICLE.
DANDY WALER VARIANT AND DW COMPLEX.DANDY WALER VARIANT AND DW COMPLEX.

60. DW MDW M
D W VARIANT

61. Jouberts syndrome

62. CHIARI MALFORMATIONCHIARI MALFORMATION
 LOW LYING PEG SHAPED TONSILS.LOW LYING PEG SHAPED TONSILS.
 EFFACED CSF SPACES.EFFACED CSF SPACES.
 SYRINXSYRINX

63. AGENISIS OF CORPUS CALLOSUMAGENISIS OF CORPUS CALLOSUM
 ABSENCE OR HYPOPLASTIC CORPUS CALLOSUM.ABSENCE OR HYPOPLASTIC CORPUS CALLOSUM.
 PARELL LATERAL VENTRICLES.PARELL LATERAL VENTRICLES.
 COLPOCEPHALY.COLPOCEPHALY.
 RADIALLY ARRANGED GYRIRADIALLY ARRANGED GYRI

64. HEMIMEGENCEPHALYHEMIMEGENCEPHALY

65. SCHIZENCEPHALYSCHIZENCEPHALY

66. LISSENCEPHALY- PACHYGYRIALISSENCEPHALY- PACHYGYRIA
POLYMICROGYRIAPOLYMICROGYRIA

67. PHAKOMATOSIS/NEURO-CUTANEOUSPHAKOMATOSIS/NEURO-CUTANEOUS
SYNDROMESSYNDROMES
 NEUROFIBROMATOSIS.NEUROFIBROMATOSIS.
 TUBEROUS SCLEROSIS.TUBEROUS SCLEROSIS.
 STRUGE – WEBER SYNDROME.STRUGE – WEBER SYNDROME.

68. NF - IINF - II
Bilateral acoustic schwannoma
with meningioma

69. TUBEROUS SCLEROSISTUBEROUS SCLEROSIS

70. AQUEDUCTAL STENOSISAQUEDUCTAL STENOSIS

71. CSF FLOW

72. White matter diseases

73. PROGRESS OF MYLENATIONPROGRESS OF MYLENATION
 PROXIMAL PATHWAYS BEFORE DISTAL.PROXIMAL PATHWAYS BEFORE DISTAL.
 SENSORY BEFORE MOTOR.SENSORY BEFORE MOTOR.
 CENTRAL WHITE MATTER BEFORE PERIPHERAL.CENTRAL WHITE MATTER BEFORE PERIPHERAL.
 POSTERIOR BEFORE ANTERIOR.POSTERIOR BEFORE ANTERIOR.

74. MRI - 2-DAY-OLD INFANT BRAIN.MRI - 2-DAY-OLD INFANT BRAIN.
T1-W- REGIONS OF HIGH SIGNAL INTENSITY CORRESPONDINGT1-W- REGIONS OF HIGH SIGNAL INTENSITY CORRESPONDING
TO KNOWN MYELINATION PRESENT AROUND BIRTH.TO KNOWN MYELINATION PRESENT AROUND BIRTH.
DORSAL BRAINSTEM, OPTIC APPARATUS, POSTERIORDORSAL BRAINSTEM, OPTIC APPARATUS, POSTERIOR
LIMB INTERNAL CAPSULE, VENTRAL LATERAL NUCLEUS OFLIMB INTERNAL CAPSULE, VENTRAL LATERAL NUCLEUS OF
THALAMUS, CENTRAL CORONA RADIATA, AND PERIROLANDICTHALAMUS, CENTRAL CORONA RADIATA, AND PERIROLANDIC
REGIONREGION

75. T2-W:T2-W:
LOW SIGNAL INTENSITY IN THESE SAME REGIONS.LOW SIGNAL INTENSITY IN THESE SAME REGIONS.
SIGNAL INTENSITY OF THE REMAINDER OF THE WHITESIGNAL INTENSITY OF THE REMAINDER OF THE WHITE
MATTER ON THE T1- AND T2-WEIGHTED IMAGES DUE TO THEMATTER ON THE T1- AND T2-WEIGHTED IMAGES DUE TO THE
NORMAL HIGHER WATER CONTENT OF THE INFANT BRAIN.NORMAL HIGHER WATER CONTENT OF THE INFANT BRAIN.
CORTEX SHOWS LOW SIGNAL INTENSITY ON THE T2-ANDCORTEX SHOWS LOW SIGNAL INTENSITY ON THE T2-AND
STANDS OUT HIGH SIGNAL WHITE MATTER.STANDS OUT HIGH SIGNAL WHITE MATTER.

76. Multiple SclerosisMultiple Sclerosis
 MOST COMMON AND EXTENSIVELY STUDIEDMOST COMMON AND EXTENSIVELY STUDIED
DEMYELINATING DISEASES.DEMYELINATING DISEASES.
 ETIOLOGY IS UNKNOWN.ETIOLOGY IS UNKNOWN.
 AUTOIMMUNE MECHANISMS DIRECTED AGAINST MYELINAUTOIMMUNE MECHANISMS DIRECTED AGAINST MYELIN
PROTEINS.PROTEINS.
 LINKAGE OF MS TO HISTOCOMPATIBILITY COMPLEX ONLINKAGE OF MS TO HISTOCOMPATIBILITY COMPLEX ON
CHROMOSOME 6P21 .CHROMOSOME 6P21 .

78.  PERIVENTRICULAR WHITE MATTER.PERIVENTRICULAR WHITE MATTER.
 INTERNAL CAPSULE.INTERNAL CAPSULE.
 CORPUS CALLOSUM.CORPUS CALLOSUM.
 PONS, AND BRACHIUM PONTIS .PONS, AND BRACHIUM PONTIS .
LESIONS MAY SEEN THROUGHOUT THE MYELINATED WHITELESIONS MAY SEEN THROUGHOUT THE MYELINATED WHITE
MATTER AND WITHIN GRAY MATTER.MATTER AND WITHIN GRAY MATTER.

83. METACHROMATIC LEUKODYSTROPHYMETACHROMATIC LEUKODYSTROPHY

84. ADRENOLEKODYSTROPHYADRENOLEKODYSTROPHY

85. CANAVAN DISEASECANAVAN DISEASE

86. CNS INFECTIONSCNS INFECTIONS

87. INFECTIVEINFECTIVE
 MENINGITIS.MENINGITIS.
 ENCEPHALITIS.ENCEPHALITIS.
 TUBERCULOMA.TUBERCULOMA.
 NEUROCYSTICERCOSIS.NEUROCYSTICERCOSIS.
 ABSCESS.ABSCESS.

88. MeningitisMeningitis

89. Subdural Empyema

90. Cerebellar Abscess

91. Cerebral abscess

92. ENCEPHALITISENCEPHALITIS

93. ADEMADEM

94. Tubercular Meningitis

96. TB meningitis
with tuberculomas

97. TUBERCULOMATATUBERCULOMATA

98. Tubercular Abscess

99. TUBERCULARTUBERCULAR

100. Neuro-cysticercosisNeuro-cysticercosis

101. NEUROCYSTICERCOSIS

103. Aspergelloma

104. TOXOPLASMOSIS

105. Hydatid cyst