This document discusses advanced magnetic resonance (MR) imaging techniques for epilepsy. It provides an overview of various structural and functional imaging findings and concepts. The document outlines several etiologies of epilepsy that can be identified on imaging such as malformations of cortical development, mesial temporal sclerosis, tumors, and vascular or nonvascular insults. Advanced MR techniques discussed include high resolution structural imaging, susceptibility weighted imaging, and functional techniques like radionuclide imaging, T2 relaxometry, MR spectroscopy, diffusion tensor imaging, and arterial spin labeling that can help localize the epileptogenic lesion. The document also presents some of the author's preliminary work utilizing 3T MR imaging and quantitative volumetry to detect subtle lesions, improve detection
This document discusses tractography, which uses directional information from diffusion tensor imaging (DTI) to generate 3D maps of white matter tracts in the brain. It explains that DTI measures the diffusion of water molecules to probe cellular structure without invasiveness. Tractography approaches can be deterministic, with a single pathway from each seed point, or probabilistic, with distributions of trajectories. The document notes that tractography is useful for surgical planning by helping surgeons spare important white matter tracts to aid functional outcomes, while its limitations include providing only structural and not functional information.
This document provides an anatomical approach and differential diagnosis for lesions in and around the pituitary gland and sellar region. It outlines key points such as identifying the pituitary gland and sellar turcica to determine if the lesion is intrasellar, suprasellar, or lateral to the sella. Common pathologies are then discussed based on their location, such as pituitary adenomas, craniopharyngiomas, meningiomas, and other lesions that can occur in the pituitary stalk, hypothalamus, cavernous sinus, sphenoid sinus, and carotid artery. Imaging characteristics and distinguishing features between pathologies are provided.
This document provides definitions and classifications of seizures and epilepsy. It discusses who needs neuroimaging for epilepsy and recommends MRI as the best imaging modality. It reviews common MRI protocols and discusses key imaging findings and features of various epilepsy etiologies. Recent advances in neuroimaging for epilepsy are also summarized, including quantitative MRI techniques like volumetry, voxel-based morphometry, and texture analysis as well as advanced techniques like diffusion tensor imaging, tractography, magnetic resonance spectroscopy, and functional MRI.
Normal & abnormal radiology of brain part ivMohammed Fathy
1. Brain tumors can be either intra-axial (within the brain parenchyma) or extra-axial (outside the brain).
2. Key differences are that extra-axial tumors displace brain tissue and widen CSF spaces, while intra-axial tumors infiltrate brain tissue.
3. Common extra-axial tumors are meningiomas and schwannomas, while common intra-axial tumors in adults are gliomas and metastases. Location helps to distinguish tumor type and guide differential diagnosis.
This presentation was basically a test for IMM candidates who were appearing in the IMM exam Dec. This test in the form of PPT contain the format of CPSP. Very helpfull for candidates.
Presentation1.pptx sellar and para sellar massesAbdellah Nazeer
The document provides information on imaging techniques and differential diagnosis for sellar and parasellar masses. CT and MRI techniques are described for imaging the sella turcica region with details on slice thickness, field of view, and contrast usage. An anatomic approach is outlined to analyze sellar masses which involves identifying the pituitary gland, lesion location and characteristics, and establishing a differential diagnosis. Common pathologies that can occur in the sella and surrounding structures are then described individually, including the pituitary gland, stalk, optic chiasm, hypothalamus, carotid artery, cavernous sinus, and meninges. Imaging examples of lesions such as pituitary adenomas, craniopharyngiomas, and meningi
Phakomatoses are a group of neurocutaneous syndromes characterized by tumors or tumor-like conditions affecting the eye and nervous system. Some of the most common phakomatoses include neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), tuberous sclerosis complex (TSC), Sturge-Weber syndrome, and Von Hippel-Lindau disease. Each syndrome has distinct clinical features and patterns of involvement across organ systems that are important for diagnosis. Imaging plays a key role in identifying lesions and confirming the diagnosis. Management involves monitoring for complications and treating affected organ systems.
Computed Tomography Angiography in Chronic Pulmonary ThromboembolismApollo Hospitals
Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.
This document discusses tractography, which uses directional information from diffusion tensor imaging (DTI) to generate 3D maps of white matter tracts in the brain. It explains that DTI measures the diffusion of water molecules to probe cellular structure without invasiveness. Tractography approaches can be deterministic, with a single pathway from each seed point, or probabilistic, with distributions of trajectories. The document notes that tractography is useful for surgical planning by helping surgeons spare important white matter tracts to aid functional outcomes, while its limitations include providing only structural and not functional information.
This document provides an anatomical approach and differential diagnosis for lesions in and around the pituitary gland and sellar region. It outlines key points such as identifying the pituitary gland and sellar turcica to determine if the lesion is intrasellar, suprasellar, or lateral to the sella. Common pathologies are then discussed based on their location, such as pituitary adenomas, craniopharyngiomas, meningiomas, and other lesions that can occur in the pituitary stalk, hypothalamus, cavernous sinus, sphenoid sinus, and carotid artery. Imaging characteristics and distinguishing features between pathologies are provided.
This document provides definitions and classifications of seizures and epilepsy. It discusses who needs neuroimaging for epilepsy and recommends MRI as the best imaging modality. It reviews common MRI protocols and discusses key imaging findings and features of various epilepsy etiologies. Recent advances in neuroimaging for epilepsy are also summarized, including quantitative MRI techniques like volumetry, voxel-based morphometry, and texture analysis as well as advanced techniques like diffusion tensor imaging, tractography, magnetic resonance spectroscopy, and functional MRI.
Normal & abnormal radiology of brain part ivMohammed Fathy
1. Brain tumors can be either intra-axial (within the brain parenchyma) or extra-axial (outside the brain).
2. Key differences are that extra-axial tumors displace brain tissue and widen CSF spaces, while intra-axial tumors infiltrate brain tissue.
3. Common extra-axial tumors are meningiomas and schwannomas, while common intra-axial tumors in adults are gliomas and metastases. Location helps to distinguish tumor type and guide differential diagnosis.
This presentation was basically a test for IMM candidates who were appearing in the IMM exam Dec. This test in the form of PPT contain the format of CPSP. Very helpfull for candidates.
Presentation1.pptx sellar and para sellar massesAbdellah Nazeer
The document provides information on imaging techniques and differential diagnosis for sellar and parasellar masses. CT and MRI techniques are described for imaging the sella turcica region with details on slice thickness, field of view, and contrast usage. An anatomic approach is outlined to analyze sellar masses which involves identifying the pituitary gland, lesion location and characteristics, and establishing a differential diagnosis. Common pathologies that can occur in the sella and surrounding structures are then described individually, including the pituitary gland, stalk, optic chiasm, hypothalamus, carotid artery, cavernous sinus, and meninges. Imaging examples of lesions such as pituitary adenomas, craniopharyngiomas, and meningi
Phakomatoses are a group of neurocutaneous syndromes characterized by tumors or tumor-like conditions affecting the eye and nervous system. Some of the most common phakomatoses include neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), tuberous sclerosis complex (TSC), Sturge-Weber syndrome, and Von Hippel-Lindau disease. Each syndrome has distinct clinical features and patterns of involvement across organ systems that are important for diagnosis. Imaging plays a key role in identifying lesions and confirming the diagnosis. Management involves monitoring for complications and treating affected organ systems.
Computed Tomography Angiography in Chronic Pulmonary ThromboembolismApollo Hospitals
Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.
Presentation1.pptx, radiological imaging of spinal dysraphism.Abdellah Nazeer
This document discusses radiological imaging in spinal dysraphism. It describes how various imaging modalities such as radiography, ultrasound, CT, and MRI can be used to identify and characterize different types of spinal dysraphism including open dysraphism, closed dysraphism, lipomyelomeningocele, diastematomyelia, dermal sinus, and tethered cord. Examples of imaging findings for each condition are provided with representative images to illustrate the pathology.
This document contains descriptions of several pediatric medical cases involving children presenting with seizures, fever, vomiting, and other neurological symptoms. For each case, it lists key questions about the presenting symptoms, possible diagnoses, imaging findings, causative agents or etiologies, recommended treatments and management plans. The document also contains a list of various pediatric neurological conditions.
This document discusses various surgical approaches for pituitary adenomas. It begins with a brief history of pituitary surgery dating back to 1893. There are two main categories of approaches - extracranial (transnasal, transmaxillary) and intracranial (subfrontal, subtemporal). The transnasal transsphenoidal approach is the most common due to its advantages. Extended approaches are sometimes needed for large tumors. Complications can include CSF leaks, hormonal issues, and visual changes. Landmarks, techniques, and closure methods are outlined for different procedures. Indications for alternative approaches like transcranial are also summarized.
- A 14-year-old boy presented with worsening headaches, nausea, and vomiting and was found to have upward gaze palsy on examination.
- CT showed a mass in the pineal region engulfing a calcified pineal gland.
- Pineal region tumors can be germ cell tumors, pineal cell tumors, glial cell tumors, or other miscellaneous tumors.
- The presentation, imaging characteristics, biopsy results, and tumor markers would help determine if this is a germinoma or other type of pineal region tumor.
This document discusses a case study of a 60-year-old male patient who presented with left-sided hemiplegia and increased intracranial pressure. CT scans showed diffuse abnormalities in the left thalamus, internal capsule, and basal ganglia. A biopsy revealed a mixed grade III-IV astrocytoma. The patient received radiation therapy but died 4 months after diagnosis. The document then discusses characteristics and diagnosis of diffuse astrocytomas, their tendency to progress to higher grades over time, and challenges in treating thalamic gliomas.
Meningiomas account for 15% of all intracranial tumors and originate from the dura or arachnoid membranes. They are most common in middle-aged adults and affect women twice as often as men. Meningiomas are typically benign, slow-growing tumors that indent the brain as they enlarge. On CT imaging, meningiomas appear well-circumscribed, homogeneous, and hyperdense, and may induce hyperostosis of adjacent bone. MRI often reveals a characteristic "dural tail" sign of enhancement. Other histologic variants include hemangiopericytomas, which have a narrow dural attachment and lobulated shape.
This document contains CT images and descriptions of the anterior, middle, and posterior cranial fossae and infra-temporal fossa. In the anterior fossa, images show the cribriform plate, optic canals, and anterior clinoid processes. The middle fossa images display the foramen rotundum, ovale, spinosum, and greater and lesser sphenoid wings. The posterior fossa images highlight the jugular foramen, hypoglossal canal, foramen magnum, and condylar canals. The infra-temporal fossa images outline the carotid canal, jugular foramen, hypoglossal canal, mandibular condyle, and occipital bone.
This document discusses disorders of myelination. It begins by defining myelin and its functions, describing normal myelination milestones. It then covers various white matter disorders including dysmyelination, hypomyelination, and delayed myelination. Specific leukodystrophies are discussed in more detail such as Canavan's disease, Alexander disease, Van der Knapp disease, and glutaric aciduria type 1. Clinical features, imaging findings, and pathology are described for each condition. The document provides an overview of disorders of myelination.
This document summarizes evidence from 27 trials involving over 10,000 participants on the safety and efficacy of clot-dissolving drugs (thrombolytics) such as alteplase for treating acute ischemic stroke. The trials compared thrombolytics administered intravenously or intra-arterially within 4.5 hours of stroke onset to placebo or no treatment. Thrombolytics were found to improve outcomes after stroke but also increase the risk of serious bleeding in the brain. While thrombolytics can restore blood flow and reduce brain damage if given promptly, the risks and benefits were shown to depend on the time since stroke onset.
This document contains 20 quiz cases related to neuroimaging. Each case provides the radiological sign, associated condition, and brief description. The cases cover a wide range of neurologic conditions seen on CT and MRI, including infections, demyelinating diseases, vascular abnormalities, tumors and developmental anomalies. Key information about the featured conditions is also summarized.
This document provides information on performing and interpreting renal Doppler ultrasounds. It discusses the optimal approaches for imaging the renal arteries, including the anterior, oblique, and flank approaches. It also outlines criteria for evaluating renal artery stenosis, including peak systolic velocity measurements and the renal-aortic ratio. Common renal pathologies that can be identified with Doppler ultrasound are also summarized, such as fibromuscular dysplasia, atherosclerosis, aneurysms, and hydronephrosis.
Presentation1.pptx, radiological imaging of hydrocephalus.Abdellah Nazeer
This document discusses radiological imaging techniques for evaluating hydrocephalus. It describes various imaging findings in different types of hydrocephalus like congenital hydrocephalus and hydrocephalus secondary to tumors. It focuses on techniques for evaluating normal pressure hydrocephalus (NPH), including phase contrast MRI to quantify cerebrospinal fluid flow. It hypothesizes that NPH may be caused by a combination of naturally enlarged ventricles and later deep white matter ischemia restricting CSF flow, leading to symptomatic hydrocephalus. Quantitative CSF flow studies can help diagnose shunt-responsive NPH.
This document provides an overview of brain anatomy, beginning with the structures of the skull and meninges. It describes the major divisions of the brain including the forebrain, midbrain, and hindbrain. It outlines the lobes of the cerebral hemispheres and internal structures such as the basal ganglia and corpus callosum. Key structures such as the ventricles and cisterns are identified. The rest of the document illustrates various sections of the brain with labeled diagrams and MRI images.
1) The document describes the MRI anatomy of the shoulder, highlighting key supporting structures like the rotator cuff muscles and tendons.
2) It examines the shoulder in different planes including axial, coronal, and sagittal views, and provides a checklist of structures and pathologies to evaluate in each view.
3) Special attention is given to evaluating common shoulder injuries like labral tears and rotator cuff tears using specialized views like the ABER position.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Presentation1.pptx, radiological anatomy of the brain and pituitary glandAbdellah Nazeer
The document summarizes the normal radiological anatomy of the brain and pituitary gland as seen on computed tomography (CT) and magnetic resonance imaging (MRI). It describes the overall structure of the brain, including the cerebrum, cerebellum, brainstem, and four ventricles. It details the anatomy of the lateral, third, and fourth ventricles. It then outlines the major lobes and gyri of the cerebral hemispheres, including important motor and sensory areas. The document concludes by reviewing sectional anatomy as seen on axial CT and MRI scans.
PI-RADS is a structured reporting scheme for evaluating the prostate for prostate cancer using multi-parametric MRI. Version 2 of PI-RADS (PI-RADSv2) was created by a joint committee to standardize terminology and simplify reporting. It aims to improve cancer detection, localization, characterization, and risk stratification. PI-RADSv2 uses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging to assess different areas of the prostate and assigns a score to help determine need for biopsy or treatment. It provides a standardized way to evaluate prostate MRI but has limitations such as not addressing other cancer scenarios or prescribing technical parameters.
This chapter defines an epileptic seizure as transient abnormal neuronal activity in the brain. Around 5% of people experience seizures in their lifetime, with incidence highest in infants and elderly adults. Epilepsy is defined as recurrent seizures and the consequences of this condition. A diagnosis of epilepsy can be made after one seizure if EEG or MRI findings indicate increased epileptogenicity. Drug-resistant epilepsy persists despite adequate treatment with two tolerated anti-seizure medications. Seizure freedom requires being seizure-free for at least one year while on medication.
On the occasion of National Epilepsy Day 2014, Dr. Rama Krishnan gave a talk titled "Integrated Diagnostics – A Unique Epilepsy Approach" at the Epilepsy Knowledge Forum in Chennai organised by Neurokrish & Trimed and Sponsored Medall.
Presentation1.pptx, radiological imaging of spinal dysraphism.Abdellah Nazeer
This document discusses radiological imaging in spinal dysraphism. It describes how various imaging modalities such as radiography, ultrasound, CT, and MRI can be used to identify and characterize different types of spinal dysraphism including open dysraphism, closed dysraphism, lipomyelomeningocele, diastematomyelia, dermal sinus, and tethered cord. Examples of imaging findings for each condition are provided with representative images to illustrate the pathology.
This document contains descriptions of several pediatric medical cases involving children presenting with seizures, fever, vomiting, and other neurological symptoms. For each case, it lists key questions about the presenting symptoms, possible diagnoses, imaging findings, causative agents or etiologies, recommended treatments and management plans. The document also contains a list of various pediatric neurological conditions.
This document discusses various surgical approaches for pituitary adenomas. It begins with a brief history of pituitary surgery dating back to 1893. There are two main categories of approaches - extracranial (transnasal, transmaxillary) and intracranial (subfrontal, subtemporal). The transnasal transsphenoidal approach is the most common due to its advantages. Extended approaches are sometimes needed for large tumors. Complications can include CSF leaks, hormonal issues, and visual changes. Landmarks, techniques, and closure methods are outlined for different procedures. Indications for alternative approaches like transcranial are also summarized.
- A 14-year-old boy presented with worsening headaches, nausea, and vomiting and was found to have upward gaze palsy on examination.
- CT showed a mass in the pineal region engulfing a calcified pineal gland.
- Pineal region tumors can be germ cell tumors, pineal cell tumors, glial cell tumors, or other miscellaneous tumors.
- The presentation, imaging characteristics, biopsy results, and tumor markers would help determine if this is a germinoma or other type of pineal region tumor.
This document discusses a case study of a 60-year-old male patient who presented with left-sided hemiplegia and increased intracranial pressure. CT scans showed diffuse abnormalities in the left thalamus, internal capsule, and basal ganglia. A biopsy revealed a mixed grade III-IV astrocytoma. The patient received radiation therapy but died 4 months after diagnosis. The document then discusses characteristics and diagnosis of diffuse astrocytomas, their tendency to progress to higher grades over time, and challenges in treating thalamic gliomas.
Meningiomas account for 15% of all intracranial tumors and originate from the dura or arachnoid membranes. They are most common in middle-aged adults and affect women twice as often as men. Meningiomas are typically benign, slow-growing tumors that indent the brain as they enlarge. On CT imaging, meningiomas appear well-circumscribed, homogeneous, and hyperdense, and may induce hyperostosis of adjacent bone. MRI often reveals a characteristic "dural tail" sign of enhancement. Other histologic variants include hemangiopericytomas, which have a narrow dural attachment and lobulated shape.
This document contains CT images and descriptions of the anterior, middle, and posterior cranial fossae and infra-temporal fossa. In the anterior fossa, images show the cribriform plate, optic canals, and anterior clinoid processes. The middle fossa images display the foramen rotundum, ovale, spinosum, and greater and lesser sphenoid wings. The posterior fossa images highlight the jugular foramen, hypoglossal canal, foramen magnum, and condylar canals. The infra-temporal fossa images outline the carotid canal, jugular foramen, hypoglossal canal, mandibular condyle, and occipital bone.
This document discusses disorders of myelination. It begins by defining myelin and its functions, describing normal myelination milestones. It then covers various white matter disorders including dysmyelination, hypomyelination, and delayed myelination. Specific leukodystrophies are discussed in more detail such as Canavan's disease, Alexander disease, Van der Knapp disease, and glutaric aciduria type 1. Clinical features, imaging findings, and pathology are described for each condition. The document provides an overview of disorders of myelination.
This document summarizes evidence from 27 trials involving over 10,000 participants on the safety and efficacy of clot-dissolving drugs (thrombolytics) such as alteplase for treating acute ischemic stroke. The trials compared thrombolytics administered intravenously or intra-arterially within 4.5 hours of stroke onset to placebo or no treatment. Thrombolytics were found to improve outcomes after stroke but also increase the risk of serious bleeding in the brain. While thrombolytics can restore blood flow and reduce brain damage if given promptly, the risks and benefits were shown to depend on the time since stroke onset.
This document contains 20 quiz cases related to neuroimaging. Each case provides the radiological sign, associated condition, and brief description. The cases cover a wide range of neurologic conditions seen on CT and MRI, including infections, demyelinating diseases, vascular abnormalities, tumors and developmental anomalies. Key information about the featured conditions is also summarized.
This document provides information on performing and interpreting renal Doppler ultrasounds. It discusses the optimal approaches for imaging the renal arteries, including the anterior, oblique, and flank approaches. It also outlines criteria for evaluating renal artery stenosis, including peak systolic velocity measurements and the renal-aortic ratio. Common renal pathologies that can be identified with Doppler ultrasound are also summarized, such as fibromuscular dysplasia, atherosclerosis, aneurysms, and hydronephrosis.
Presentation1.pptx, radiological imaging of hydrocephalus.Abdellah Nazeer
This document discusses radiological imaging techniques for evaluating hydrocephalus. It describes various imaging findings in different types of hydrocephalus like congenital hydrocephalus and hydrocephalus secondary to tumors. It focuses on techniques for evaluating normal pressure hydrocephalus (NPH), including phase contrast MRI to quantify cerebrospinal fluid flow. It hypothesizes that NPH may be caused by a combination of naturally enlarged ventricles and later deep white matter ischemia restricting CSF flow, leading to symptomatic hydrocephalus. Quantitative CSF flow studies can help diagnose shunt-responsive NPH.
This document provides an overview of brain anatomy, beginning with the structures of the skull and meninges. It describes the major divisions of the brain including the forebrain, midbrain, and hindbrain. It outlines the lobes of the cerebral hemispheres and internal structures such as the basal ganglia and corpus callosum. Key structures such as the ventricles and cisterns are identified. The rest of the document illustrates various sections of the brain with labeled diagrams and MRI images.
1) The document describes the MRI anatomy of the shoulder, highlighting key supporting structures like the rotator cuff muscles and tendons.
2) It examines the shoulder in different planes including axial, coronal, and sagittal views, and provides a checklist of structures and pathologies to evaluate in each view.
3) Special attention is given to evaluating common shoulder injuries like labral tears and rotator cuff tears using specialized views like the ABER position.
Its important to recognise the myelination pattern in neonates and infants. This presentation talks about the myelination pattern and imaging of white matter diseases in children.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Presentation1.pptx, radiological anatomy of the brain and pituitary glandAbdellah Nazeer
The document summarizes the normal radiological anatomy of the brain and pituitary gland as seen on computed tomography (CT) and magnetic resonance imaging (MRI). It describes the overall structure of the brain, including the cerebrum, cerebellum, brainstem, and four ventricles. It details the anatomy of the lateral, third, and fourth ventricles. It then outlines the major lobes and gyri of the cerebral hemispheres, including important motor and sensory areas. The document concludes by reviewing sectional anatomy as seen on axial CT and MRI scans.
PI-RADS is a structured reporting scheme for evaluating the prostate for prostate cancer using multi-parametric MRI. Version 2 of PI-RADS (PI-RADSv2) was created by a joint committee to standardize terminology and simplify reporting. It aims to improve cancer detection, localization, characterization, and risk stratification. PI-RADSv2 uses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging to assess different areas of the prostate and assigns a score to help determine need for biopsy or treatment. It provides a standardized way to evaluate prostate MRI but has limitations such as not addressing other cancer scenarios or prescribing technical parameters.
This chapter defines an epileptic seizure as transient abnormal neuronal activity in the brain. Around 5% of people experience seizures in their lifetime, with incidence highest in infants and elderly adults. Epilepsy is defined as recurrent seizures and the consequences of this condition. A diagnosis of epilepsy can be made after one seizure if EEG or MRI findings indicate increased epileptogenicity. Drug-resistant epilepsy persists despite adequate treatment with two tolerated anti-seizure medications. Seizure freedom requires being seizure-free for at least one year while on medication.
On the occasion of National Epilepsy Day 2014, Dr. Rama Krishnan gave a talk titled "Integrated Diagnostics – A Unique Epilepsy Approach" at the Epilepsy Knowledge Forum in Chennai organised by Neurokrish & Trimed and Sponsored Medall.
This document discusses temporal lobe epilepsy and the MRI protocol for evaluating epilepsy. It notes that temporal lobe epilepsy is the most common form of epilepsy in adults and involves structures of the mesial temporal lobe like the hippocampus. The key MRI findings of hippocampal sclerosis include hippocampal atrophy on T1-weighted images, increased signal on T2-weighted and FLAIR images due to increased water content, and secondary findings like enlargement of the temporal horn and thinning of the fornix. The described MRI protocol for epilepsy includes T1-weighted, coronal FLAIR, and T2-weighted axial and coronal sequences.
Presentation1.pptx. radiological imaging of epilepsy.Abdellah Nazeer
1) Hippocampal sclerosis, characterized by hippocampal atrophy and increased signal intensity on MRI, is the most common epileptogenic abnormality found after epilepsy surgery.
2) Malformations of cortical development, including focal cortical dysplasias and heterotopias, are also common epileptogenic lesions found in surgical series, especially in patients with childhood-onset seizures.
3) In addition to structural abnormalities, low-grade gliomas and hamartomas located near the cerebral cortex are also important causes of drug-resistant epilepsy that may require surgery.
This document discusses imaging in medial temporal lobe epilepsy. It begins by explaining why MRI is important for detecting epileptogenic lesions in refractory cases. It then describes the anatomy of medial temporal lobe structures like the hippocampus and amygdala. The document discusses how hippocampal sclerosis appears on MRI, including features like gliosis, neuronal loss, and atrophy. It also covers other imaging modalities that can help lateralize the seizure focus, such as hippocampal volumetry, relaxometry, MRS, PET, and SPECT. In conclusion, MRI is the best way to diagnose mesial temporal sclerosis by identifying hippocampal hyperintensity and atrophy.
1) The document discusses several types of neoplasms that can arise intraventricularly, including medulloblastoma, ependymoma, subependymoma, and choroid plexus tumors.
2) Medulloblastoma most commonly presents in the roof of the fourth ventricle in children, while ependymoma can occur in any age and location.
3) Imaging plays an important role in the diagnosis and characterization of intraventricular masses, with MRI providing the best visualization of location and extent of disease.
This document discusses retinopathy of prematurity (ROP), a disorder in premature infants where abnormal blood vessel growth occurs in the retina. It begins with definitions and embryology of the retina and retinal vasculature. Key points include that the retina remains avascular until the 4th month of gestation, and develops its mature vascular pattern by 5 months after birth. The document then covers the historical perspectives of ROP, pathogenesis involving oxygen and growth factors, classification system involving zones/stages/plus disease, risk factors like low birth weight and oxygen therapy, and recent advances.
This document provides an overview of CT and MRI interpretation for various neurological conditions. It begins with examples of MRI sequences showing normal brain anatomy and proceeds to discuss key pathologies including infarction, hemorrhage, infection, tumors, trauma, dementia, multiple sclerosis, epilepsy, and cranial neuropathies. For each condition, representative imaging findings are presented and briefly described to aid in diagnosis and clinical management. The document serves as an educational guide for interpreting neuroimaging studies.
Ultrasonography is the most valuable imaging modality for evaluating the thyroid gland. It is a simple, non-invasive exam that allows visualization of the thyroid anatomy and assessment of focal lesions. Normal thyroid gland appears homogeneous and mildly hypoechoic relative to surrounding tissues, with few small blood vessels visible on Doppler. Common benign thyroid findings include nodules, colloid cysts, and inflammatory nodules from chronic thyroiditis. Malignant nodules tend to have irregular margins, microcalcifications, and increased vascularity but appearance alone is not definitive.
The hippocampus is located in the medial temporal lobe and plays an important role in memory formation and emotion. It helps transfer information from short-term to long-term memory. Damage to the hippocampus is linked to memory loss and cognitive impairments seen in conditions like Alzheimer's disease and epilepsy. The hippocampus also appears to shrink in patients with schizophrenia and severe depression.
Nuclear medicine techniques such as radioactive iodine scans and therapy are important in evaluating and treating thyroid diseases. Radioactive iodine is selectively taken up and concentrated in the thyroid gland, allowing functional imaging and selective internal radiotherapy for hyperthyroidism and thyroid cancer. Radioactive iodine therapy is the primary treatment for Graves' disease and toxic multinodular goiter. It is also used to ablate residual thyroid tissue after surgery and treat thyroid cancer metastases. Precautions must be taken after radioactive iodine therapy to limit radiation exposure to others.
A variety of neoplasms can arise in the ventricular system, including ependymomas, medulloblastomas, subependymomas, central neurocytomas, subependymal giant cell astrocytomas (SGCA), choroid plexus papillomas, choroid plexus carcinomas, and intraventricular meningiomas. These lesions present variably with increased intracranial pressure, focal neurologic deficits, or incidentally found on imaging. Location within the ventricles and patient age, gender, and underlying conditions can help narrow the differential diagnosis.
This document discusses hydatid disease, caused by a tapeworm that infects dogs, dingoes and foxes. It forms cysts in the internal organs of intermediate hosts like humans, especially the liver and lungs. The disease requires surgery for treatment. Control involves eliminating the tapeworm from dogs. With better control in livestock and dogs, wildlife are becoming a relatively more important threat to human health. Symptoms vary depending on the infected organ, such as jaundice and pain for liver involvement, and coughing for lung cysts. Prevention focuses on hygiene and deworming dogs. The document then examines clinical signs and images of hydatid cysts in various body organs.
Hyperparathyroidism exists in three different forms: primary, secondary and tertiary. Primary hyperparathyroidism (pHPT) is the most frequent pathological condition of the parathyroid glands and one of the most frequent endocrine disorders overall. The most probable location of parathyroid gland is posterior to the thyroid gland. The parathyroid glands produce parathyroid hormone (PTH), which is important for maintaining calcium, phosphate and vitamin D homeostasis, and ultimately bone health.
Primary hyperparathyroidism is characterized by increased production and secretion of parathyroid hormone. This condition causes nephrocalcinosis, urolithiasis, osteoporosis, gastrointestinal disturbances, neuromuscular manifestation and neuropsychiatric disorders. Parathyroidectomy is the only curative treatment for pHPT. pHPT is typically caused by a solitary parathyroid adenoma (80%-90%), hyperplasia (10%) and less frequently parathyroid carcinoma (5%).
Secondary hyperparathyroidism develops as a consequent to a chronic hypocalcemic condition that can be caused by renal failure, gastroinstinal malabsorption, dietary rickets and ingestion of drugs. Secondary hyperparathyroidism is a frequent and serious complication in haemodialysis patients. Tertiary hyperparathyroidism is a condition where parathyroid hyperplasia, secondary to chronic hypocalcemia, becomes autonomous with development of hypercalcemia. Tertiary hyperparathyroidism is used to designate hyperparathyroidism that persists or develops after renal transplantation.
Localization of hyperfunctioning parathyroid tissue (adenomas or hyperplasia) in primary hyperparathyroidism is useful before surgery to help the surgeon localize the lesion, thus shortening the time of the procedure. Parathyroid glands can be imaged with multiple modalities, including scintigraphy, high-resolution ultrasonograhy, thin-section CT and MRI. Parathyroid scintigraphy may also be indicated for localization of hyperfunctioning parathyroid tissue in patients with persistent or
recurrent disease. For this situation scintigraphy is superior to any other radiological modalities, including MRI, CT scan, ultrasonography combined with needle aspiration and also some invasive techniques like arteriography, selective venography and mediastinoscopy.
The document discusses thyroid ultrasound techniques, anatomy, pathologies, and diseases. It provides details on:
1. Indications for thyroid ultrasound including evaluating nodules, diffuse changes, and post-operative evaluation.
2. Techniques including using a high-frequency linear probe in transverse and longitudinal planes with color Doppler.
3. Common pathologies include multinodular goiter, Hashimoto's thyroiditis, Graves' disease, and thyroid cancers. Features helpful for characterizing benign versus malignant nodules are described.
The hippocampus is located in the medial temporal lobe beneath the cortex and plays important roles in converting short-term to long-term memory, emotions, navigation, and spatial orientation. Studies have shown that severe stress in children can decrease hippocampal size by increasing stress hormones like cortisol. Long-term ecstasy use was also found to damage the hippocampus, with users' hippocampi being 10.5% smaller than average for alcoholics. Higher physical fitness in children has been correlated with larger hippocampal size likely due to increased growth of neurons and cell survival. Damage to the hippocampus can cause amnesia and difficulties learning and remembering, and may contribute to the development of Alzheimer's disease.
The hippocampus is located in the medial temporal lobe below the cortex and plays an important role in memory consolidation, emotions, navigation, and spatial orientation. Three studies were summarized. The first found that more physically fit children had a larger hippocampus. The second found that long-term ecstasy users had a smaller hippocampus. The third found that Gulf War veterans who had recovered from PTSD had larger hippocampal volumes than those who had not recovered. Damage to the hippocampus can cause amnesia or memory loss and may eventually lead to Alzheimer's disease.
This document discusses radionuclide imaging of the thyroid and parathyroid glands. It describes the use of various radiotracers like I-123, I-131, Tc-99m pertechnetate, and Tc-99m MIBI in thyroid scans, thyroid uptake measurements, and parathyroid scans to evaluate conditions like hyperthyroidism, thyroid nodules, thyroid cancer, and hyperparathyroidism. Imaging findings are presented for different pathological cases. Preparation, technique, interpretation and clinical indications for these nuclear medicine procedures are provided.
Thyroid lesions – evaluation with sonographyDR Laith
This document discusses the evaluation of thyroid lesions using sonography. It outlines common thyroid disorders such as enlargement, nodules, hyperthyroidism and hypothyroidism. Imaging approaches like ultrasound, thyroid scintigraphy, CT and MRI are discussed. Sonography can detect masses, cysts, calcifications, tissue texture changes and cervical lymph nodes. Benign lesions like cysts, hematomas, and inflammatory conditions are described. Malignant lesions like papillary carcinoma are also outlined, noting features like ill-defined margins, hypoechogenicity, microcalcifications, hypervascularity and cervical lymph node involvement. Thyroid nodule isotope scans can identify hot or cold nodules.
This document discusses imaging of acute stroke. It begins by describing the pathophysiology and classifications of stroke. CT and MRI are the main imaging modalities used to image acute stroke. CT is useful for ruling out hemorrhage and detecting early signs of ischemia. MRI, particularly DWI and perfusion imaging, can more accurately detect the ischemic core and penumbra. These imaging techniques help determine treatment and prognosis. Angiography via CTA, MRA, or DSA may also be used to identify vessel occlusions. The goal of acute stroke imaging is to establish a diagnosis, identify revascularization targets, and guide acute treatment decisions.
Preoperative assessment of epilepsy clinical & radiological, eeg, megDr Fakir Mohan Sahu
Preoperative Assessment of Epilepsy and their localization, clinical semiology and Radiological evaluation MRI imaging, Video EEG MEG SPECT PET and patient management conference explained in simplified way
Recent Modalities of Neuro-imaging discusses various imaging techniques used to image the brain and spinal cord, including:
- Computed tomography perfusion which uses contrast to generate maps of cerebral blood flow, volume, and transit time to identify ischemic tissue.
- Myelography which uses intrathecal contrast for spinal imaging.
- Magnetic resonance techniques like quantitative MRI, diffusion tensor imaging, and MR spectroscopy which provide microstructural data on tissues.
- Perfusion imaging uses ultrasound contrast to assess cerebral blood flow.
Imaging findings are discussed for conditions like multiple sclerosis, epilepsy, and stroke.
differentiating different brain lesion using MR Spectroscopy which is a newer MR technique to quantify different metabolites present within the lesion and adjacent parenchyma
Brief description of various neuroimaging modalities used in psychiatry which help in early detection, diagnosis and treatment of various neuropsychiatric disorders.
This document discusses craniospinal irradiation (CSI) techniques. It defines CSI as radiation delivered to the entire cranial-spinal axis. The document outlines the indications for CSI including various types of brain tumors. It then discusses the challenges of CSI due to the large irregular target volume and proximity to critical structures. The document focuses on the 3D conformal technique in supine position used at the author's department. It describes patient positioning, immobilization, simulation, target and organ at risk delineation, and treatment planning. Complications of CSI and the role of chemotherapy are also reviewed. Alternative CSI techniques like IMRT and proton therapy are mentioned but have limitations. Dosimetric studies find modern
01 suh brain anatomy, planning and delivery hyderabad 2013 (cancer ci 2013) j...Dr. Vijay Anand P. Reddy
This document provides an overview of brain anatomy, advances in radiation therapy treatment planning and delivery for brain tumors, and methods to focus radiation dose on tumors while minimizing dose to healthy brain tissue. It discusses contouring important brain structures, use of imaging like CT and MRI in treatment planning, and the evolution of techniques like intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). It also reviews stereotactic radiosurgery and different technologies used like Gamma Knife and linear accelerators. The document concludes that understanding brain anatomy and dose constraints is essential for optimizing radiation delivery for brain tumors.
Neuroimaging of Alzheimer’s disease and Healthy Aging
BY DR WASIM
UNDER THE GUIDANCE OF
DR R.K.SOLANKI
ANATOMICAL BRAIN IMAGING
CT – cerebral tomography
MRI – magnetic resonance imaging
FUNCTIONAL BRAIN IMAGING
SPECT – single photon emission computed tomography
PET – FDG – Positron emission tomography
BRAIN CHEMISTRY MEASUREMENT
MRS (spectroscopy – NAA/Cr: estimate neuronal volume)
BRAIN PATHOLOGY IMAGING
FDDNP – neurofibrillary pathology
Evolution of Neuroimaging in AD
Computed Tomography
MRI
Volumetric MRI
Functional MRI
FDG Glucose PET
Amyloid Imaging
FDG-PET in AD and MCI
Dr. Ra'ed Ahmed discusses investigations of neurological diseases. He describes how history alone makes 90% of diagnoses but investigations may include imaging like CT and MRI to assess structure, neurophysiology to assess function, CSF analysis, and other tests. He provides details on various neuroimaging techniques including their indications, advantages, disadvantages, and interpretation. Neurophysiological tests like EEG, EMG, and evoked potentials are described. Lumbar puncture for CSF analysis is also outlined.
This document summarizes experiments on avascular necrosis of the femoral head. It discusses diagnostic experiments including MRI diagnosis and isotope scanning. It also discusses non-surgical interventions such as restricted weight bearing, pharmacological agents, hyperoxygenation, bisphosphonates, and core decompression with adjunct therapies. Surgical interventions discussed include core decompression, core decompression with bone morphogenetic protein and autologous bone marrow, and total hip replacement for advanced cases.
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerve...InsideScientific
A New Frontier of Precision Medicine: Using PET for Image-Guided Neurointerventions
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ON DEMAND
Experts discuss how PET/CT imaging can be used to enable image-guided neurointerventions and to study targeted delivery and clearance of therapeutic agents.
WATCH WEBINAR
Mice are by far the most frequently used animal for modeling disease and developing therapeutic strategies including neurointerventions. However, due to its anatomical and physiological barriers, the brain is a difficult target for delivery of therapeutic agents. Systemic administration is plagued with marginal brain accumulation and high risk of off-target side effects.
In this webinar sponsored by Scintica Instrumentation, Dr. Piotr Walczak, Dr. Mirosław Janowski and Dr. Wojciech Lesniak address this challenge and discuss why advanced imaging is essential to perform image-guided neurointerventions.
First, Dr. Janowski provides rationale as to how imaging can be used to better understand how therapeutic agents are delivered to the brain and subsequently cleared. Next, Dr. Walczak reviews methodological and technological advances for improving precision and reproducibility of brain targeting in mice based on MRI and two-photon microscopy. Finally, Dr. Lesniak presents recently-published results using ARGUS PET/CT to quantify intra-artrial delivery of antibodies, nanobodies and poly(amidoamine) dendrimers.
Key Learning Objectives Include:
- Why advanced imaging is essential to perform image-guided neurointerventions
- Why we need to visualize not only penetration of therapeutic agents to the brain, but also their clearance
- How image-guided procedures can be used to visualize and optimize delivery of therapeutic agents to the brain
This document discusses the management of primary central nervous system lymphoma (PCNSL). It begins with defining PCNSL and discussing its epidemiology, which includes that it is a rare brain tumor with an increasing incidence in immunocompromised patients. The standard treatment involves high-dose methotrexate-based chemotherapy followed by whole brain radiotherapy, which provides the best outcomes compared to other regimens. Prognostic scoring systems can help determine a patient's prognosis based on factors like age, performance status, lactate dehydrogenase levels, and tumor location. Ongoing research is evaluating adding agents like cytarabine, thiotepa, and rituximab to standard chemotherapy regimens to improve survival further
This document provides information on supratentorial brain tumors, including:
1. It describes the normal anatomy of the brain including the supratentorial and infratentorial components.
2. It discusses the incidence, classification, and common signs/symptoms of supratentorial tumors.
3. It outlines the diagnostic workup for brain tumors including imaging studies, biopsy procedures, and cytology examinations.
This document summarizes research on correlating MRI findings with neuropathological features in multiple sclerosis (MS). Key points include:
- MRI techniques like MTR can detect myelin and axonal loss validated by histology. Non-lesional white matter shows more extensive pathology than just lesions.
- Cortical grey matter also shows demyelination, neuronal loss, and atrophy correlated with disability.
- Spinal cord pathology including diffuse axonal loss and myelin damage contributes to disability, not just atrophy.
- Validating MRI with post-mortem tissue is important for diagnosis, predicting disease progression, and understanding substrates of disability in MS.
The document discusses various neuroimaging techniques used to study the brain, including their basic principles and psychiatric applications. It describes CT, MRI, MRS, fMRI, and SPECT, explaining what each measures, how they work, and what tissues appear as on the images. It provides examples of structural images and contrasts the advantages and disadvantages of the different modalities. It also outlines specific indications for neuroimaging in clinical practice and research into psychiatric disorders.
The document discusses various topics related to neurology including:
1. Common neurological disorders such as headache, low back pain, and stroke.
2. Components of a neurological examination including signs, reflexes, and tests of sensory and motor function.
3. Diagnostic tools used in neurology such as CT, MRI, angiography, EEG, lumbar puncture, and PET.
4. Types of disturbances of consciousness including those caused by brainstem or cortical damage.
5. Criteria for determining brain death.
MRI markers to understand progression mechanisms by Maria A. Rocca
Neuroimaging Research Unit, Institute of Experimental
Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Leptomeningeal carcinomatosis is the infiltration of malignant cells into the leptomeninges, which is the protective layers surrounding the brain and spinal cord. It occurs in 5% of cancer patients and most commonly spreads from primary cancers of the breast and lung. Clinical presentation involves neurological symptoms affecting the brain, cranial nerves, and spinal cord. Diagnosis is made through lumbar puncture and imaging of the craniospinal axis. Treatment aims to palliate symptoms and improve survival through radiotherapy targeting symptomatic areas and CSF flow pathways. Craniospinal irradiation provides wider treatment but is associated with acute and late toxicities. Localized radiotherapy to specific sites offers additional palliation with reduced side effects.
ECoG involves placing electrodes directly on the surface of the exposed brain to record electrical activity with greater spatial resolution than traditional EEG. The document discusses using ECoG to monitor spreading depolarizations, waves of sustained neuronal depolarization that can propagate through brain tissue. Studies found spreading depolarizations commonly occur after traumatic brain injury and are associated with worse outcomes. ECoG may help guide individualized treatment by continuously monitoring these depolarizations in neuroICU patients.
Similar to Neurology advanced mr imaging in epilepsy v lai (20)
This document discusses interventional radiology techniques for renal tumors, including biopsy and radiofrequency ablation (RF). It first covers using biopsy for diagnosing small solid renal tumors, noting its accuracy and importance for determining appropriate treatment. RF is then discussed as a treatment option for renal tumors. The technique, evaluation criteria pre-procedure, expected results from studies showing effectiveness rates of 80-90% and predictive factors for success, and post-procedure follow up are summarized. RF ablation is indicated for tumors under 4 cm, especially if exophytic or in high-risk patients.
This document discusses the use of MRI in staging cervical cancer according to the FIGO staging system. It provides details on the MRI protocol, what areas to evaluate for tumor extension, and the accuracy of MRI findings. Key areas MRI can evaluate include parametrial invasion, vaginal involvement, pelvic sidewall extension, hydronephrosis, and lymph node status. Accuracy is high for staging tumor extension locally and detecting lymph node metastases.
Urology gynecology correlative imaging of gynecological diseases t lamJFIM
This document discusses the use of correlative imaging techniques for gynecological diseases. It provides examples of using structural imaging like MRI and CT to detail anatomy and lesion characteristics. It also explores tissue characterization to differentiate tissues and tumors. Cancer staging is discussed, highlighting how imaging can accurately assess tumor extent and involvement of surrounding structures. Functional imaging techniques like PET/CT are also summarized for evaluating tumor response to treatment and detecting metastases in ovarian and other gynecological cancers.
Urology gynecology anapath et imagerie c balleyguierJFIM
This document discusses how to assess benignity in rare ovarian tumors using imaging and pathology. It notes that imaging alone can nearly never determine benignity, except for some functional ovarian lesions, fibrous tumors, and mature teratomas. Pathology is nearly always needed to avoid misdiagnosis, especially for functional lesions. The document provides examples of imaging findings that suggest benignity for certain tumor types like ovarian fibromas and dermoid cysts. It also discusses imaging features that may indicate malignancy and provides examples of rare malignant ovarian tumors.
MDCT plays an expanding role in planning various cardiovascular procedures such as PCI, TAVI, LAA closure, and cardiac resynchronization by identifying high-risk anatomical features. MDCT is useful for planning re-do cardiac surgery and evaluating para-prosthetic valve leaks. Key findings on MDCT can impact surgical approach and reduce risks for re-do procedures. MDCT also helps guide percutaneous treatments for para-prosthetic leaks.
This document discusses various imaging modalities used to image non-small cell lung carcinoma (NSCLC) including anatomical, functional, and molecular imaging. It describes the evolution of imaging from the 1980s using X-ray and CT to visualize anatomy, to current use of functional imaging techniques like dual-energy CT, diffusion-weighted MRI, and PET-CT to provide information on tissue characteristics and metabolism. These advanced imaging methods help evaluate NSCLC for diagnosis, staging, assessing treatment response and detecting recurrence compared to anatomical imaging alone.
Thorax cardio coeur heart evaluation asymptomatic smoker p douekJFIM
The document discusses cardiovascular risk assessment in asymptomatic patients, specifically evaluating a 50-year-old asymptomatic smoker using coronary artery calcium scoring. Coronary artery calcium scoring can help reclassify patients' risk levels compared to traditional risk models and may lead patients to modify risk factors or receive preventative treatments. However, calcium scoring has limitations and its ability to improve outcomes beyond risk factor modification requires further study.
Thorax cardio chest imaging in up to 50 year old non symptomatic smoker g fer...JFIM
Chest imaging in asymptomatic smokers aged 50 and under can identify both normal aging changes in the lungs as well as potentially serious conditions. Normal aging changes include bronchial dilation, enlarged alveolar spaces, and pulmonary cysts in over 25% of those over age 75. Potentially serious conditions identified include emphysema, respiratory bronchiolitis, interstitial lung disease such as NSIP and UIP patterns, and air trapping. Screening studies have found that both the prevalence and progression of interstitial lung abnormalities are higher in current smokers. Low-dose CT is now recommended for lung cancer screening in smokers aged 55-74 with at least 30 pack-year history.
Thorax cardio adult dyspnea imaging g ferrettiJFIM
The document discusses dyspnea (shortness of breath), which is a common symptom in patients presenting to the emergency department with thoracic diseases. High-resolution computed tomography (HRCT) is highlighted as the best non-invasive tool for evaluating dyspnea, as it can identify underlying causes such as emphysema, asthma, pulmonary embolism, and interstitial lung diseases. The document presents several case examples where HRCT provided a diagnosis when other tests were nondiagnostic or revealed atypical features of diseases. HRCT is particularly useful when initial clinical exams and tests fail to identify a cause of dyspnea.
This document discusses subarachnoid hemorrhage (SAH), providing information on epidemiology, clinical presentation, causes, imaging techniques, and complications. It can be summarized as follows:
SAH most commonly results from a ruptured intracranial aneurysm (80% of cases), with imaging playing a key role in confirming the presence of SAH, identifying its cause, and detecting complications. CT and CT angiography are the initial imaging modalities, allowing diagnosis of SAH in 95% of cases as well as characterization of aneurysms. MR angiography and cerebral angiography provide alternatives for evaluating SAH of unknown origin or atypical presentations. Managing SAH requires a multidisciplinary approach including emergency
This document provides an overview of multi-modality imaging techniques for dementia. It discusses how dementia is an umbrella term used to describe cognitive disorders caused by specific diseases and conditions. Alzheimer's disease accounts for about 60% of dementia cases. Imaging plays an important role in the diagnosis and evaluation of dementia subtypes. Standard MRI is the primary imaging method and can detect features of various dementias like hippocampal atrophy in Alzheimer's disease or white matter lesions in vascular dementia. Advanced MRI techniques and other modalities like PET are also discussed. The document reviews what constitutes normal age-related brain changes versus abnormalities seen in different neurodegenerative dementias.
1) The document describes cerebrospinal fluid (CSF), including its production in the choroid plexus at a rate of 20 cm3/h, composition, flow through the ventricles and absorption via arachnoid granulations into the dural sinuses.
2) It then discusses two clinical cases of young women presenting with headaches and the differential diagnoses of intracranial hypotension and idiopathic intracranial hypertension.
3) Intracranial hypotension is described as being caused by a CSF leak leading to decreased CSF volume and pressure, with characteristic MRI findings of dural enhancement and venous distension.
This document provides an overview of cerebral vein anatomy and pathology. It describes the external cortical veins that drain into the superior sagittal sinus and internal veins like the vein of Galen. Common pathologies involving cerebral veins include thrombosis of the superior cerebral veins which can cause seizures or bleeding. Malformations of the vein of Galen like aneurysms can cause heart failure in newborns or neurological issues in older children.
1. Arterial spin labeling (ASL) is an MRI technique for assessing cerebral blood flow non-invasively and without the need for contrast agents.
2. ASL uses radiofrequency pulses to magnetically label arterial blood water protons upstream of the imaging region. Images are then acquired with and without labeling to quantify perfusion.
3. ASL acquisitions suffer from low signal-to-noise but various techniques like continuous, pulsed, and pseudo-continuous labeling as well as higher field strengths and multichannel coils have been used to improve quality.
This document discusses imaging of the sacroiliac joint, including radiography and MRI findings. It begins with an overview of sacroiliac joint anatomy. It then describes common radiographic views and classifications of sacroiliac joint damage. The document focuses on using MRI to identify inflammatory lesions in the sacroiliac joints that can indicate early spondyloarthritis. It discusses how stopping NSAIDs before MRI may have little impact on findings. Repeating sacroiliac MRI months later generally does not reveal new cases, except possibly in HLA-B27 positive men. The document recommends sacroiliac MRI over spine MRI alone for axial spondyloarthritis workup given the low yield of isolated spinal findings without sac
This document discusses bone tumors of the pelvis based on a study of 3,398 cases from a bone tumor institute in Italy between 1900-2012. It finds that the most common tumors were primary malignant tumors (40.7%), followed by bone metastases (24.9%), benign tumors (25.4%), and systemic tumors (9.0%). For benign tumors, the most frequent diagnoses were osteochondroma and bone cysts. Examples of specific benign and malignant bone tumors are also presented along with imaging findings.
1. The document discusses the anatomical evolution of the pelvis in primates and humans from quadrupedal to bipedal locomotion.
2. Key anatomical adaptations that enabled human bipedalism include the development of a specialized human foot, a long femoral neck, and a pelvis optimized for weight bearing stability over mobility.
3. The human pelvis and hip joint are uniquely adapted among primates for an upright, bipedal stance and gait under the compressive forces of standing, with implications for conditions like hip osteoarthritis.
The document summarizes a presentation on image-guided musculoskeletal (MSK) interventions. It discusses various core MSK interventions like joint aspiration and injection as well as more advanced procedures. It emphasizes using readily available imaging equipment and low-cost instruments. The goal is to provide high-quality "wrap-up" images to demonstrate expertise to referrers and patients.
This document provides an overview of hip imaging and common hip pathologies. It discusses early onset osteoarthritis, hip dysplasia, femoroacetabular impingement, labral tears, cartilage damage, and tendon injuries that can be seen on hip imaging. The document outlines techniques for evaluating the acetabulum, femoral head, labrum, cartilage and surrounding soft tissues. It also notes that many asymptomatic individuals may have incidental findings on hip imaging and that the level of activity plays a role in determining which morphological abnormalities become symptomatic.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
1. Advanced
MR
Imaging
in
Epilepsy
Dr.
Vincent
Lai
MBChB,
FRCR(UK),
FHKCR,
FHKAM(Radiology)
Consultant
Radiologist,
Hong
Kong
BapBst
Hospital
Honorary
Clinical
Assistant
Professor,
University
of
Hong
Kong
7. Are
we
doing
well?
ProblemaBc
issue
in
MR-‐negaBve
paBents
Does
this
really
exist?
8. Where
are
we
upto
?
• 2/3
of
MR
negaBve
paBents
have
idenBfiable
lesion
(oOen
subtle
MCD)
on
3.0
T
– Temporal
50%
– Frontal
40%
– Majority
is
FCD
Knake
S
et
al.
2005
Neurology
• 65%
of
drug
resistant
epilepsy
has
idenBfiable
lesion
– Frequently
MTS
Vezina
LG
2011
Epilepsia
17. Parahippocampus
Forms
mesial
&
inferior
gyrus
of
temporal
lobe
Includes:
Entorhinal
&
perirhinal
corBces
Parahippocampal
cortex
Contributes
to:
Seizure
iniBaBon
epileptogenesis
18. Parahippocampal
epilepsy
A
subset
of
MTLE
A
cause
of
MR-‐negaBve
MTLE
T2W
hyperintense
signal
in
parahippocmapal
WM
Blurring
of
GW
juncBon
Normal
corBcal
thickness
Pillay
N
er
al.
2009
Epilepsia
19. Challenging
Issue
GeneBc
Disrup:on
of
normal
cor:cal
development
Early
environmental
factors
Microdysgenesis
of
neocortex
or
subtle
MCD
Majority
of
MR-‐nega:ve
PET-‐posi:ve
cases
Mild MCD (I & II) in 12-40%: Carne RP et al. 2004 Brain; Huba R et al. 2012 Epliepsy & Behavior
23. T2
Relaxometry
T2
relaxaBon
Bme
↑
in
the
epilepBc
focus
Woermann
et
al.
1998;
Namer
et
al.
1998;
Van
Paesschen
et
al.
1995;
Jackson
et
al.
1993)
SuggesBon
of
superior
detecBon
rate
as
compared
with
volumetry
Bernasconi
A
et
al.
2000
Neuroimage
But
not
confirmed
in
later
and
recent
study
with
more
advanced
MR
volumetry:
– Improved
detec_on
rate
in
19%
of
pa_ents
only
Coan
AC
et
al.
2013;
AJNR
24. T2
Relaxometry
False
+ve
in
upto
50%
of
visually
detected
T2
signal
changes
in
hippocampus
Voxel
based
quan:ta:ve
analysis
is
more
reliable
Sumar I et al. 2011; Epilepsy research
25. MR
Volumetry
i.
Segmenta_ons
by
VBM
ii. Orienta_on-‐corrected,
spaBally
normalized,
Bssue
classified
iii. Par__on
the
whole-‐brain
to
GM,
WM
and
iv.
FIRST:
fieng
a
mesh
to
the
surface
of
the
amygdala
&
hippocampus
26. Manual
vs
automated
segmenta:on
In
a
study
of
46
paBent
Manual
method
vs
various
automated
methods
LocalInfo
>
HAMMER
>
FreeSurfer
LateralizaBon
accuracy:
Manual
(78%)
Automated
(74%)
Akhondi-Asl A et al. 2011 Neuroimage
27. Quan:ta:ve
MR
volumetry
in
hippocampal
atrophy
Automated
MR
volumetry
Hippocampal
asymmetry
(pa_ents
&
normal)
High
discriminaBng
power
Sensi_vity
89.5%;
Specificity
94.1%
LateralizaBon
accuracy:
88%
(visual
inspec_on:
76-‐85%)
Farid N et al. 2012 Radiology
28. ?
Performance
in
3T
In
a
study
of
203
paBents
with
hippocampal
sclerosis…
Help
↑
detec:on
rate
in
28%
of
pa:ents
with
hippocampal
sclerosis
Coan AC et al. 2013 AJNR
29. Pialls
reflects
a
combinaBon
of
cor:cal
thickness
&
surface
area
measurements
30. Morphological
analysis
Average
convexity
(Fischl
et
al.
1999)
Sharpness/
Curvedness/
Folding
index
(Pienaar
et
al.
2008)
GyrificaBon
index
(Schaer
et
al.
2008)
Sulcal
paiern
(Kim
et
al.
2008)
Shape
parameter
-‐
Jacobian
matrix
(Ronan
et
al.
2011)
Surface
area/geometric
distorBon
(Alhusaini
et
al.
2012)
Reflects changes in underlying connectivity and white matter tracts
31. So,
they
advocate…
Surface-‐based
MRI
morphometry
post-‐processing
surface
reconstruc_on
morphometric
measures
lesion
tracing
Sn
92%,
Sp
96%
Thesen T et al. 2011 Open Access
33. MRS
–
General
Principles
Molecules/
Metabolites
Func:on/
Clinical
relevance
NAA
Marker
of
neuronal
density
&
viability
Cr
Marker
for
energy–dependent
system
Cho
Marker
of
increased
inflammatory/glioBc
process
&
pathological
changes
in
membrane
turnover
Lactate
Elevated
aPer
seizure
&
in
hypoxia/ischemic
injury
Mitochondral
disorder
Glutamate
Major
excitatory
neurotransmiier,
toxic
if
elevated
leading
to
neuronal
death
ml
Marker
of
gliosis
34. Short
TE
(35
ms)
Long
TE
(144
ms)
Very
Long
TE
(288
ms)
Typical
Spectra
35. Single
vs
Mul:-‐voxel
Spectroscopy
Single-‐voxel
Higher
SNR
Short
acquisiBon
Bme
(~3
mins)
Metabolic
disease
1. 1
voxel
at
BG
2. 3
voxels
at
CS,
LN,
OP
cortex
Temporal
lobe
epilepsy
2
voxels
at
bilateral
hippocampi
Mul:-‐voxel
Larger
volume
of
informaBon
Long
acquisiBon
Bme
(~8
mins)
Allow
3D
acquisiBon
36. Technical
Considera:ons
• Higher
magneBc
field
strength
(higher
SNR)
• MulBchannel
(32-‐channel)
receiver
coils
(higher
SNR)
Keil
B
et
al.
2012
Magn
Reson
Med
• Shimming
(maximise
B0
homogeneity)
Kanayanma
S
et
al.
1996
Magn
Reson
Med;
Hetherington
HP
et
al.
2006
Magn
Reson
Med
• Fast
spiral
acquisiBon
(allow
fast
spa_al
encoding)
Andronesi
OC
et
al.
2012
Radiology
• AdiabaBc
pulses
(compensate
for
radiofrequency
inhomgeneity)
Garwood
M
et
al.
1989
Magn
Reson
Med;
Andronesi
OC
et
al.
2010
J
Magn
Reson
37. Role
of
MRS
Screening
of
metabolic
derangement
Adjuvant
in
evaluaBon
of
medically
refractory
TLE
CharacterizaBon
of
lesions/
masses
?Localizing
techniques
in
extratemporal
epilepsy
38. MRS
Screening
of
metabolic
derangement
Mitochondrial
disorders
↓ Cho
in
normal
appearing
cerebellar
WM
(80%)
peritrigonal
WM
(67%)
corBcal
GM
(60%)
↓ NAA/Cr
in
normal
appearing
cerebellum
(93%)
cortex
(87%)
↑
Amino
acids
&
Lactate
Bianchi C et al. 2003 AJNR
39. MRS
Screening
of
metabolic
derangement
EnzymaBc
disorders
Cr
deficiency
Prevalence:
0.25%
Inherited
enzymaBc
defects:
AGAT
GAMT
SLC6A8
↓ Cr
in
normal
brain
Arias A et al. 2007 Clin Biochem
40. MRS
Adjuvant
in
evaluaBon
of
medically
refractory
TLE
TLE
↓ NAA
↓
NAA/Cr
raBo
86%
agreement
with
EEG
(c.f.
83%
for
volumetry
with
EEG)
12%
in
MR-‐negaBve
TLE
Cendes F et al. 1997 Ann Neurol; Kuzniecky R et al. 1998 Neurology
41. MRS
CharacterizaBon
of
lesions/
masses
FCD vs
Neoplasm
FCD
↓ NAA/Cr
raBo
↑ GABA,
akanine,
tyrosine,
lactate,
inositol
No
elevaBon
in
Cho/NAA
Pathology:
type
IIB
FCD
Caruso PA et al. 2013 Neuroimag Clin N Am
42. MRS
CharacterizaBon
of
lesions/
masses
FCD
vs
Neoplasm
Astrocytoma
↓ NAA,
↑
Cho
↑
Cho/NAA
,
↓
NAA/Cr raBos
Pathology:
Angiocentric
astrocytoma
Caruso PA et al. 2013 Neuroimag Clin N Am
43. MRS
LocalizaBon
in
nonlesional
epilepsy
FCD
Using
MVS
&
subdural
electrodes
Areas
of
↑
Cho/NAA
&
↓
NAA/Cr
raBos
overlapped
with
ictal
zones
Krsek P et al. 2007 Eur Radiol
45. DTI
–
General
Principle
Measurement
of:
Magnitude
&
Direc:on
Of
water
diffusion
Indirect
evalua:on
of
integrity
of
axonal
microenvironment
anisotropic
47. FCD
Significant
reducBon
of
FA
in
underlying
subcorBcal
WM
HypomyelinaBon
?
SeneiBvity
Technical consideration: Tesla; no of gradient…
Gross DW et al. 2005 Can J Neurol Sci
48. MTLE
Widespread
WM
changes
↓ FA
values
PosiBve
correlaBon
with
hippocampal
volume
Scanlon C et al. 2013 J Neurol; Oquz KK et al. 2013; AJNR
49. Arterial
Spin
Labeling
Noninvasive
EvaluaBon
of
CBF
Interictal
–
hypoperfused;
Ictal
-‐
hyperperfused
Wolf et al. 2001 AJNR; Madan N et al. 2009 Epilepsia
50. Correla:on
with
Radionuclide
Imaging
15
children
18F-‐FDG
PET
and
DTI
MRI
Hypometabolism
correlates
with
DTI
indices
MR+ve
&
MR-‐ve
pa_ents
Lippe S et al. 2012 Epileptic disord
52. T1
rho
MR
Imaging
Provides
informaBon
on
slow
molecular
moBon
–
–
–
–
Transverse
magneBzaBon
of
T1
is
“locked”
by
spin-‐lock
frequency
Made
to
decay
slower
Followed
by
convenBonal
imaging
GeneraBon
of
T1rho
map
In
neuroimaging,
has
been
uBlized
in:
– Brain
tumors
– AD
and
Parkinson’s
disease
53. Hypothesis
&
Aim
Hypothesis:
T1
rho
imaging
is
able
to
reflect
early
neuronal
loss
in
the
epileptogenic
zone
Aim:
Determine
the
feasibility
of
noninvasive
T1
rho
MR
imaging
in
idenBficaBon
&
lateralizaBon
of
epileptogenic
zone
54. Inclusion
criteria
MR-‐posi:ve
i) PaBents
with
established
MTL
epilepsy
by
EEG,
MTL
epilepsy
seizure
semiology
and
MR
proven
MTS
ii) Unilateral
disease
iii) No
history
of
epilepsy
surgery
iv) No
other
epileptogenic
focus
Normal
subjects
i) No
known
epilepsy
or
any
structural
lesion
idenBfied
on
MR
brain
imaging
ii) No
history
of
cerebral
disease
iii) No
history
of
brain
surgery
Included:
15
normal
subjects;
7
pa_ents
2
pa_ents
excluded
(significant
mo_on
ar_facts
&
bilateral
MTS)
55. Scanning
parameters
3.0
Tesla
MR
scanner,
uBlizing
a
8-‐channel
head
coil.
T2
relaxometry:
•
Sequence:
TSE;
TR/TE
(ms):
1868/20;
FOV(mm):
240*240;
Matrix:
268*268;
Slice
thickness:
3
mm;
Gap:
0;
Scan
Bme:
6
min
42
sec.
T1rho:
•
Sequence:
B-‐TFE;
FOV(mm):
240*240;
Matrix:
160
160;
During
of
spin-‐lock
pulse
(ms):
1,
10,
20,
30,
40;
Spin-‐lock
frequency:
500
Hz;
TI
(ms):
860;
Slice
thickness:
3
mm;
Bandwidth:
130
Hz/pixel;
Echo
train
length:
4;
Scan
Bme:
9
min
10
sec.
3D
T1-‐weighted
MPRAGE:
•
Sequence:
MPRAGE;
TR/TE:
7.0/3.1
msec;
Flip
angle:
8;
FOV
(mm):
250*250;
Matrix:
256*256;
Slice
thickness:
1
mm;
Gap:
0.
56. ROIs
defini:on
–
on
T2W
Manual
drawing
of
ROI
to
contour:
Amygdala
Hippocampal
head
Hippocampal
body
Hippocampal
tail
Verified
against
automated
ROIs
-‐comparable
results
-‐
no
significant
differences
Manual
ROI
is
accurate
58. Sta:s:cal
Analysis
• Gaussian
distribuBon
and
homogeneity
tests
• Paired
t-‐test
between
leP
and
right
side
for
each
group
• StandardizaBon
of
T2
relaxometry
and
T1rho
values
according
to
the
corresponding
values
of
the
normal
control
group
through
Z-‐score
transformaBon:
z
=
(X
-‐
μ)
/
σ
• Abnormal
if:
>2
SD
away
from
the
mean
of
the
normal
group:
z
>
2
or
z
<
-‐2
p<0.05
will
be
considered
as
sta_s_cal
significant.
59. Results
–
Normal
Subjects
(mean±SD)
Asymmetric
Ra:o
SD
95.1.
±
3.12
96.20
±
3.14
0.9863
0.0122
Hippo
Head
96.51
±
3.31
97.12
±
3.49
0.9841
0.0210
Hippo
Body
90.79
±
4.72
91.27
±
3.92
0.9876
0.0085
Hippo
Tail
86.69
±
6.33
87.83
±
5.59
0.9849
0.0124
Amygdala
144.89
±
35.22
144.74
±
36.39
0.9888
0.0073
Hippo
Head
140.26
±
35.56
139.69
±
36.27
0.9896
0.0076
Hippo
Body
133.58
±
34.55
134.12
±
33.75
0.9888
0.0085
Hippo
Tail
133.97
±
34.8
134.49
±
34.61
0.9880
0.0060
Right
Lek
(mean±SD)
Amygdala
T2
relaxometry
T1
rho
Note:
Asymmetry
=
Min(L,
R)
/
Max(L,
R)
SD
=
standard
deviaBon
The
respec_ve
asymmetric
ra_o
were
then
used
as
reference
for
comparison
in
pa_ents’
group
mean
+/-‐
2SD
64. Accuracy
of
T2
relaxometry
&
T1
rho
results
Comparison
against
Volumetry
IYY
T2R
y
NKY
Amyg
T1rho
Volume
y
y
y
y
Hipp
Head
T2R
T1rho
Volume
y
y
y
y
y
y
y
y
y
y
y
Y
y
y
y
y
y
y
y
y
y
y
WYY
y
CYY
y
CHY
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
Y
FKY
CYSA
y
y
y
y
y
T2R
Hipp
Tail
T1rho
Volume
y
y
Hipp
Body
T2R
T1rho
Volume
y
T2
relaxometry:
Sn
=
60.9%
(14/23);
Sp
=
100.0%
(4/4)
T1rho:
Sn
=
100.0%
(24/24);
Sp
=
50.0%
(2/42)
66. F/7
yrs
old;
GTC
seizure;
MR-‐ve
Potential role in detecting WM changes
67. Limita:ons/
Improving
work
Recruit
more
subjects
(paBents
and
normal)
to
further
validate
diagnos_c
value
of
T1rho
Lack
of
histopathological
correlaBon
Perform
DTI
analysis
to
test
the
feasibility
in
detec_ng
WM
changes
Plane
of
imaging
-‐
coronal
3D
whole
brain
imaging
techniques
Use
of
longer
spin
lock
Bmes
68. T1
rho
MR
Imaging
• Feasible
in
idenBficaBon
of
epileptogenic
zone
• A
sensi:ve
marker
more
sensi_ve
than
T2
relaxometry
more
sensi_ve
than
volumetry
• Can
potenBally
detect
early
molecular
changes
69. Conclusion
• Wide
variety
of
eBologies
MCD,
MTS
• Concept
of
MR-‐negaBve
epilepsy
Does
it
really
exist?
• Availability
of
various
advanced
MR
imaging
techniques
+
limitaBon
Feasibility
in
clinical
prac_se?
• Promising
result
of
T1rho
imaging
Thank you