![Patient Preparation
Patient position
Technique
Scanogram [frontal, lateral]
Scan intervals
Orbito-meatal line:
From External Canthus
To Ext. Auditory meatus](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Normal brain imaging in CT and MRI for medical students
- 1. BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University ssregypt.com
- 2. Patient Preparation Patient position Technique Scanogram [frontal, lateral] Scan intervals Orbito-meatal line: From External Canthus To Ext. Auditory meatus
- 3. Patient Preparation Fasting 4- 6 hours • Contrast material [ Urographin, Telebrix, Isovest…] 1-2 ml/kg • Anesthesia Children, Uncooperative patients
- 4. Contrast material administration Traumatic cases, CVS Cold cases [headache, epilepsy, signs of increased ICT, …] NO YES
- 10. 4th Ventricle Cerebellar Hemispheres Vermis Post. Fossa level Pones Middle Cerbellar Peduncle Prepontine Cistern Ambean Cistern Basilar Art.
- 13. • Ventricular anatomy Quadrigeminal Cistern Occipital horn, Calc. pineal body
- 14. Quadrigeminal Cistern Head of caudate Lentiform nucleus Thalamus Internal Capsule External Capsule 3rd Ventricle Insula Basal Ganglia
- 16. Vellum interpositum Retro-thalamic Cistern Retro-thalamic Cistern Sup.cerebellar Cistern Quadrigeminal Cistern Pineal body Inter. Cerebr. veins Pineal body Inter. Cerebr. veins Vein of Galen Retro-thalamic Cistern
- 20. Corona Radiata
- 21. Corona Radiata (deep) Centrum Semi-ovale (superf.)
- 22. CT Vascular Anatomy ICA ACA (a1) ACA (a2) MCA A. Communicating A. Basilar A. PCA P. Comm. A.
- 23. Strong magnetic field and Radiofrequency (RF) coils • Imaging are created by the motion of hydrogen protons in response to the applied radiofrequency • Multiplanar imaging [ axial, sagittal, coronal ] • Any MR examination should include T1 and T2 Weighted images BRAIN MRI
- 24. Cisterna Magna Prepontine Cistern Interpeduncular Cistern Quadrigeminal Cistern Cavum velum interpositum Subarachnoid Cisterns Suprasellar Cistern
- 26. CLOSED MAGNET
- 27. OPEN MAGNET
- 28. OPEN MAGNET
- 29. EXTERMITY MAGNET
- 31. MR advantages Multiplanar imaging Tissue characterization No bone artifacts Shows blood vessels without contrast
- 32. • T1 WIs (TR< 800 msec TE 20 msec) • T2 WIs (TR> 1000 msec TE> 80 msec) • PD WIs (TR> 1000 msec TE= 20 msec) • T1 WIs [CSF BLACK ] • T2 WIs [CSF BRIGHT ] • FLAIR WIs [ CSF BLACK ] BRAIN MRI
- 34. T1 T2 FLAIR
- 36. Low signal lesion = hypointense = dark High signal lesion = hyperintense = bright Intermediate signal = isointense = Gray Signal intensity
- 37. Identify T1 weighted images (CSF low signal) and T2 Weighted images (CSF high signal) Assess the signal intensity of the structure or lesion in both T1 and T2 weighted images Follow the well known common signal behavior How to interpret MR Images ?!
- 38. T1[low signal] T2[low signal] [Non mobile protons] Cortical bone Mature fibrous tissue ( ligaments and tendons) Calcifications ( physiological, pathological) Flowing blood in the vessels ( fast moving protons) (signal void) Air in the sinuses, lungs,…( minimal hydrogen protons) Others……..
- 39. Subacute blood [met Hb] Others…. Fat ( subcutaneous fat, dermoid cyst,…) Others…. T1[High signal] T2[High signal] T1[High signal] T2[Low signal]
- 40. Any structure or lesion not listed before • Fluids ( CSF, urine, pleural effusion, ascites.,…) • Edema and infarctions • Most of tumors • Contrast injection [ Gd- DTPA] ++ T1[Low signal] T2[High signal]
- 41. Gadolinium – DTPA 0.1 – 0.2 mmol/kg body weight Only T1 weighted images are obtained after Gd- DTPA injection Differentiate SOLs Assess activity of some lesions like MS Assess post operative tumour recurrence
- 44. Trigeminal n.
- 45. Optic tract ,mamillary body, cerebral peduncle, substantia negra Gyrus rectus
- 46. Amegdala , hippocampus, superior vermis Interpeduncular Cistern Quadrigeminal Cistern Temporal Horn Hippocampal Formation (epilepsy)
- 49. Choroidal fissure , Hippocampal tail , Vein of Galen (Retrothalamic Cistern)
- 50. Seen in T1WIs Not seen in FLAIR No clinical correlation Anatomic sites Verchaw – Robben’s spaces (dilated perivascular spaces)
- 51. Grey matter : Whitish White matter: Greyish
- 52. Anatomic localization [Lobes] Corpus callosum delineation Cranio cervical junction Evaluation of the venous sinuses Pituitary gland Value of sagittal images
- 54. Pituitary gland, chiasm, hypothalamus Hippocampal region Skull base and posterior fossa Trigeminal nerve Vascular anatomy Value of coronal images
- 58. اليك نتوب و نستغفرك انت اال اله ال ان نشهد بحمدك و اللهم سبحانك Thank you