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NeuroImaging

NeuroImaging. Dr. Norman Pay. CT. Transmission. CT. Transmission Density differences Ionizing radiation Iodinated contrast material Spatial resolution Fast scanning times and acquisition Appropriate in emergent situations, claustrophobic patients, body coverage

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NeuroImaging

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  1. NeuroImaging Dr. Norman Pay

  2. CT • Transmission

  3. CT • Transmission • Density differences • Ionizing radiation • Iodinated contrast material • Spatial resolution • Fast scanning times and acquisition • Appropriate in emergent situations, claustrophobic patients, body coverage • Utilization for contraindications in MRI as aneurysm clips, cardiac pacemakers, etc. • Biopsies • Workstation compatibility • CT angiography

  4. RADIATION • Sv (Sievert) – absorbed dose in biological tissue • 2 mSv/ year – background radiation • 24 mSv/ year –background radiation for airline cruising altitude • 6.8 mSv – chest CT scan • 10-30 mSv – single full body CT scan • 21 Sv – fatal dose

  5. CT Angiography CAROTID TRAUMATIC ANEURYSM CAROTID STENT

  6. MRI • Proton Relaxation • Signal intensities • Contrast resolution • Gadolinium (Gd) contrast • Nephrogenic Systemic Fibrosis (NSF) – Gd contraindicated in Low GFR states (<30) and renal failure • Non-ionizing, non-invasive • Workstation compatibility • More complex, longer acquisitions and set-up • Magnet bore - claustrophobia • MR angiography

  7. MR Angiography CAVERNOMA CAROTID DISSECTION CAROTID OCCLUSION

  8. T2 Flair T1 GRE Diffusion Contrast

  9. MR sequences • T1 – anatomy, CSF dark • T2 – screening, CSF bright • FLAIR (fluid attenuated inversion recovery) – similar to T2 • MR diffusion – bright signal for restriction • GRE (gradient echo) – susceptibility- dark signal • Gadolinium, T1 – bright signal • MR angiography and perfusion – Gadolinium utilization

  10. Anatomy of the Brain • Spatial Resolution • CT Density • Contrast Resolution • MR Signal Intensity • Intravenous Contrast • Iodinated contrast • Gadolinium contrast

  11. NEURONAL MIGRATION

  12. T2 FLAIR CORTICAL DYSPLASIA

  13. Stroke • Acute ischemic stroke (AIS) – 3rd leading cause of death, leading cause of disability in adults • 700,000 ischemic strokes annually in the U.S. • Reperfusion therapy is the only proven treatment of AIS

  14. CT and MR • Time to infarct • Time to treatment • Extent of infarct • Hematoma • Recovery

  15. POST THROMBUS LYSIS PRE THROMBUS LYSIS

  16. CT POST THROMBUS LYSIS PRE THROMBUS LYSIS

  17. MOYA-MOYA FLAIR

  18. Pattern Recognition Diagnostic Neuroradiology, pg 130-131. Osborn, Anne G., M.D. Mosby – Year Book, Inc., 1994.

  19. Pattern Recognition Diagnostic Neuroradiology, pg 130-131. Osborn, Anne G., M.D. Mosby – Year Book, Inc., 1994.

  20. MR DIFFUSION • Diffusion refers to the general transport of molecules, mixing through agitation and randomly • The driving force is the motion of water within water, driven by thermal agitation called Brownian motion • If restricted as in acute infarcts, decreased diffusion results • Decreased diffusion displayed as bright MR signal

  21. MR DIFFUSION • Failure of Na+/K+ ATPase and other ionic pumps – net shift of water from the extracellular to the intracellular space • Cell swelling with decrease in extracellular space • Increased intracellular viscosity and cell membrane permeability • Temperature decrease • Decreased diffusion in acute stroke

  22. CEREBELLAR INFARCT CT MR DIFFUSION

  23. CT MR MIDDLE CEREBRAL ARTERY INFARCT

  24. DIFFUSION DIFFUSION DIFFUSION MRA MRA BASILAR ARTERY OCCLUSION

  25. DIFFUSION FLAIR ACUTE INFARCT

  26. MR DIFFUSION EMBOLIC DISEASE – ATRIAL FIBRILLATION

  27. T1 T2 T1 CONTRAST POSTERIOR CEREBRAL ARTERY INFARCT

  28. FLAIR T2 FLAIR VASCULITIS

  29. DIFFUSION DIFFUSION FLAIR FLAIR STATUS POST AORTIC VALVE SURGERY HYPOTENSION

  30. Neuroimaging in acute ischaemic stroke: insights into unanswered questions of pathophysiology. Wardlaw, J. M. Journal of Internal Medicine 267; 172–190. Blackwell Publishing Ltd. 2010.

  31. MR DIFFUSION Neuroimaging in acute ischaemic stroke: insights into unanswered questions of pathophysiology. Wardlaw, J. M. Journal of Internal Medicine 267; 172–190. Blackwell Publishing Ltd. 2010.

  32. CT MR MIDDLE CEREBRAL ARTERY INFARCT

  33. Hematoma • Hemorrhagic transformation – dreaded complication • Exclusion of hematoma -prerequisite for treatment • Cue for emergent intervention

  34. HEMORRHAGE INTO INFARCT INFARCT CT

  35. HEMATOMA EPIDURAL EPIDURAL SUBDURAL

  36. REBLEED ISODENSE SUBDURAL HEMATOMA

  37. Magnetic Resonance Imaging of the Brain and Spine, 3rd ed., Vol. 1, pg 788. Atlas, Scott W., M.D., editor. Lippincott Williams & Wilkins, 2002.

  38. FLAIR GRE HEMATOMA

  39. T1 T2 CT SUBDURAL HYGROMA AND HEMATOMA

  40. T1 CT T2 CHRONIC CHRONIC CHRONIC SUBDURAL HEMATOMA

  41. FLAIR FLAIR CT SUBARACHNOID HEMORRHAGE

  42. ANTERIOR COMMUNICATING ARTERY (ACA) ANEURYSM

  43. T1 FLAIR T1 VENOUS THROMBOSIS AND VENOUS INFARCT

  44. GRE SIDEROSIS

  45. HEMATOMA FLAIR CT GRE MALIGNANT MALIGNANT BENIGN

  46. T1 T2 CONTRAST MALIGNANT HEMATOMA

  47. T1 GRE CT T2 CYST

  48. SUMMARY • CT and MR utilize different technologies, often complementary • Advantages and disadvantages of CT and MR • CT and MR advances pari-passu with computing capabilities • Moore’s Law

  49. REFERENCES • Diagnostic Neuroradiology, pg 130-131. Osborn, Anne G., M.D. Mosby – Year Book, Inc., 1994. • Magnetic Resonance Imaging of the Brain and Spine, 3rd ed., Vol. 1, pg 788. Atlas, Scott W., M.D., editor. Lippincott Williams & Wilkins, 2002. • Neuroimaging in acute ischaemic stroke: insights into unanswered questions of pathophysiology. Wardlaw, J. M. Journal of Internal Medicine 267; 172–190. Blackwell Publishing Ltd. 2010.

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