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NEURORADIOLOGY

Made Widhi Asih


Radiology Departemen Sanglah HOSPITAL – MEDICAL
FACULTY Udayana UNIVERSITY
INTRODUCTION

• Knowledge of the basic neuro-anatomy is


essential to establish the diagnosis
• Several imaging modalities are currently available
to evaluate CNS disorders
• Its important for physicians to be able to request
the correct radiological study depending on the
symptoms and suspected diagnosis
Imaging Modalities
• Plain X ray
• Computerized radiography(CT)
• Magnetic resonance imaging(MRI)
• Ultrasound
• Myelografi
• Angiografi
PLAIN X RAY
• Plain X-ray is essential modality for initial assessment of the vertebral column
• Good display of bony details
• Skull X ray is of limited value in evaluation of head trauma since it may not reflect
underlying CNS damage
• Skull X ray can shows :
- calcification: tumor, AVM, post infection
- widening of pituitary fossa
- Bone lesion : fracture, tumor primary, metastases, infections, abnormalities
congenital
• Skull X ray also helps in classification of skull fractures and its extent and therefore
further management
SKULL RADIOGRAPHY
SULL LATERAL
BASE POSTERIOR
SKULL
(SUBMENTOVERTICAL
VIEW)
Fontanel - Sutures
• A fontanel is an anatomical feature of the infant skull comprising any
of the soft membranous gaps between the cranial bones
• Posterior fontanel is triangle-shaped. It lies at the junction between
the sagittal and lambdoid suture
• Anterior fontanel is a diamond-shaped at the junction of the coronal
and sagittal suture
• Two smaller fontanelles : the sphenoidal or anterolateral fontanelle
(between the sphenoid, parietal, temporal, and frontal bones) and
mastoid or posterolateral fontanelle (between the temporal,
occipital, and parietal bones)
• The posterior fontanelle generally closes 2 to 3 months after birth
• The sphenoidal fontanelle closes around 6 months after birth
• The mastoid fontanelle closes from 6 to 18 months after birth
• The anterior fontanelle is generally the last to close between 18–24
months
 A very tense or bulging anterior fontanelle indicates raised intracranial
pressure. It can occur due to: - Encephalitis swelling (inflammation)
of the brain
- Hydrocephalus  a buildup of fluid inside the skull
- Meningitis  infection of the membranes covering the
brain
 A sunken (also called "depressed") fontanelle indicates dehydration or
malnutrition
 The cranial sutures are fibrous joints connecting the bones of the skull :
• The sagittal suture joins the two parietals
• The lambdoid suture marks the borders between the parietal and occipital bones
• The coronal suture separates the frontal bone and the parietal bone
Suture , Fontanella
Fracture vs Suture
Linear Fracture
Depressed fracture
Osteolytic and osteoblastic
lesion
Balloning sella
Comminuted Depressed
Fracture
WATER’S
Sinusitis
Fracture
Nasal View
Nasal bone fracture
SCHULLER VIEW
Mastoiditis akut -
chronic
CERVICAL X RAY : AP / LATERAL /
OBLIQUE
OPEN MOUTH CERVICAL
Thoracal X Ray AP / Lateral
Lumbosacral X Ray AP / Lateral
Spine Fracture
Lysthesis
Metastatic bone disease
COMPUTERIZED TOMOGRAPHY
(CT) SCAN
• Readily available fast modality for evaluation
of intracranial and spine structures
• Rapid acquisition of axial images
• The procedure of choice for evaluation of
patients with trauma and stroke patients
• Provides fine details of the bony structures
CT Terminology

• Attenuation :
• Hyperattenuating (hyperdense)
• Hypoattenuating (hypodense)
• Isoattenuating (isodense)

• Attenuation is measured in Hounsfield units


• Scale -1000 to 1000
• -1000 is air
• 0 is water
• +1000 is cortical bone
Tulang + 1000

+100
0
-100

Udara -1000
Head CT Scan

Axial
HEAD CT SCAN

Soft tissue window


Fracture
3D RECONSTRUCTION
Sinusitis
Stroke
Intracranial Hemorrhage (ICH)
SDH and EDH

SDH EDH
Intraventricular hemorrhage(IVH)
Subarachnoid
Hemorrhage (SAH)
Non Contrast CT Scan

• Trauma Capitis
• Cerebro Vascular Disease (CVD)
• Cerebral Atrophy
• Hydrocephalus  not for mass
• Follow up VP Shunt
CT Scan with contrast

• Tumor
• Infection
• Vascular malformation : - Aneurysma
- AVM
LUMBOSACRAL CT SCAN
3 D RECONSTRUCTION
MAGNETIC RESONANCE IMAGING
(MRI)
• Provides fine details of the brain and spine
• Does not involve irradiation
• Needs special equipment for patient monitoring.
• Few specific contraindication, e.g. pacemakers, old
cerebral aneurysms clips, cochlear implants
Patient Immobilization
CEREBRAL MRI
CT Scan
MRI DWI
T1WI T2WI
FLAIR DWI
AVM
LUMBOSACRAL MRI
CERVICAL MRI
Spinal Cord Injury
MYELOGRAPHY / CAUDOGRAPHY

• Lumbal punction (usually at the level of L4/


L5) contrast insertion into spinal canal
insertion (using iodium contrast) about 10 -15 cc
• Serial photo : AP/ lateral / oblique
MYELOGRAPHY -
CAUDOGRAPHY
HEAD ULTRASOUND
• Head US:
• High resolution images of the brain
• It uses the fontanelles as acoustic window
• Procedure of choice to evaluate for ICH
• Helpful in evaluating for congenital anomalies
and peri-natal hypoxemia
HEAD ULTRASOUND
CT ANGIOGRAFI
Cerebral Aneurysm
MR Angiografi
AVM
Aneurysm
Cerebral Arteriografi
Cerebral aneurysm