NEURO-IMAGING

CT & MRI ANATOMY

DR. JAMAL YAQOOB

MBBS, MCPS, FCPS (Pak), FRCR(UK), CBCCT(USA)

Consultant Radiologist, Dallah Hospital

RADIOLOGY TOOLS
X- RAY
ULTRASOUND
NUCLEAR MEDICINE
MAGNETIC RESONANCE
COMPUTED TOMOGRAPHY

COMPUTED TOMOGRAPHY
CT
HIGH ENERGY PHOTON
IONIZING RADIATION
EXPOSES DETECTOR

MAGNETIC RESONANCE
Magnetic fields
Radio wave transmission
No ionizing radiation

TOMOGRAPHIC IMAGES
ARE
IN A SPECIFIC PLANE

AXIAL
RT

CORONAL

SAGITTAL

RT

Patient Preparation
Fasting 4- 6 hours

Contrast material
[ Urographin, Telebrix, Isovest] 1-2 ml/kg
NO - Trauma, atrophy, stroke patients
severe allergy, poor renal function
YES- epilepsy, infections, tumors, etc

Anesthesia

Children, uncooperative
Children, Uncoperative
pts.

Patient position
CT ScanningTechnique
Scanogram [lateral]
Scan intervals
10mm for adults
7mm for children
Orbito-meatal line:
From External Canthus
To Ext. Auditory meatus

POST. FOSSA LEVEL

Basilar Art.

Prepontine
Cistern
Ambian
Cistern
Pons
Middle
Cerbellar
Peduncle

4th Ventricle

Cerebellar Hemispheres Vermis

Medulla Oblongata

4th Ventricle

Vallecula

Cisterna Magna

Aqueduct
of Sylvius

Midbrain

Cerebellar Folia
Quadrigeminal Cistern

Quadrigeminal Cistern

Occipital horn, Calc. pineal body

Ventricular anatomy

Pineal body
Int. Cerebral veins
Vein of Galen

Vellum interpositum

Retro-thalamic Cistern

Retro-thalamic Cistern
Sup.cerebellar Cistern

Pineal body
Inter. Cerebr.
veins

Quadrigeminal Cistern

Retro-thalamic Cistern

External Capsule

Internal Capsule

Basal Ganglia
Head of caudate
Lentiform nucleus
Thalamus
3rd Ventricle

Quadrigeminal Cistern

Insula

Body of caudate

Septum
Pellucidum

F
T

T
O

F
F

F
T

P
P

BRAIN MRI
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

How to interpret MR Images ?

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

BRAIN MRI
PROTOCOL

Signal intensity
Low signal lesion = hypointense = dark
High signal lesion = hyperintense = bright
Intermediate signal = isointense = Gray

T1

T2

FLAIR

MRI ADVANTAGES
Multiplanar
No ionizing radiation
Tissue characterization
Visualization of vascular structures witho

ut need for contrast injection (signal void

phenomenon)
MRA, MRV, MR cholangiography, MR myel
ography

MRI LIMITATIONS
ABSOLUTE
Cardiac pacemaker
Intracranial aneurysm clips
Intraocular foreign body
RELATIVE
Metallic implants
Colostrophobia

MRI MACHINES

Grey matter : Whitish

White matter: Greyish

Choroidal fissure , Hippocampal tail , Vein of Galen

(Retrothalamic Cistern)

V R spaces (dilated perivascular spaces)

Seen in T1WIs
Not seen in FLAIR
No clinical correlation
Anatomic sites

Subarachnoid Cisterns

Cavum velum
interpositum
Quadrigeminal
Cistern
Interpeduncular
Cistern
Prepontine
Cistern
Cisterna Magna

Suprasellar Cistern

Trigeminal n.

Gyrus rectus

Optic tract ,mamillary body, cerebral peduncle, substantia negra

Quadrigeminal
Cistern

Temporal Horn

Interpeduncular
Cistern

Amegdala , hippocampus, superior vermis

Hippocampal Formation
(epilepsy)

Hippocampal region

Mesial temporal sclerosis

ALZHEIMERS DISEASE VS MESIAL TEMPORAL SCLEROSIS

Corona Radiata

Centrum Semi-ovale (superf.)

Corona Radiata (deep)

LOBAR ANATOMY

Functional- Motor Cortex

Somatic Sensory Cortex

Language Areas

The Central Sulcus

Precentral
gyrus
Superior frontal
sulcus

Precentral
sulcus

Central sulcus

Pars bracket

Paracentral
lobule

Central sulcus

Central sulcus

Postcentral
sulcus
Pars bracket

Central sulcus

Postcentral
sulcus

Postcentral
sulcus
Pars bracket

Value of sagittal images

Anatomic localization [Lobes]
Corpus callosum delineation
Cranio cervical junction
Evaluation of the venous sinuses
Pituitary gland

Value of coronal images

Pituitary gland, chiasm, hypothalamus
Hippocampal region
Skull base and posterior fossa
Trigeminal nerve
Vascular anatomy

CT Vascular Anatomy
MCA

A. Communicating A.

ACA (a2)
ACA (a1)
ICA

P. Comm. A.

PCA

Basilar A.

MRI Vascular Anatomy

Post Contrast sagittal T1

Wtd M.R.I.
Section at the level of
medulla

Answers
7

Fig. 1.2 Post Contrast Axial MR Image of

the brain

6. Medulla
7. Sigmoid Sinus

1
4
1
3

1
7
1
6

1
2
1
1

1
0
1
5

Fig. 1.3 Post Contrast Axial MR Image of

the brain

Post Contrast sagittal T1

Wtd M.R.I.
Section at the level of Pons

Answers

9
8

8. Cerebellar
Hemisphere
9. Vermis
10. IV
Ventricle
11. Pons
12. Basilar
Artery

13. Internal Carotid

Artery
14. Cavernous Sinu
15. Middle
Cerebellar Peduncle
16. Internal
Auditory Canal
17. Temporal Lobe

2
0

2
2

1
9
2
1

1
8

Post Contrast sagittal T1

Wtd M.R.I.
Section at the level of Mid
Brain

Answers

Fig. 1.4 Post Contrast Axial MR Image of

the brain

18. Aqueduct of Sylvius

19. Midbrain
20. Orbits
21. Posterior Cerebral
Artery
22. Middle Cerebral
Artery

2
7

2
5

2
4

Post Contrast sagittal T1

Wtd M.R.I.
SectionIII
atVentricle
the level of the

Answers
2
6

Fig. 1.5 Post Contrast Axial MR Image of

the brain

2
3

23.
24.
25.
26.
27.

Occipital Lobe
III Ventricle
Frontal Lobe
Temporal Lobe
Sylvian Fissure

3
8
3
7

3
2

3
6

3
1

3
5

Post Contrast sagittal T1

Wtd M.R.I.
Section at the level of
Thalamus

3
0

2
9
3
4
3
3

2
8

Fig. 1.6 Post Contrast Axial MR Image of

the brain

Answers
28. Superior Sagittal
Sinus
29. Occipital Lobe
30. Choroid Plexus within
the
occipital horn
31. Internal Cerebral Vein
32. Frontal Horn

33.
34.
35.
36.
37.
38.

Thalamus
Temporal Lobe
Internal Capsule
Putamen
Caudate Nucleus
Frontal Lobe

4
1

4
0
3
9

Post Contrast sagittal T1

Wtd M.R.I.
Section at the level of
Corpus Callosum

Answers

Fig. 1.7 Post Contrast Axial MR Image of

the brain

39. Splenium of corpus

callosum
40. Choroid plexus within
the
body of lateral
ventricle
41. Genu of corpus
callosum

4
4

4
3
Post Contrast sagittal T1
Wtd M.R.I.
Section at the level of Body
of Corpus Callosum
4
2

Answers

Fig. 1.8 Post Contrast Axial MR Image of

the brain

42. Parietal Lobe

43. Body of the Corpus
Callosum
44. Frontal Lobe

46

4
5

Post Contrast sagittal T1

Wtd M.R.I.
Section above the Corpus
Callosum

Answers
45. Parietal Lobe
46. Frontal Lobe

Fig. 1.9 Post Contrast Axial MR Image of

the brain

Thank You For Your Attention