Basic Neuroimagings

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Advanced Diagnostic and Image-Guided Minimal Invasive Therapy Center (AIMC) Ramathibodi Hospital Mahidol University

AIMC

Learning Objectives
The main purpose of this lesson is to stimulate the students to recognize the value of gross anatomy and physiology of the CNS as major foundations in clinical practice. The students will be able to 1. Understand the principles of CT, MRI, Angiography PET and SPECT 2. Recognize the multiplanar normal neuroimaging anatomy 3. Recognize the imaging of the CSF pathway, intracranial arteries and venous system

Content Outlines
1. Basic knowledge of CT, MRI, Angiography, PET and SPECT 2. CT scan of the nervous system 3. MRI of the nervous system 4. Vascular imaging of the CNS: angiography, CT angiogram and venogram and MRA/MRV

Learning Organization
1. Study the learning materials provided in advanced 2. Lecture 40 minutes 3. Questions and answers 10 minutes

 Self study of the following topics

1. Meninges and intracranial spaces 2. Intracranial vascular circulation 2.1 Cervical and intracranial carotid and vertebrobasilar system 2.2 Circle of Willis 2.3 Deep and superficial cerebral veins 2.4 Dural venous sinuses 3. Structural and functional correlation of the nervous sys. 3.1 Visual pathway and cortex 3.2 Language center: Brocas and Wernickes 3.3 Auditory cortex 3.4 Motor and sensory cortex 3.5 Brain stem 3.6 Pituitary gland

Imaging Modalities
1. 2. 3. 4. 5. 6. 7. 8. Plain films/ Tomogram Ultrasonogram CT MRI Myelogram Angiogram Venogram Nuclear SPECT/ PET

Imaging Modalities

Ultrasonogram

Computed Tomography(CT)
Magnetic Rasonance Imaging(MRI)

Digital C-arm

Computed Radiography

Digital Angiography

Metabolic Imaging

PET Scan Images in Mices: Differences in Thymidine kinase gene expression

The brain
1. 2. 3. 4. 5. 6. 7. 8. The cerebral hemispheres The posterior fossa The deep gray nuclei White matter tracts The ventricular system The meningies Vascular supply Venous drainage

Normal CT Anatomy

Normal CT Anatomy

Basal Ganglion

Normal graywhite matter

The posterior fossa Foramen Magnum Base of Skull

C1-2

Foramen Magnum

Cervicomedullary Junction

Hypoglossal nerve canal

Brain Stem

Sagittal Midline MRI

Brain stem

temporal lobe

pons cerebellar peduncle: middle cerebellum

Medulla

Pons- CPA - IAC Middle Cerebellar Peduncle

Cerebellum

Cerebellar hemisphere Cerebellar vermis

PonsCerebellum Infundibulum

Mid Brain

Third Ventricle Tectal Plate

Brain Parenchymal Anatomy

The cerebral hemispheres

1. 2. 3. 4. 5. 6. Frontal lobes Parietal lobes Temporal lobes Occipital lobes Insular lobes Limbic lobes

frontal

Occipital lobe

Posterior Fossa Temporal Lobes

Uncus: Temporal Horn

Hypothalamus Midbrain- Aqueduct

Frontal -Temporal Occipital Lobes

Frontal and Parietal Lobes

No C Concept of Blood Brain Barrier

+C

Centrum Semiovale Frontoparietal lobes

Central Sulcus: The Fronto-Parietal Boundary No C

+C

BG- Pineal- Thalamus

Higher Sensitivity: fMRI

Finger tapping fMRI

Functional Brain Anatomy

1. 2. 3. 4. 5. Primary Motor cortex Primary Sensory Cortex Primary Visual Cortex Primary Auditory Cortex Language
1. Brocas area 2. Wernickes area

Functional Cortical Brain Mapping

Blood Oxygen Level Dectection :Bold Effect

Combined visualization of fMRI maps and EEG/MEG multiple dipole models

Central sulcus
Hand motor area

Precentral gyrus central sulcus Postcentral gyrus

* **
Cingulate sulcus

Motor Cortical brain mapping:Glioma

Cognitive - Picture Encoding

Picture Encoding

Auditory cortex

Internal Medicine Review November 11,2001

The Ventricular System

The ventricular system

Lateral ventricles Frontal horn Body Temporal horn Trigone Occipital horn Third ventricle Aqueduct of Sylvius Forth ventricle The Foramina of Magendie and Luschka

Concept of CSFBrain Barrier

f t

The Lateral Ventricle: frontal horn, body, occipital horn, trigone & temporal horn

b tr t f b o

tr

tr

b o

The Foramen of Monro

The Third Ventricle

3rd

3rd

3rd

Basal Ganglion Frontal Horn Pulvinar

The aqueduct of Sylvius

Suprasellar Cistern Temporal horns Aqueduct of Sylvius

The Forth Ventricle

4th 4th 4th

4th

4th

4th

The Foramina of Magendie and Luschka

4th FM 4th

FL FM

FL

Foramen of Lushka and Magendie

Fourth Ventricle

Frontal Horns Foramen of Monroe Third Ventricle Glomus of the choroid Plexus Aqueduct of Sylvius Pineal Gland

Third Ventricle Aqueduct of Sylvius Perimesencephalic Cistern

Frontal Horns Trigone Occipital Horns

Body of The Lateral Ventricle Corona Radiata

Centrum Semiovale

Pituitary Fossa Visual Pathway

Sellar-suprasellar Region

Infundibulum

Sellar tursica

Suprasellar cistern
Infundibulum

Hypothalamus

Sellar tursica

Suprasellar cistern

Hypothalamus

Normal CT Anatomy

Pituitary Fossa

Suprasellar Cistern Optic Apparati

Hypothalamus opticTracts-Radiations

Optic Radiation Calcarine cortex

White Matter Tracts

Fiber tracking: DTI

Commisure fibers (corpus callosum) Projection fibers (internal capsule) Cortico-cortical association fibers (IFO)

Central sulcus
Hand motor area

Precentral gyrus central sulcus Postcentral gyrus

* **
Cingulate sulcus

Central Sulcus

Centrum Semiovale

Body of the Lateral Ventricle Coronal Radiata

The Corpus Callosum

Thalamus Basal Ganglion Frontal Horn Pulvinar

Suprasellar Cistern- Optic Chiasm

Mid pons

Pons

Medulla

Cervicomedullary Junction

Fornix

Meningies

Intracranial spaces

Normal Meningeal Enhancement: CT

NORMAL DURAL ENHANCEMENT: MRI

EXTENSIVE DURAL ENHANCEMENT

History:A 45 y.o. F presented with sudden onset of thunderclap headche for 1 week starting from bil. temporal areas progressing to the occiput with recent posterior right sided neck and occiput pain.

Vascular Supply And Venous Drainage

Circle Of Willis

Cerebral Angiogram

CT Angiogram of the Brain and Neck

MRA: Pipe
2DTOF MRA: Neck

3DTOF MRA: Brain

Suprasellar Cistern Circle of willis

Sylvian Fissure

Examples of CE-TOFMRA

Routine 2DTOFMRA of the neck: inplane flow artifact is demonstrated.

Contrasted TOFMRA of the neck demonstrating no inplane flow artifact

2DPCMRA with all directions encoded 2DTOFMRA with superior (VENC 50 cm/sec) showed bilateral VA saturation band showed only RVA

RVA LVA

2DPCMRA with SI encoding direction showed bilateral VA with different flow directions

VENC

contrasted 3DTOFMRA showed bilateral VA,complete occlusion of the left CCA and SCA origins but well visualized LVA

DIAGNOSIS SUBCLAVIAN STEAL SYNDROME

Takayasus arteritis: routine and contrasted MRA

Dural Venous Sinuses

Dural Venous sinuses

MRV

3D PC MRV
2DPC

2D PC MRV

2DTOFMRV: AVM

Superior Sagittal Sinus

SSS

Third Ventricle Pineal Gland Internal Cerebral Vein

Basal Vein of Rosenthal Straight Sinus

Transverse Sigmoid Sinuses

Sigmoid Sinus Jugular foramen

Ramathibodi Hospital