Neuroradiology. J.Lisý

Transcription

1 Neuroradiology J.Lisý

2 X-ray of skull/spine trauma (2 perpendicular projections) congenital developemental errors (scoliosis, spina bifida)

3 Perimyelography (PMG) Lumbar puncture, isoosmolar iodine CM Dural sack Impression by herniated disc Amputation of sheaths of nerve roots Stop in filling by tumour

4 US of brain in neonates open great fontanel/transtemporal higher frequency of US probe size of ventricles (hydrocefalus) width of SA spaces (cortical atrophy) focal changes hemorrhage (ED, SD, SA, IC)

5 susp. tumour Ischemic involvement of MCA

6 CT brain acute trauma (hemorrhage, fracture) acute ischemic event x MRI faster cortical bone

7 Hemorrhage intracerebral epidural subdural subarachnoideal developement in time: acute hyperdense subacute isodense (3 we) chronic hypodense

8 Epidural hematoma bone- dura mater biconvex limited by sutures (dura attached to sutures) rather arterial

9 Subdural hematoma dura-arachnoidea crescent-shape not limited by sutures usually venous

10 Subarachnoidal hematoma arachnoidea-pia matter SA spaces, basal cisterns severe headache trauma aneurysm rupture CT angio

11 Intracerebral hematoma hypertensive h. involves basal ganglia

12 Traumatic contusion FLAIR (T2W with fluid suppresion gliosis x encephalomalacia frontal basal temporal ventral basal

13 Microbleeds (hemosiderin) Gradient echo T2* (sensitive to magnet.field inhomogenities) Difusse axonal injury

14 Ischemic involvement acute: hyperdense MCA sign SA narrowing lost of GM/WM differetiation chronic:encefalomalatic pseudocyst (hypodense), gliosis ev. thrombolysis till 6 h (Ag selective)

15 Ischemia CT

16 Ischemia development MRI DWI after 3 mo

17 Hyper- / hypodese lesions of a brain hyperdense: calcifications hypodense: a acute hemorrhage (developed in time becomes hypodense) edema cyst (encephalomalatia) gliosis

18 Signs of an expansion 1) perifocal oedema (hypodensity, increased water content) 2) compression of a ventricles or SA spaces 3) midline shift to the healthy side

19 MRI of a brain lack of radiation/ionisation contrast difference of gray x white matter sensitive to distinguish gliosis x encephalomalacia angiography (arteries/veins) without Gad application

20 Indications MR epilepsy demyelinisation inflammation tumours vascular malformations inborn developemental errors

21 Myelinisation of white matter completed postnatally mo from occipital to frontal caudal to cranial central- periphery

22 lesion within basal ganglia (gl.pallidus) Metabolic disease

23 Multiple sclerosis demyelinisation (Ab against myelin of nerve fibres of WM) autoimmune oval shaped foci periventricularly paralel in coronal plane supra and infratentorial, intrameddular active enhancing after Gd negative finding doesn t mean healthy patient

24 Disorders of neuronal migration neurons from embryonal germinal matrix form gray matter cortex (superficial) basal ganglia (deep) heterotopy of GM cortical dysplasia

25 Disorders of midline and posterior fossa agenesis of CC Chiari Dandy Walker enlarged PF, cyst in PF high pos. of tentorium

26 Chiari malformation descensus of tonsils under for. magnum narrowed IV.ventricle smaller posterior fossa syringohydromyely

27 Epilepsy (CT useless) sensitivity of MR depends on technique mesial temporal sclerosis disorders of neuronal migration vascular malformations (AVM) tumours gliosis (posttraumatic, postsurgical)

28 Mesial temporal sclerosis hippocampal atrophy and gliosis high signal of smaller hippocampus most common lesional epilepsy FLAIR (T2W with supression of fluid signal)

29 Cerebrovascular malformation cavernoma T2W/gradient echo (sensitive to hemosiderin)

30 Venous angioma

31 Aneurysma v.magna Galeni MRA angiography (without CM) Arterial TOF Venous PC L-R heart shunt LV insuficiency

32 Inflammation encephalitis acute negative finding chronic small round shaped gliosis subcortically herpetic encefalitis temporal lobes

33 Inflammation meningitis enhancement of leptomeninges after CM TB basilar meningitis

34 Hydrocephalus enlarged ventricles narrowed SA spaces

35 Hydrocephalus flow void in aqueductus (supratentorial h. meningitis) transependymal shift of CSF (decompensation)

36 Tumours small solid nodule enhnacing after Gd great cystic portion astrocytoma cystic hemangioblastoma

37 Ependymoma arises from ependyma propagation below foramen magnum

38 Meduloblastoma most common malignant tumour in posterior fossa microcalcifications solid nodule

39 Pontine glioma relatively benign (absence of Gad enhancement) non operabile (floor of the IV. ventricle) RT (central necrosis)

40 Meningeoma (Extraaxial tumor) extraxial lesion of leptomeninges impression on cortex, perifocal edema homogenous enhancement after Gd dural tail (comet) sign

41 Quiz case??? Lipoma T1 hypersignal of fat st. associated with partial agenesis of CC Sag T1w native

42 Pituitary macroadenoma young females, oligomenorhea, infertility, prolaktinemia native T1 adenohypophysis isosignal neurohypophysis hypersignal (phospholipids)

43 Pituitary microadenoma defect in pituitary gland after Gad, deformation of contour, dislocation of infundibulum macro x micro 1 cm

44 Craniopharyngeoma 2 nd most common tumor of sella turcica small solid and large cystic portion

45 Metastases intracerebral BCA lung Breast carcinoma Melanoma expansion, perifocal edema

46 Metastases extraaxial leptomeningeal subependymal (medulloblastoma) Gad mandatory brain and spinal canal