NEURORADIOLOGY Part I

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1 NEURORADIOLOGY Part I Vörös Erika University of Szeged Department of Radiology SZEGED

2 BRAIN IMAGING METHODS Plain film radiography Ultrasonography (US) Computer tomography (CT) Magnetic resonance imaging (MRI) Digital subtraction angiography (DSA) (Cisternography, ventriculography)

3 IMAGING METHODS Plain film radiography trauma foreign bodies bone lesions calcifications

4 IMAGING METHODS Ultrasonography newborn, infant intracranial lesions (transfontanelle) vascular structures Doppler US

5 IMAGING METHODS Ultrasonography Doppler (duplex, colorcoded) vascular structures - extracranial, transcranial

6 IMAGING METHODS Computer tomography direct method - density differences (hypo-, iso- or hyperdense lesions) axial and reformatted pictures contrast material enhancement CT angiography Special techniques

7 IMAGING METHODS Computer tomography direct method axial and reformatted images spiral/helical CT contrast material enhancement CT angiography Special techniques

8 IMAGING METHODS Computer tomography direct method axial and reformatted pictures contrast material enhancement (vessels, blood-brain barrier damage) CT angiography Special techniques

9 IMAGING METHODS Computer tomography direct method axial and reformatted pictures contrast material enhancement CT angiography helical CT Special techniques

10 IMAGING METHODS Computer tomography direct method axial and reformatted pictures contrast material enhancement CT angiography Special techniques CT perfusion: CBF, CBV, MTT, TTP

11 IMAGING METHODS Computer tomography Indications bone lesions calcifications fresh blood tumours infarcts trauma Unfavorable near the bones in posterior fossa adjacent to the sella metallic material

12 IMAGING METHODS MRI direct method signal intensity differences (hypo-, iso- or hyperintensive lesions) multiplanar modality different sequences (T1W, T2W, FLAIR, ) contrast material enhancement (vessels, blood-brain barrier damage) MR angiography Special MR techniques

13 IMAGING METHODS MRI direct method multiplanar modality different sequences contrast material enhancement MR angiography: TOF, PC, CE-MRA, dynamic MRA Special MR techniques: SWI, DWI, PWI, DTI, fmri, MR spectroscopy,e.g.

14 IMAGING METHODS MRI Indications developmental anomalies tumours infarcts inflammations subtle lesions etc. Unfavorable calcification, bone lesions (non-organic components) metallic material

15 IMAGING METHODS DSA invasive, catheter method - for vascular structures contrast material, radiation dose best spatial and temporal resolution 3 D imaging interventional procedures!

16 IMAGING METHODS DSA Indications preoperative Diagnostic role Non-invasive angiographies! differential diagnosis intervention

17 Developmental anomalies MRI, CT, plain film, DSA arachnoid cyst Chiari malformations etc.

18 Cerebrovascular disorders - STROKE CT, MRI, US, DSA Intracerebral lesions: ischaemic haemorrhagic Underlying vascular processes Developmental aneurysms vascular malformations Acquired stenoocclusive lesions thromboembolic processes

19 Cerebrovascular disorders Ischaemic infarcts Initial stage: CT-CTP, MR Hyperdense arterial sign Early ischaemic signs CBFdefect-CBVdefect=PENUMBRA Developing stage End stage CBF CBV

20 Cerebrovascular disorders Ischaemic infarcts Initial stage: CT, MR-DWI,PWI PWIdef DWIdef=penumbra Developing stage Mismatch End stage PWI DWI

21 Cerebrovascular disorders Ischaemic infarcts Initial stage Developing stage: CT, MR Cytotoxic oedema -> mass effect Contrast enhancement End stage

22 Cerebrovascular disorders Ischaemic infarcts Initial stage Developing stage End stage: CT, MR Retraction -> CSF density/signal

23 Cerebrovascular disorders Ischaemic infarcts Territorial a larger artery occlusion Lacunar small perforator occlusion Diffuse white matter small vessels disease Border zones decresed perfusion at the border of the supplying territory

24 Cerebrovascular disorders Haemorrhagic infarcts: CT Initial stage: Hyperdense, mass effect Developing stage: Continuous decrease of density End stage: Nearly CSF density Mass effect disappears

25 Cerebrovascular disorders Haemorrhagic infarcts: MR Initial stage: SWI Developing stage: Blood degradation products: high signal End stage

26 Cerebrovascular disorders Haemorrhagic infarcts : MR Initial stage Developing stage End stage: T2W sequences T2* GRE, SWI: low signal

27 Cerebrovascular disorders Haemorrhagic infarcts Basal ganglia - hypertension Lobar AVM, tumor, others

28 Cerebrovascular disorders Underlying processes Developmental lesions Aneurysms -> SAH CT, MR Angiography (CTA/MRA, DSA) vascular malformations

29 Cerebrovascular disorders Underlying processes Developmental lesions aneurysms vascular malformations: AVM (cavernoma, teleangiectasia) Haemorrhage, ischaemia CT MR Angiography (CTA, MRA, DSA)

30 Cerebrovascular disorders Underlying processes Acquired vascular diseases stenoocclusive processes (artherosclerosis) US, CTA, MRA angiography thromboembolic processes

31 Cerebrovascular disorders Underlying processes Acquired vascular diseases stenoocclusive processes (arteriosclerosis) US, CTA, MRA Angiography/stentig thromboembolic processes

32 Cerebrovascular disorders Underlying processes Acquired vascular diseases stenoocclusive processes (arteriosclerosis) thromboembolic processes: Arterial Extracranial: US Intracranial: CTA, MRA, DSA venous

33 Cerebrovascular disorders Underlying processes Acquired vascular diseases stenoocclusive processes (arteriosclerosis) thromboembolic processes: arterial Venous CT, MR CTA, MRA, DSA

34 Cerebrovascular disorders Thrombectomy Arterial thrombus: ICA, ACA, ACM, AB Venous sinus thrombus

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