BRAIN IMAGING CT & MRI - SSR Egypt · BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of...

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BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University ssregypt.com

Transcript of BRAIN IMAGING CT & MRI - SSR Egypt · BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of...

Page 1: BRAIN IMAGING CT & MRI - SSR Egypt · BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University ssregypt.com. Patient Preparation Patient position Technique

BRAIN IMAGING

CT & MRI

Mamdouh Mahfouz MD Professor of Radiology

Cairo University

ssregypt.com

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Patient Preparation

Patient position

Technique

Scanogram [frontal, lateral]

Scan intervals

Orbito-meatal line:

From External Canthus

To Ext. Auditory meatus

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Patient Preparation

Fasting 4- 6 hours

• Contrast material

[ Urographin, Telebrix, Isovest…] 1-2 ml/kg

• Anesthesia

Children, Uncooperative patients

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Contrast material administration

Traumatic cases, CVS

Cold cases [headache, epilepsy,

signs of increased ICT, …]

NO

YES

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Page 7: BRAIN IMAGING CT & MRI - SSR Egypt · BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University ssregypt.com. Patient Preparation Patient position Technique
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4th Ventricle Cerebellar Hemispheres Vermis

Post. Fossa level

Pones

Middle

Cerbellar

Peduncle

Prepontine

Cistern

Ambean

Cistern

Basilar Art.

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Vallecula

4th Ventricle

Medulla Oblongata

Cisterna Magna

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Cerebellar Folia

Quadrigeminal Cistern

Midbrain Aqueduct

of Sylvius

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•

Ventricular anatomy

Quadrigeminal Cistern Occipital horn, Calc. pineal body

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Quadrigeminal Cistern

Head of caudate

Lentiform nucleus

Thalamus

Internal Capsule External Capsule

3rd Ventricle

Insula

Basal Ganglia

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Quadrigeminal Cistern

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Vellum interpositum

Retro-thalamic Cistern Retro-thalamic Cistern

Sup.cerebellar Cistern

Quadrigeminal Cistern

Pineal body

Inter. Cerebr.

veins

Pineal body

Inter. Cerebr. veins

Vein of Galen

Retro-thalamic Cistern

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Septum

Pleusedum

Body of caudate

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F

O

F

P

F

T

O

F

P

O

P

P

T T

F

O

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Corona Radiata

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Corona Radiata (deep)

Centrum Semi-ovale (superf.)

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CT Vascular Anatomy

ICA

ACA (a1)

ACA (a2) MCA A. Communicating A.

Basilar A.

PCA

P. Comm. A.

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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

BRAIN MRI

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Cisterna Magna

Prepontine

Cistern

Interpeduncular

Cistern

Quadrigeminal

Cistern

Cavum velum

interpositum

Subarachnoid Cisterns

Suprasellar Cistern

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CLOSED MAGNET

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OPEN MAGNET

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OPEN MAGNET

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EXTERMITY MAGNET

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MR advantages

Multiplanar imaging

Tissue characterization

No bone artifacts

Shows blood vessels without contrast

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• T1 WIs (TR< 800 msec TE 20 msec)

• T2 WIs (TR> 1000 msec TE> 80 msec)

• PD WIs (TR> 1000 msec TE= 20 msec)

• T1 WIs [CSF BLACK ]

• T2 WIs [CSF BRIGHT ]

• FLAIR WIs [ CSF BLACK ]

BRAIN MRI

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BRAIN MRI

PROTOCOL

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T1 T2 FLAIR

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Low signal lesion = hypointense = dark

High signal lesion = hyperintense = bright

Intermediate signal = isointense = Gray

Signal intensity

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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

How to interpret MR Images ?!

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T1[low signal] T2[low signal]

[Non mobile protons]

Cortical bone

Mature fibrous tissue ( ligaments and tendons)

Calcifications ( physiological, pathological)

Flowing blood in the vessels ( fast moving protons) (signal void)

Air in the sinuses, lungs,…( minimal hydrogen protons) Others……..

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Subacute blood [met Hb]

Others….

Fat ( subcutaneous fat, dermoid cyst,…)

Others….

T1[High signal] T2[High signal]

T1[High signal] T2[Low signal]

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Any structure or lesion not listed before

• Fluids ( CSF, urine, pleural effusion, ascites.,…)

• Edema and infarctions

• Most of tumors

• Contrast injection [ Gd- DTPA] ++

T1[Low signal] T2[High signal]

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Gadolinium – DTPA 0.1 – 0.2 mmol/kg body weight

Only T1 weighted images are obtained after Gd- DTPA injection

Differentiate SOLs

Assess activity of some lesions like MS

Assess post operative tumour recurrence

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Trigeminal n.

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Optic tract ,mamillary body, cerebral peduncle, substantia negra

Gyrus rectus

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Amegdala , hippocampus, superior vermis

Interpeduncular

Cistern

Quadrigeminal

Cistern

Temporal Horn

Hippocampal Formation

(epilepsy)

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Hippocampal region

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Mesial temporal sclerosis

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Choroidal fissure , Hippocampal tail , Vein of Galen

(Retrothalamic Cistern)

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Seen in T1WIs

Not seen in FLAIR

No clinical correlation

Anatomic sites

Verchaw – Robben’s spaces (dilated perivascular spaces)

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Grey matter : Whitish

White matter: Greyish

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Anatomic localization [Lobes]

Corpus callosum delineation

Cranio cervical junction

Evaluation of the venous sinuses

Pituitary gland

Value of sagittal images

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Pituitary gland, chiasm, hypothalamus

Hippocampal region

Skull base and posterior fossa

Trigeminal nerve

Vascular anatomy

Value of coronal images

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MRI Vascular Anatomy

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سبحانك اللهم و بحمدك نشهد ان ال اله اال انت نستغفرك و نتوب اليك

Thank you

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