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NeurodiagnosticNeurodiagnostic

ProceduresProceduresJunchen ZhangJunchen Zhang

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Who is heWho is he

Bruce Lee is Hong Kong kungfuBruce Lee is Hong Kong kungfu

star. He was borned instar. He was borned in SanSanFrancisco in November 1940 .His firstFrancisco in November 1940 .His firstfilm was called The birth of Mankind,film was called The birth of Mankind,

his last film which was uncompleted athis last film which was uncompleted at

the time of his death in 1973 wasthe time of his death in 1973 was

called Game of Death(called Game of Death( ..

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There are and the numerous different theories on how he died.There are and the numerous different theories on how he died.Original cause of death listed as marijuana poisoning, later changed toOriginal cause of death listed as marijuana poisoning, later changed to

death by misadventure.death by misadventure.

Resently,some scholar think cerebral aneursym was the cause of leesResently,some scholar think cerebral aneursym was the cause of lees

death.death.

How to identify the cause of leesHow to identify the cause of lees

death?death?

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craniocerebral traumacraniocerebral trauma

brain tumorsbrain tumors

cerebral vascular diseasecerebral vascular disease infectioninfection

congenitalcongenital [k n'd enitl] [k n'd enitl]

diseasedisease

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How to diagnosis the CNSHow to diagnosis the CNS

disease?disease?

Neurodiagnostic ProceduresNeurodi

agnostic Procedures isisnecessary to diagnosis andnecessary to diagnosis and

guide the therapy of neurologicguide the therapy of neurologic

disordersdisorders..

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Plain film radiographyPlain film radiography

Computed tomography[t 'm gr fi] Computed tomography[t 'm gr fi]

MRIMRI DSADSA

MyelographyMyelography

PETPET Ultrasound(Ultrasound(

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1 Plain film radiography1 Plain film radiography

Are useful in the initial assessment ofAre useful in the initial assessment ofspinal traumaspinal trauma

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Are useful in suspected [s s'pektid]Are useful in suspected [s s'pektid]

infectioninfection

Are useless in cases with neurologicAre useless in cases with neurologic

deficitsdeficits

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2 Computed tomograthy2 Computed tomograthy

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The Basic principleThe Basic principle

the CT image is a computer-generatedthe CT image is a computer-generatedacross-sectional representation of anatomyacross-sectional representation of anatomy

crected by analysis of the attennuation of X-crected by analysis of the attennuation of X-

ray beams that have been passed throughray beams that have been passed through

various points around a section of the brainvarious points around a section of the brain

X-ray

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X-ray attenuation

(X- )X-ray

Greater x-ray attenuation caused by bone results inareas of high density

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CT

Canthomeatal line

-

(150) (red line)

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CT is useful in imagingCT is useful in imaging

osseous-structuresosseous-structures

HemotomasHemotomas Cerebral atroophyCerebral atroophy

HydrocephalusHydrocephalus

cerebral infarctioncerebral infarction

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Because ofBecause of lesionslesions

situated nera the skull base are moresituated nera the skull base are more

difficult to delineate with CTdifficult to delineate with CT

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CTACTA

Multidetector CTMultidetector CT

(( CTCT

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3 Ultrasound(US)3 Ultrasound(US)

The US is the standard technique forThe US is the standard technique for

evaluating the premature infant forevaluating the premature infant for

hydruocephalus.hydruocephalus.

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Intraoperative ultrasound can also beIntraoperative ultrasound can also be

used to help position the ventricularused to help position the ventricular

catheter ['kit ] during shuntingcatheter ['kit ] during shunting

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4 Magnetic resonance4 Magnetic resonanceimaging(MRI)imaging(MRI)

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The Basic principleThe Basic principle

the imges that are created reflect the density ofthe imges that are created reflect the density ofhydreogen protons as well as their relaxation rates.hydreogen protons as well as their relaxation rates.

MRIMRI

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TT11 imagesimages

T2 imagesT2 images

FLAIR imagesFLAIR images are sensitve for corticalare sensitve for corticallesion and meningeal processes.lesion and meningeal processes.

EPI imagesEPI images is the most sensitive foris the most sensitive forindentifying aacute infarcion and perfusionindentifying aacute infarcion and perfusionimaging .imaging .

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T1 imagesT1 images T2 imagesT2 images FLAIR imagesFLAIR images

EPI imagesEPI images

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Gadolinium [gd 'lini m] are often Gadolinium [gd 'lini m] are often

used to increase the sensitivity of MRused to increase the sensitivity of MR

to various disease.to various disease.

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GD-DTPA

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MRA delineate the majorMRA delineate the major

extracranial and intracranial vesselsextracranial and intracranial vessels

without the need for contrastwithout the need for contrast

agents.agents.

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MRI is useful in imagingMRI is useful in imaging traumatrauma

tumortumor Cerebral vascular diseaseCerebral vascular disease

Spine and spinal cordSpine and spinal cord

infectioninfection

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5 myelography5 myelography

Is a radiographic studyIs a radiographic studythay outlines the spinalthay outlines the spinal

canal and its contents.canal and its contents.

Water-soluble nonionicWater-soluble nonionic

contrast material iscontrast material is

injected into theinjected into the

subarachniod space viasubarachniod space viaa lumber punctrea lumber punctre

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6 Digital aubtraction6 Digital aubtraction

angioraphy(DSAangioraphy(DSA))

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Definition[defi'ni n]Definition[defi'ni n] Radiographic visualization of theRadiographic visualization of the

arterial and venous systems of thearterial and venous systems of the

neck,brain,and spinal cord isneck,brain,and spinal cord isaccomplished by intra-arterial injectionaccomplished by intra-arterial injection

of a water-soluble iodinated contrastof a water-soluble iodinated contrast

agent.agent.

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MethodsMethods

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DSA is the best procedure forDSA is the best procedure for

characterizing aneurysms and AVM.characterizing aneurysms and AVM.

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MRA and CTA have improved inMRA and CTA have improved in

recent years,making possiblerecent years,making possible

noninvasive assessment of many ofnoninvasive assessment of many of

these vascular disorders.these vascular disorders.

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6 Radionuclide imaging6 Radionuclide imaging

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IntroductionIntroduction

NoninvasiveNoninvasive

Utilizes radiopharmaceuticalsUtilizes radiopharmaceuticals

(radioisotopes)(radioisotopes)

Evaluates pathophysiology ofEvaluates pathophysiology of

systemssystems

Most common systems scanned are:Most common systems scanned are:

skeleton, lungs, liver, thyroid andskeleton, lungs, liver, thyroid and

heartheart

Usually done in combination with X-Usually done in combination with X-ra CT or MRI

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Radionuclide ImagingRadionuclide Imaging

Several modalities of imaging systemsSeveral modalities of imaging systems

Bone scan/bone scintigraphyBone scan/bone scintigraphy

SPECT (single photon emission computedSPECT (single photon emission computed

tomography)tomography) Ventilation/perfusion scansVentilation/perfusion scans

Myocardial perfusion scansMyocardial perfusion scans

PET (positron emission tomography)PET (positron emission tomography)

Bone scan is the most commonlyBone scan is the most commonlyperformed procedureperformed procedure

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Pathological FindingsPathological Findings

Bone scans are useful for diagnosing the followingBone scans are useful for diagnosing the followingconditions:conditions: Metastatic diseaseMetastatic disease

TraumaTrauma

InfectionInfection Paget diseasePaget disease

Hypertrophic osteoarthropathyHypertrophic osteoarthropathy

Reflex sympathetic dystrophyReflex sympathetic dystrophy

Avascular necrosisAvascular necrosis

SpondylolysisSpondylolysis Venous obstructionVenous obstruction

ExtraosseousExtraosseous

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Normal Bone ScanNormal Bone Scan

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Prostate MetastasisProstate Metastasis

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NeuroblastomaNeuroblastoma

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SPECT ImagingSPECT Imaging

SPECT (single photon emission computedSPECT (single photon emission computedtomography)tomography)

Three dimensional imagesThree dimensional images Axial, coronal and sagittal slicesAxial, coronal and sagittal slices

Gamma camera is rotated around the patient in all threeGamma camera is rotated around the patient in all threeanatomical planesanatomical planes

Competing signal from overlying structures isCompeting signal from overlying structures iseliminatedeliminated

Accurate detection of subtle signal changes andAccurate detection of subtle signal changes and

better spatial resolution of signal changesbetter spatial resolution of signal changes Useful for detecting occult pars/spinous fracturesUseful for detecting occult pars/spinous fractures

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Spinous Process FracturesSpinous Process Fractures

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PETPET

PET (positron emission tomography)PET (positron emission tomography) Physiologic imaging methodPhysiologic imaging method

NeuroimagingNeuroimaging Oncological imagingOncological imaging

Radionuclide used is fluorodeoxyglucoseRadionuclide used is fluorodeoxyglucose((1818F-FDG)F-FDG)

Utilizes beta decayUtilizes beta decay Expensive studyExpensive study Utilized mostly in research settings butUtilized mostly in research settings but

PET is gaining acceptance outside ofPET is gaining acceptance outside ofresearchresearch

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PETPET

Positron is emitted by beta plus decayPositron is emitted by beta plus decay Electron is emitted by beta minus decayElectron is emitted by beta minus decay Positron collides with electronPositron collides with electron

2 gamma rays are emitted2 gamma rays are emitted Gamma rays are detected by a ring ofGamma rays are detected by a ring of

detectors around the patientdetectors around the patient PET is now commonly being combined withPET is now commonly being combined with

dual MRI/PET scanners and CT/PET,dual MRI/PET scanners and CT/PET,CT/PET Fusion scansCT/PET Fusion scans

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PET Scanner DiagramPET Scanner Diagram

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CNS Lymphoma-MRI/PET ScanCNS Lymphoma-MRI/PET Scan

CNS L h C l PETCNS L h C l PET

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CNS Lymphoma-Color PETCNS Lymphoma-Color PET

ScanScan