diagnostic neuroradiology

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  • 1.Diagnostic Radiology of Central Nervous System Raphael B. Jiang, Section ofDiagnostic Radiology Sun Yat-Sen University First Affiliated Hospital

2. Outline

  • Normal Imaging Anatomy of Brain
  • Basic Features ofBrain Lesions
  • Brain Tumor
  • Cerebrovascular Disease
  • Traumatic Brain Injury

3. Normal Imaging Anatomy of BrainMeninges

  • Dura mater
  • Falx cerebriTentoriumcerebelliVenous sinuses
  • Arachnoid mater
  • subdural space a potential space btw dura and arachnoid
  • subarachnoid space interval btw arachnoid and pia
  • P ia mater

4. Falx cerebri Tentorium cerebelli Normal Imaging Anatomy of BrainMeninges 5. Falx cerebri Dura mater Arachnoid Subarachnoid space Pia mater Arachnoid granulation S. sagittal sinus Normal Imaging Anatomy of BrainMeninges 6. Normal Imaging Anatomy of BrainMeninges Falx and Tentorium Iso-/-mildly hyperdense compared with cortex on CT Hyperdense when calcified Markedly enhanced after iodine contrast Hypointense in T 1 WI and T 2 WI Homogeneity in signal intensity Markedly enhanced after Gadolinium 7. Normal Imaging Anatomy of Brain Cerebral Hemisphere

  • The layer ofgray mattercover sentire surface of cerebral hem .
  • Its deep layer is white matterand nucleus
  • Gray matter is slightly hyperattenuating thanwhite matter
  • White matter slightly hyperintense thangray matter onT 1 WI
  • Graymatter hyperintense than whitematter onT 2 WI

8. T 1 WI T 2 WI Normal Imaging Anatomy of Brain Cerebral Hemisphere 9. Frontal lobe Centrum semiovaleParietal lobeLongitudinal fissure Superior sagittal sinusFL CS PL LF SSS SECTION AT CENTRUM SEMIOVALE Normal Imaging Anatomy of Brain 10. Normal Imaging Anatomy of Brain Basal Ganglia Clusters of neurons, located deep in the brain Caudate nucleus, putamen, globus pallidus, substantia nigraCT and MR finding Basal ganglia and Thalamus gray matter density/intensityInternal and External capsule white matter density/intensity 11. Normal Imaging Anatomy of Brain 12. SECTION AT BASAL GANGLION Caudate Nucleus Head Putamen Thalamus I nternal Capsule External CapsuleFalx Cerebri Normal Imaging Anatomy of Brain CNH PU EC FC TH IC 13. Caudate Nucleus Head Putamen Thalamus I nternal Capsule External CapsuleFalx Cerebri SECTION AT BASAL GANGLION Normal Imaging Anatomy of Brain CNH PU EC FC TH IC 14. Normal Imaging Anatomy of Brain Brain Stem Mid-brain, pons and medulla oblongata CT appearance Brain stemnuclei notidentifiable Surrounded by fluid-density cistern MR findingB rain stemnuclei Mildly hypointense onT 1 WI,hyperintense onT 2 WI White matter fiber a slightly high intensity signal M ildly hyperintense onT 1 WI,hypointense onT 2 WI 15. SECTION AT OPTICAL CHIASM Gyrus RectusSylvian FissureHippocampus Mid- brainAqueduct of SylviusOptical Chiasm Occipital L S. Cerebellar Vermis Normal Imaging Anatomy of Brain GR OC MB OL SF HI AS SCV 16. Normal Imaging Anatomy of Brain CerebellumCTappearanceGray and white matter can bedistinguished Cerebellar tonsils and vermis slightly denser than other parts MRfindingSignals of cortex, medulla and nuclei similar to those of brain 17. SECTION AT FOURTH VENTRICLE Occipital LobeCerebellar HemispherePonsTemporal LobeTrigeminal NerveFourth Ventricle Normal Imaging Anatomy of Brain PO CH OL TL TN FV 18. Normal Imaging Anatomy of Brain 19. Corpus callosumThalamus Aqueduct of Sylvius Fourth Ven.Mid-brain Pons CerebellumMedulla oblongata SECTION AT MID-SAGITTAL PLANE Th AS Ce FV CC Mb Po MO 20. Lateral Ven. Third Ven. Corpus CallosumInsulaTemporal Lobe LV IN TL CC TV SECTION AT LATERAL & THIRD VEN. 21. Normal Imaging Anatomy of Brain Cerebral Vasculature

  • Internal Carotid Artery
  • anterior cerebral artery and middle cerebral artery
  • Basilar Artery
  • posterior cerebral artery
  • Communicating Artery
  • anterior and posterior communicating arteries
  • Cerebral Vein
  • superior sagittal, transverse, straight, sigmoid sinuses
  • inferior sagittal sinus, Vein of Galen

22. Normal Imaging Anatomy of Brain 23. Internal Carotid ArteryAnterior CAMiddle CAPosterior CABasilar A.Anterior&Posterior Com. ANormal Imaging Anatomy of Brain ICA MCA PCA BA ACA 24. Normal Imaging Anatomy of Brain 25. SuperiorSagittalSinus Straight Sinus Confluenceof sinuses InferiorSagittal Sinus Normal Imaging Anatomy of Brain Transverse Sinuse Sigmoid Sinus 26. Normal Imaging Anatomy of Brain 27. 28. Basic Features ofBrain Lesions Hydrocephalus The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus" meaning head As the name implies, it is a condition in which the primary characteristic is excessive accumulation of fluid in the brainThe excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles This widening creates potentially harmful pressure on the tissues of the brain 29. 30. Normal CSF flow passage Lateral V (Foramina of Monro) Third V (Aqueduct of Sylvius) Fourth V (Median aperture & Luschka Foramina) Subarachnoid Space (Arachnoid Granulations) Superior SS 31. 32. Classification Non-communicating Communicating Basic Features ofBrain Lesions Hydrocephalus 33.

  • Non-communicatingHydrocephalus
  • Obstructive hydrocephalus
  • CSF-flow obstruction ultimately preventing CSF from flowing
  • into subarachnoid space
  • Secondary to congenital,infectious or tumor diseases
  • D ilation ofVentricles aboveobstructi on
  • Ventricles normal belowobstructi on

Basic Features ofBrain Lesions Hydrocephalus 34. 35. 36.

  • CommunicatingHydrocephalus
  • Impaired CSF re-absorption in the absence of any CSF-flow
  • obstruction btw ventricles
  • Secondary to s ubarachnoid inflammation, craniocerebral injury,
  • intracranial hemorrhage and brain tumors
  • V entricles and cisterns ubiquitouslyenlarged

Basic Features ofBrain Lesions Hydrocephalus 37. CommunicatingHydrocephalus 38. 39.

  • Reduction in brain tissue volume
  • Secondary to expansion of the cranial CSF volume
  • Caused by Normal Aging and diseases
  • D iffused brain atrophy andl ocalizedbrain atrophy

Basic Features ofBrain Lesions Brain Atrophy 40. 41. 42.

  • Lack of blood supply orinterruption of bloodflow
  • Tissuenecrosisand liquefaction-cystic degeneration
  • Commonly found intumor

Basic Features ofBrain Lesions Necrosis and cystic degeneration 43. 44. 45.

  • Physiological Calcification
  • Pineal calcification
  • Age-related basal ganglia calcification
  • Pathological calcification
  • Calcification of craniopharyngioma
  • Calcification of gliomas
  • Calcification of meningioma

Basic Features ofBrain Lesions Calcification 46. CHONDROMA MENINGIOMA 47.

  • Structure departed from normal position due to intracranial lesion
  • Commonly found in tumors, hematoma, infarction, abscess, etc

Basic Features ofBrain Lesions Mass effect 48.

  • Signs of supratentorial space-occupying
  • Displaced or compressed ventricle
  • Narrowing or occlusion of ipsilateral cerebral sulcus and cistern
  • Shift of midline structures
  • Signs of infratentorial space-occupying
  • Deformation and shift of fourth ventricle and brainstem
  • Ventricular dilatation caused by CSF pathway obstruction

Basic Features ofBrain Lesions Mass effect 49. 50. 51.

  • Primary
  • Glioma40 ~50
  • 70 Astrocytoma
  • A ngioma
  • Medulloblastoma
  • Lymphoma
  • Secondary
  • Metastatic

Brain Tumor I ntra-axial tumor 52.

  • Astrocytoma
  • The most common type of gliomas
  • A t any age, most commonly between the ages of20 -40
  • S upratentorial predominantly for adult, infratentorial for children
  • P resent with seizures or focal neurological deficits,headache andincreased intracranial pressure
  • G radedfromItoIVbasedonhistological differentiation

Brain Tumor I ntra-axial tumor 53.

  • AstrocytomaGrade 1
  • Lower density on CT
  • Long T 1and long T 2intensity
  • Slight mass effect
  • Mildsurrounding edema
  • Well-demarcated boundary
  • No post-contrast enhancement
  • Malignantastrocytoma
  • Heterogeneousdensity
  • Mixed signal intensity
  • Marked mass effect
  • Severesurrounding edema
  • Ill-demarcated boundary
  • Post-contrast enhancement

Brain Tumor I ntra-axial tumor 54. Astrocytoma Grade 1 55. Astrocytoma Grade 2 56. Astrocytoma Grade 2 57. Glioblastoma multiforme(Malignant) 58.

  • Brain Metastases
  • Via blood stream route
  • M ost commonly from lungcancer
  • Imaging