Conventional Neuroradiological Conventional Neuroradiological ExaminationsExaminations

Başar Sarıkaya, M.D.Başar Sarıkaya, M.D.

Associate Professor of RadiologyAssociate Professor of Radiology

Yeditepe UniversityYeditepe University

What is neuroradiology?What is neuroradiology?

Neuroradiology is a subspecialty of Neuroradiology is a subspecialty of radiology which deals with imaging of the radiology which deals with imaging of the nervous system disorders using various nervous system disorders using various imaging modalities.imaging modalities.

What is neuroradiology?What is neuroradiology?

Plain X-rays, [Plain X-rays, [contrast enhanced X-rays contrast enhanced X-rays (myelogram, cisternogram, etc)(myelogram, cisternogram, etc)]]

Computed Tomography (CT)Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)

DSA (Digital Subtraction Imaging)DSA (Digital Subtraction Imaging)

What is neuroradiology?What is neuroradiology?

Current practice focuses on advanced Current practice focuses on advanced imaging methods such as perfusion MRI, imaging methods such as perfusion MRI, MR tractography, functional MRI, MR MR tractography, functional MRI, MR spectroscopy etc as well as noninvasive spectroscopy etc as well as noninvasive cerebrovascular imaging such as MRA cerebrovascular imaging such as MRA and CTA.and CTA.

Unfortunately I am not going to talk about Unfortunately I am not going to talk about these fancy stuff!!!these fancy stuff!!!

What do we mean by conventional?What do we mean by conventional?

“ “used and accepted by most people : usual used and accepted by most people : usual or traditional”or traditional”

Meriam-WebsterMeriam-Webster

Conventional Neuroradiological Conventional Neuroradiological ExaminationsExaminations

Herein this lecture, we will mostly talk Herein this lecture, we will mostly talk about plain X-ray films.about plain X-ray films.

Already partially representing history and Already partially representing history and soon to be totally historical.soon to be totally historical. OUTDATED!!!

Wilhelm Conrad Roentgen(27 March 1845 – 10 February 1923)Nobel Prize in Physics 1901

December 22, 1895

Plain X-ray FilmsPlain X-ray Films

Widely available and easy to obtainWidely available and easy to obtain

Image obtained is a superposition of Image obtained is a superposition of tissues (3D is converted into 2D) and tissues (3D is converted into 2D) and mainly reflects bone because of mainly reflects bone because of penetration issues of X-ray.penetration issues of X-ray.

Plain films of the headPlain films of the head

PA and lateral views PA and lateral views

2 view series2 view series

4 view series4 view series

Towne and WatersTowne and Waters

DON’T FORGET: One view is no view!!!DON’T FORGET: One view is no view!!!

Plain Films of the SpinePlain Films of the Spine

AP and lateralAP and lateral

R and L obliqueR and L oblique

Special positions (Swimmer’s view for the Special positions (Swimmer’s view for the cervicothoracic junction)cervicothoracic junction)

When do we obtain?When do we obtain?

For routine preoperative imaging For routine preoperative imaging (neurosurgery, ENT...)(neurosurgery, ENT...)

TraumaTrauma

Sinus diseaseSinus disease

Headache?Headache?

Waters Caldwell

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me

AP, lateral and oblique views of the spineAP, lateral and oblique views of the spine

CervicalCervical

ThoracicThoracic

LumbarLumbar

How many vertebrae do we have?How many vertebrae do we have?

Cervical: 7Cervical: 7

Thoracic: 12Thoracic: 12

Lumbar: 5Lumbar: 5

Sacral: 5Sacral: 5

Coccyx: 3-4Coccyx: 3-4

Plain Films for Spine ImagingPlain Films for Spine Imaging

First line of imaging for back or cervical First line of imaging for back or cervical pain or in case of trauma.pain or in case of trauma.

To see any misalignment, lytic or To see any misalignment, lytic or destructive lesions or congenital issues.destructive lesions or congenital issues.

If negative: most of the time, MRI is If negative: most of the time, MRI is required.required.

In the trauma setting: CT is preferred over In the trauma setting: CT is preferred over MRI. MRI.

Plain Films for Spine ImagingPlain Films for Spine Imaging

Routine views are AP and lateralRoutine views are AP and lateral

Oblique views are required to see the Oblique views are required to see the neural foramina of the C spine and the neural foramina of the C spine and the pars interarticularis region of the lumbar pars interarticularis region of the lumbar level.level.

Lateral views can be obtained in flexion Lateral views can be obtained in flexion and extension positionsand extension positions

AnatomyAnatomyT12

L1

L2

L3

L4

L5

S

C

12th12th

I I

si si

AnatomyAnatomy

B

s

TT P P

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B

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Quiz-1Quiz-1

27 year-old male is brought to ER after motor 27 year-old male is brought to ER after motor vehicle accident. Patient suffers from intense vehicle accident. Patient suffers from intense head neck pain with bruises over the occipital head neck pain with bruises over the occipital bone. What is the preferred imaging method?bone. What is the preferred imaging method?

a.a. UltrasoundUltrasound

b.b. X-ray of the C-spineX-ray of the C-spine

c.c. MRIMRI

d.d. Computed TomographyComputed Tomography

e.e. None of the aboveNone of the above

Quiz-2Quiz-2

Which X-ray view best demonstrates the Which X-ray view best demonstrates the acute sinusitis involving the maxillary acute sinusitis involving the maxillary sinuses?sinuses?

a.a. WatersWaters

b.b. CaldwellCaldwell

c.c. TowneTowne

d.d. LateralLateral

e.e. APAP

Regarding the Regarding the “Scotty dog” of “Scotty dog” of the oblique the oblique lumbar view, lumbar view, what structure what structure represents neck represents neck of the dog? of the dog?

Quiz-3Quiz-3

a.a. PediclePedicle

b.b. Inferior articular Inferior articular processprocess

c.c. Superior articular Superior articular processprocess

d.d. Transverse Transverse processprocess

e.e. Pars interarticularisPars interarticularis