neuroimaging - north carolina state optometric society · 2017. 10. 30. · neuroimaging spencer...
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Neuroimaging
Spencer Johnson, O.D., F.A.A.O.
Northeastern State University
Oklahoma College of Optometry
Neuroimaging
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Angiography
• Ultrasonography
Neuroimaging
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Angiography
• Ultrasonography
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Electromagnetic Spectrum
http://knowledgeserver.wordpress.com/2012/07/31/electromagnetic-spectrum/
X-rays
• Wilhelm Röntgen
• German physicist
• Credited as the
discoverer of X-rays in
1895
(March 27, 1845 to February 10, 1923)
X-rays
• Hand mit Ringen (Hand
with Rings): print of
Wilhelm Röntgen's first
"medical" X-ray, of his
wife's hand, taken on 22
December 1895
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X-rays
• Won the first Nobel
Prize in Physics in 1901.
• In honor of his
accomplishments,
IUPAC named element
111, Roentgenium, a
very radioactive
element with multiple
unstable isotopes, after
him.
Pedoscope
CT Scanner
http://www.wired.com/gadgets/miscellaneous/news/2008/04/Toshiba_CTScanner
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CT - Indications
• Orbital and sinus pathology/trauma (except
optic nerve)
• Acute cerebral or subarachnoid hemorrhage
• Localization of metallic foreign body
CT Ordering
• Location• Orbit
• Brain
• Sinuses
• Iodinated Contrast• Without contrast
• With and Without Contrast
• Presumptive Diagnosis
CT Ordering - Contrast
• Iodine Based
• Hard on the kidneys
• Visually translucent,
radiographically
opaque
http://www.usermeds.com/medications/visipaque-270
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CT Ordering - Contrast
Without Contrast With Contrast
http://www.hawaii.edu/medicine/pediatrics/pemxray/v4c01.html
•Enhances Sensitivity and Specificity
CT Ordering - Contrast
• Lab tests prior to scan
if ordering contrast
– Blood Urea Nitrogen
(BUN)
– Creatinine
– Glomerular Filtration
Rate (GFR)http://www.usermeds.com/medications/visipaque-270
CT Ordering - Contrast
• Contraindications
– Allergy to iodine
– Impaired renal function
– Diabetes – must stop
metformin 48 hours
prior to scan
http://www.usermeds.com/medications/visipaque-270
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CT Ordering - Contrast
• Not indicated (may mask visualization) in:
Bony Injury Acute Hemorrhage Localization of
Foreign Bodies
BONE BLOOD BBhttp://alliedps.blogspot.com/2012/03/allied-in-community-2012-blood-drive.html
Slice Size
• Images can be provided in
as thin as 0.5mm slices.
Thin slice rendering is
advantageous when trying
to detect very small
objects (i.e. metallic
foreign body, bone
fragments in the optic
nerve, etc.)
CT
Moretti et al. Journal of Medical Case Reports 2012, 6:91 http://www.jmedicalcasereports.com/content/6/1/91
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Moretti et al. Journal of Medical Case Reports 2012, 6:91 http://www.jmedicalcasereports.com/content/6/1/91
MRI
http://www.bayhealth.org/BayhealthContentPage.aspx?nd=1149&news=823
MRI
http://www.made-in-china.com/showroom/anke-mri/product-detailpqxQbnoYIvWm/China-Open-Mri-Machine.html
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MRI - Weighting
www.tremorjournal.org
Electromagnetic Spectrum
http://knowledgeserver.wordpress.com/2012/07/31/electromagnetic-spectrum/
MRI Indications
• Technique of choice for visual pathway
– Optic nerve and optic nerve sheath
– Pituitary tumors
– Cavernous sinus pathology
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MRI Ordering
• Location• Orbit
• Brain
• Sinuses
• Iodinated Contrast• Without contrast
• With and Without Contrast
• Presumptive Diagnosis
Pre-Acquisition Sequences
• T1
• T2
• Fat-suppression/saturation
• FLAIR
MRI Ordering - Contrast
• Gadolinium based - acquires magnetic moment when placed in an electromagnetic field
• Administered intravenously and remains intravascular unless there is a breakdown of the blood-brain barrier
• Only visualized on T1 weighted images. Enhancing lesions such as tumors and areas of inflammation will appear bright
http://commons.wikimedia.org/wiki/File:Omniscan_nima.JPG
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Fat Suppression
http://www.oculist.net/downaton502/prof/ebook/duanes/pages/v2/v2c014.html
FLAIR
www.tremorjournal.org
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Table Limits
National Imaging Price Variances
www.changehealthcare.com
CT vs MRI
CT MRI
http://dorshav.typepad.com/hebrewwisdom/2007/08/basar-part-two-.htmlhttp://alliedps.blogspot.com/2012/03/allied-in-community-2012-blood-drive.html
http://www.clker.com/clipart-steel-ball.html
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CT orbitw/o contrastr/o fracture
Diagnosis: xxx.xx
MRI brain and orbitw/ and w/o contrastc/o multiple sclerosis
Diagnosis: xxx.xx
CT brain and orbitw/o contrastr/o metallic foreign body
Diagnosis: xxx.xx
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MRI orbitw/ and w/o contrastc/o optic neuritis
Diagnosis: xxx.xx
CT brainw/o contrastc/o acute intracranial hemorrhage
Diagnosis: xxx.xx
MRI brainw/ and w/o contrastc/o mass lesion right parietal lobe
Diagnosis: xxx.xx