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Imaging

This document discusses various imaging and investigative modalities used to examine the nervous system, including: 1. Indirect imaging techniques like pneumoencephalography were used prior to CT and MRI to visualize the brain. CT scanning in the 1970s and MRI in the 1980s allowed for direct imaging of brain tissue with improved soft tissue contrast. 2. Neurosonography uses ultrasound to image CSF, blood, brain malformations, and masses without radiation. Doppler ultrasound and transcranial Doppler ultrasound are also discussed. 3. CT, MRI, angiography, myelography, and digital subtraction angiography involve the use of x-rays, contrast dyes, or magnetic fields to examine tissues, blood vessels

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Harun Mohamed
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39 views

Imaging

This document discusses various imaging and investigative modalities used to examine the nervous system, including: 1. Indirect imaging techniques like pneumoencephalography were used prior to CT and MRI to visualize the brain. CT scanning in the 1970s and MRI in the 1980s allowed for direct imaging of brain tissue with improved soft tissue contrast. 2. Neurosonography uses ultrasound to image CSF, blood, brain malformations, and masses without radiation. Doppler ultrasound and transcranial Doppler ultrasound are also discussed. 3. CT, MRI, angiography, myelography, and digital subtraction angiography involve the use of x-rays, contrast dyes, or magnetic fields to examine tissues, blood vessels

Uploaded by

Harun Mohamed
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Imaging/investigations

DR JULIET SEKABUNGA NALWANGA


History of Imaging of the Nervous
System

•Indirect imaging prior to CT and MRI:


•Prior to the advent of CT and MRI, brain imaging relied on radiographic
techniques.
•The brain is not directly visible on radiographs, so various forms of
introduced contrast were required.
•For example, in pneumoencephalography, air was introduced into the
cerebrospinal fluid to highlight ventricular and cisternal anatomy.
 1920s – Cerebral angiography:
 Cerebral angiography, obtained through the intra-arterial injection of radiodense
contrast agents, was introduced by Egas Moniz in 1927.
 Angiography allowed demonstration of intracranial vascular anatomy
 1970s – CT: The advent of CT imaging in the 1970s allowed direct imaging of the
brain parenchyma
 Progressive improvements in CT technology have followed, including
multidetector scanners and helical acquisition.
 1980s – MRI: The introduction of clinical MRI in the early 1980s brought improved
soft-tissue contrast, compared with CT, and allowed imaging in multiple planes.
Neurosonography of the Brain

•Neurosonography does not require ionizing radiation.


•Ultrasound equipment is portable and can be brought to the
bedside.
•CSF and blood well imaged: Intraventricular hemorrhage and
hydrocephalus
•Major brain malformations and large intracranial masses
•The level of the bottom of an infant’s spinal cord can be
determined during the first few months of life.
Other USS modalities

 Doppler USS
 Transcranial Doppler USS
X-ray Examination

 Skull X-rays
 Spine X-rays
 Angiograms
 Myelograms
 Dynamic spine imaging
 Neurography
 Spine angiography
 Digital subtraction angiography
Computerized Tomography Imaging of the Brain

• CT imaging of the brain requires only a few seconds on modern


scanners.

•Useful in trauma and hydrocephalus.

•CT is indispensable for the accurate evaluation of fractures and


developmental anomalies.

•Minimize radiation dose: CT scans require the use of ionizing


radiation (x-rays).
•CT scanning should be avoided when other suitable
alternatives are available (for example, MRI or ultrasound).

•Brightness reflects density: Brightness on CT images


reflects the radiodensity of corresponding tissues—denser
structures are brighter.

•Radiodensity on CT is quantitated in Hounsfield units (HU).


•Helical versus conventional image acquisition:
Conventional axial CT images are acquired sequentially, one
slice at a time.
•Modern CT scanners also allow continuous (helical)
acquisition.
•Helical acquisition is faster, facilitating dynamic CT techniques
including CT angiography.
•In some circumstances, helical acquisition also permits
decreased x-ray dose.
CT Angiography of the Brain

Angiography methods demonstrate the arterial and venous


anatomy.

•CT angiography, together with MRI angiography, has largely


replaced invasive cerebral angiography in children.

•CT angiography requires the use of intravenous iodinated


contrast material. Iodinated contrast can cause renal toxicity
(contrast-induced nephropathy).
Magnetic Resonance Imaging of the Brain

• Magnetic resonance imaging uses time-varying


electromagnetic fields to produce images that reflect
regional biophysical properties of the CNS.
• MRI thereby provides unparalleled evaluation of the
brain and spinal cord parenchyma.
• Where available, MRI is the preferred method for
evaluation of most CNS abnormalities.
•MRI provides excellent soft-tissue contrast.
•MR images can be obtained in any plane, including axial,
coronal, and sagittal.
•MRI does not use x-rays or other ionizing radiation.
•Typical brain MRI examinations require 20–25 minutes, and
the patient must remain motionless during this time.
•Sedation is often required for younger children.
•MRI is also expensive.
MRI – How it Works

•Multiple MRI sequences are obtained to highlight differing


structural or functional brain features.
•In the normal CNS, MRI image intensity depends heavily on
myelination state.
•According to radiologic convention, left-sided structures are
presented on the viewer’s right.
•Viewers should attend to the directionality labels (L/R and A/P)
presented at the margins of the MR images.
•T1-weighted images: The relative intensity of gray and white matter varies
according to its myelination stage—the mature pattern is shown below. The
CSF is dark. The T1 sequence is excellent for the evaluation of anatomy.

T2-weighted images: Fluid, including CSF, is bright on this sequence. The


relative intensity of gray and white matter varies according to its myelination
stage—the mature pattern is shown.
This sequence is excellent for the demonstration of anatomy, evaluation of
hydrocephalus, and identification of CNS tumors.
•FLAIR images: This sequence is similar to T2-
weighted images, except that the signal from CSF is
suppressed.
•T1-weighted post contrast: Gadolinium-based
contrast material, injected intravenously, results in
increased signal intensity on T1-weighted images.
•MR angiographyand venography evaluates presence
of blood flow in arteries and veins.
Functional MRI of the Brain
fMRI aims to demonstrate the cortical regions important for specific functions, such
as motor control and language. This is accomplished through identification of the
subtle changes in blood flow that accompany neuronal activation.

MR Spectroscopy of the Brain


•Identifies metabolites: Numerous metabolites can be identified, with varying
efficiency. For clinical purposes, choline (Cho), creatine (Cr), n-acetylaspartate
(NAA), and lactate are the most important.
•Choline elevates in multiplying cells: Choline is increased in rapidly dividing cell
populations. This property can be used to predict the
histological grade of some brain tumors.
Blood work
CSF

 Analysis
 Culture and sensitivity
 Cytology
 ALP,bHCG,AFP
 LP
 ICP monitoring
Neurophysiological studies

 EEG
 Urodynamic studes
 EMG
 Visual assessment
 Auditory assessment
 Tests for vestibular function
 electronystagmography
 electrooculography

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