• congenital developemental errors (scoliosis,

Neuroradiology

J.Lisý

X-ray of skull/spine

• trauma (2 perpendicular projections)

• congenital developemental errors (scoliosis,

spina bifida)

Perimyelography (PMG)

Lumbar puncture, isoosmolar iodine CM

Dural sack

• Impression by herniated disc

• Amputation of sheaths of nerve roots

• Stop in filling by tumour

US of brain in neonates

open great fontanel/transtemporal higher frequency of US probe

• size of ventricles (hydrocefalus)

• width of SA spaces (cortical atrophy)

• focal changes

• hemorrhage (ED, SD, SA, IC)

susp. tumour

Ischemic involvement of MCA

CT brain

• acute trauma (hemorrhage, fracture)

• acute ischemic event x MRI

• faster

• cortical bone

Hemorrhage

• intracerebral

• epidural

• subdural

• subarachnoideal

developement in time: acute hyperdense

subacute isodense (3 we)

chronic hypodense

Epidural hematoma

• bone- dura mater

• biconvex

• limited by sutures (dura attached to sutures)

• rather arterial

Subdural hematoma

• dura-arachnoidea

• crescent-shape

• not limited by sutures

• usually venous

Subarachnoidal hematoma

• arachnoidea-pia matter

• SA spaces, basal cisterns

• severe headache

• trauma

• aneurysm rupture

• CT angio

Intracerebral hematoma

hypertensive h.

involves basal ganglia

Traumatic contusion

• FLAIR (T2W with fluid suppresion

• gliosis x encephalomalacia

• frontal basal

• temporal ventral basal

Difusse axonal injury

• Microbleeds (hemosiderin)

• Gradient echo T2* (sensitive to

magnet.field inhomogenities)

Ischemic involvement

• acute: hyperdense MCA sign SA narrowing

lost of GM/WM differetiation

• chronic: encefalomalatic pseudocyst (hypodense), gliosis

ev. thrombolysis till 6 h (Ag selective)

Ischemia CT

Ischemia development MRI DWI

after 3 mo

Hyper- / hypodese lesions of a brain

• hyperdense: calcifications

acute hemorrhage (developed in time becomes hypodense)

• hypodense: edema

cyst (encephalomalatia) gliosis

a

Signs of an expansion

1) perifocal oedema (hypodensity, increased water content)

2) compression of a ventricles or SA spaces

3) midline shift to the healthy side

MRI of a brain

• lack of radiation/ionisation

• contrast difference of gray x white matter

• sensitive to distinguish gliosis x encephalomalacia

• angiography (arteries/veins) without Gad

application

Indications MR

• epilepsy

• demyelinisation

• inflammation

• tumours

• vascular malformations

• inborn developemental errors

Myelinisation of white matter

• completed postnatally 36-40 mo

• from occipital to frontal caudal to cranial central- periphery

Metabolic disease

• lesion within basal

ganglia (gl.pallidus)

Multiple sclerosis

demyelinisation (Ab against

myelin of nerve fibres of WM) autoimmune

• oval shaped foci

• periventricularly

• paralel in coronal plane

• supra and infratentorial, intrameddular

• active enhancing after Gd

negative finding doesn´t mean healthy patient

Disorders of neuronal migration

• neurons from embryonal germinal matrix form gray matter cortex (superficial)

basal ganglia (deep)

heterotopy of GM cortical dysplasia

Disorders of midline and posterior fossa

agenesis of CC Chiari Dandy Walker

enlarged PF, cyst in PF high pos. of tentorium

Chiari malformation

• descensus of tonsils under for. magnum

• narrowed IV.ventricle

• smaller posterior fossa

syringohydromyely

Epilepsy

(CT useless) sensitivity of MR depends on technique

• mesial temporal sclerosis

• disorders of neuronal migration

• vascular malformations (AVM)

• tumours

• gliosis (posttraumatic, postsurgical)

Mesial temporal sclerosis

• hippocampal atrophy and gliosis

• high signal of smaller hippocampus

• most common lesional epilepsy

• FLAIR (T2W with

supression of fluid signal)

Cerebrovascular malformation cavernoma

• T2W/gradient echo (sensitive to hemosiderin)

Venous angioma

Aneurysma v.magna Galeni

MRA angiography (without CM)

• Arterial TOF

• Venous PC

• L-R heart shunt

• LV insuficiency

Inflammation encephalitis

• acute negative finding

• chronic small round shaped gliosis subcortically

• herpetic encefalitis temporal lobes

Inflammation meningitis

• enhancement of leptomeninges after CM

• TB basilar meningitis

Hydrocephalus

• enlarged ventricles

• narrowed SA spaces

Hydrocephalus

• flow void in aqueductus (supratentorial h.

meningitis)

• transependymal shift of CSF (decompensation)

Tumours

• small solid nodule enhnacing after Gd

• great cystic portion

astrocytoma cystic hemangioblastoma

Ependymoma

• arises from ependyma

• propagation below

foramen magnum

Meduloblastoma

• most common malignant tumour in posterior fossa

• microcalcifications

• solid nodule

Pontine glioma

• relatively benign (absence of Gad enhancement)

• non operabile

(floor of the IV.

ventricle)

• RT (central

necrosis)

Meningeoma (Extraaxial tumor)

• extraxial lesion of leptomeninges

• impression on cortex, perifocal edema

• homogenous enhancement after Gd

• dural tail (comet) sign

Lipoma

• T1 hypersignal of fat

• st. associated with

partial agenesis of CC

Quiz case ???

Sag T1w native

Pituitary macroadenoma

• young females, oligomenorhea, infertility, prolaktinemia

• native T1 adenohypophysis isosignal

neurohypophysis hypersignal

(phospholipids)

Pituitary microadenoma

• defect in pituitary gland after Gad, deformation of contour, dislocation of infundibulum

• macro x micro 1 cm

Craniopharyngeoma

• 2

most common tumor of sella turcica

• small solid and large cystic portion

Metastases intracerebral

BCA lung

Breast carcinoma Melanoma

expansion, perifocal edema

Metastases extraaxial

• leptomeningeal

• subependymal (medulloblastoma)

• Gad mandatory

brain and spinal canal