01-Normal CT Anatomy of the Brain for Medical Students
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Transcript of 01-Normal CT Anatomy of the Brain for Medical Students
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รศ . พ.ญ . จิ�รพร เหล่�าธรรมทั�ศน์�
Advanced Diagnostic and Image-Guided Minimal Invasive Therapy Center
(AIMC)Ramathibodi Hospital
Mahidol University
Basic Neuroimagings
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AIMC
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Learning Objectives The main purpose of this lesson is to stimulate the students to recognize the value of gross anatomy and physiology of the CNS as major foundations in clinical practice. The students will be able to 1. Understand the principles of CT, MRI, Angiography PET and SPECT 2. Recognize the multiplanar normal neuroimaging anatomy 3. Recognize the imaging of the CSF pathway, intracranial arteries and venous system
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Content Outlines
1. Basic knowledge of CT, MRI, Angiography, PET and SPECT2. CT scan of the nervous system3. MRI of the nervous system4. Vascular imaging of the CNS: angiography, CT angiogram and venogram and MRA/MRV
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Learning Organization
1. Study the learning materials provided in advanced2. Lecture 40 minutes3. Questions and answers 10
minutes
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Self study of the following topics
1. Meninges and intracranial spaces 2. Intracranial vascular circulation 2.1 Cervical and intracranial carotid and vertebrobasilar system 2.2 Circle of Willis 2.3 Deep and superficial cerebral veins 2.4 Dural venous sinuses 3. Structural and functional correlation of the nervous
sys. 3.1 Visual pathway and cortex 3.2 Language center: Broca’s and Wernicke’s 3.3 Auditory cortex 3.4 Motor and sensory cortex 3.5 Brain stem 3.6 Pituitary gland
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Imaging Modalities1. Plain films/ Tomogram2. Ultrasonogram3. CT4. MRI5. Myelogram6. Angiogram7. Venogram8. Nuclear SPECT/ PET
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Magnetic Rasonance Imaging(MRI)
Computed Tomography(CT)
Ultrasonogram
Digital C-arm
Computed Radiography
Imaging Modalities
Digital Angiography
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PET ScanImages in
Mices: Differences in
Thymidine kinase gene expression
Metabolic Imaging
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The brain1. The cerebral hemispheres2. The posterior fossa3. The deep gray nuclei4. White matter tracts5. The ventricular system6. The meningies7. Vascular supply8. Venous drainage
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Normal CT Anatomy
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Normal CT Anatomy
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Basal Ganglion
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Normal gray-white matter
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Foramen Magnum Base of Skull
The posterior fossa
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C1-2
Foramen Magnum
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Cervicomedullary Junction
Hypoglossal nerve canal
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Brain Stem
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Sagittal Midline MRI
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Brain stem
pons
cerebellum
temporal lobe
cerebellar peduncle: middle
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Medulla
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Pons- CPA - IAC Middle Cerebellar Peduncle
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Cerebellum
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Cerebellar hemisphere Cerebellar vermis
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Pons-Cerebellum
Infundibulum
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Mid Brain
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Third Ventricle Tectal Plate
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Brain Parenchymal Anatomy
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The cerebral hemispheres
1. Frontal lobes2. Parietal lobes3. Temporal lobes4. Occipital lobes5. Insular lobes6. Limbic lobes
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Occipital lobe
frontal
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Posterior Fossa
Temporal Lobes
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Uncus: Temporal Horn
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Hypothalamus Midbrain- Aqueduct
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Frontal -Temporal
Occipital Lobes
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Frontal and Parietal Lobes
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Centrum Semiovale
Fronto-parietal lobes
Concept of Blood Brain Barrier
No C
+C
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Central Sulcus:The Fronto-Parietal Boundary
No C
+C
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BG- Pineal- Thalamus
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Higher Sensitivity: fMRI
Finger tappingfMRI
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Functional Brain Anatomy
1. Primary Motor cortex2. Primary Sensory Cortex3. Primary Visual Cortex4. Primary Auditory Cortex5. Language
1. Broca’s area2. Wernicke’s area
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Functional Cortical Brain Mapping
Blood Oxygen Level Dectection :Bold Effect
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Combined visualization of
fMRI maps and EEG/MEG
multiple dipole models
Combined visualization of
fMRI maps and EEG/MEG
multiple dipole models
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Central sulcus
*
Hand motor area
Precentral gyrus
Postcentral gyrus
central sulcus
Cingulate sulcus**
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Motor Cortical brain mapping:Glioma
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Cognitive - Picture Encoding
Picture Encoding
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Auditory cortexAuditory cortex
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Internal Medicine Review November 11,2001
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The Ventricular System
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The ventricular system• Lateral ventricles
– Frontal horn– Body– Temporal horn– Trigone– Occipital horn
• Third ventricle• Aqueduct of Sylvius• Forth ventricle• The Foramina of Magendie and Luschka
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Concept of CSF-Brain Barrier
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The Lateral Ventricle:frontal horn, body,
occipital horn, trigone & temporal horn
f
b
o
tr
t
trt
fo
t
tr
f
b
o
b
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The Foramen of Monro
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The Third Ventricle
3rd 3rd
3rd
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Basal Ganglion Frontal Horn
Pulvinar
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The aqueduct of Sylvius
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Suprasellar CisternTemporal horns
Aqueduct of Sylvius
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The Forth Ventricle
4th 4th
4th
4th
4th
4th
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The Foramina of Magendie and Luschka
4th
4th
FM
FM
FL FL
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Foramen of Lushka and Magendie
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Fourth Ventricle
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Frontal Horns Foramen of Monroe
Third VentricleGlomus of the choroid Plexus
Aqueduct of SylviusPineal Gland
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Third Ventricle Aqueduct of Sylvius
Perimesencephalic Cistern
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Frontal HornsTrigone
Occipital Horns
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Body of The Lateral Ventricle
Corona Radiata
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Centrum Semiovale
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Pituitary FossaVisual Pathway
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Sellar-suprasellar Region
Sellar tursica
Sellar tursica
Hypothalamus
Suprasellar cistern
Suprasellar cistern
Infundibulum
Infundibulum
Hypothalamus
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Normal CT Anatomy
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Pituitary Fossa
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Suprasellar Cistern Optic
Apparati
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Hypothalamus opticTracts-Radiations
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Optic RadiationCalcarine cortex
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White Matter Tracts
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Commisure fibers (corpus callosum)Projection fibers (internal capsule)Cortico-cortical association fibers (IFO)
Fiber tracking: DTI
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Central sulcus
*
Hand motor area
Precentral gyrus
Postcentral gyrus
central sulcus
Cingulate sulcus**
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Central Sulcus
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Centrum Semiovale
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Body of the Lateral Ventricle
Coronal Radiata
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The Corpus Callosum
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ThalamusBasal Ganglion
Frontal HornPulvinar
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Suprasellar Cistern- Optic Chiasm
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Mid pons
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Pons
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Medulla
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Cervicomedullary Junction
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Fornix
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Meningies
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Intracranial spaces
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Normal Meningeal Enhancement: CT
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NORMAL DURAL ENHANCEMENT: MRI
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EXTENSIVE DURAL ENHANCEMENT History:A 45 y.o. F presented with sudden onset of thunderclap headche for 1 week starting from bil. temporal areas progressing to the occiput with recent posterior right sided neck and occiput pain.
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Vascular SupplyAnd
Venous Drainage
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Circle Of Willis
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Cerebral Angiogram
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CT Angiogram of the Brain and Neck
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MRA: Pipe 2DTOF MRA: Neck 3DTOF MRA: Brain
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Suprasellar CisternCircle of
willis
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Sylvian Fissure
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Examples of “CE-TOFMRA”
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Routine 2DTOFMRA of the neck: inplane flow
artifact is demonstrated.
Contrasted TOFMRA of the neck demonstrating no inplane flow artifact
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2DTOFMRA with superior saturation band showed only RVA
2DPCMRA with all directions encoded (VENC 50 cm/sec) showed bilateral VA
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RVA
LVA
VENC
2DPCMRA with SI encoding
direction showed bilateral VA with
different flow directions
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contrasted 3DTOFMRA showed bilateral VA,complete occlusion of the left CCA and SCA origins but well visualized LVA
DIAGNOSIS SUBCLAVIAN
STEAL SYNDROME
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Takayasu’s arteritis: routine and contrasted MRA
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Dural Venous Sinuses
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Dural Venous sinuses
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MRV
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2DPC
2D PC MRV
3D PC MRV
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2DTOFMRV: AVM
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Superior Sagittal Sinus
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SSS
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Third VentriclePineal Gland
Internal Cerebral Vein
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Basal Vein of Rosenthal
Straight Sinus
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TransverseSigmoid Sinuses
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Sigmoid SinusJugular foramen
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Ramathibodi HospitalRamathibodi Hospital