Anatomía radiológica del cerebro
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Transcript of Anatomía radiológica del cerebro
รศ. พ.ญ. จิรพร เหล่าธรรมทัศน์Advanced Diagnostic and Image-Guided Minimal Invasive Therapy Center (AIMC)
Ramathibodi HospitalMahidol University
Basic Neuroimagings
AIMC
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
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
Learning Organization
1. Study the learning materials provided in advanced2. Lecture 40 minutes3. Questions and answers 10 minutes
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
Imaging Modalities1. Plain films/ Tomogram2. Ultrasonogram3. CT4. MRI5. Myelogram6. Angiogram7. Venogram8. Nuclear SPECT/ PET
Magnetic Rasonance Imaging(MRI)
Computed Tomography(CT)
Ultrasonogram
Digital C-arm
Computed Radiography
Imaging Modalities
Digital Angiography
PET ScanImages in
Mices: Differences in
Thymidine kinase gene expression
Metabolic Imaging
The brain1. The cerebral hemispheres2. The posterior fossa3. The deep gray nuclei4. White matter tracts5. The ventricular system6. The meningies7. Vascular supply8. Venous drainage
Normal CT Anatomy
Normal CT Anatomy
Basal Ganglion
Normal gray-white matter
Foramen Magnum Base of Skull
The posterior fossa
C1-2
Foramen Magnum
Cervicomedullary Junction
Hypoglossal nerve canal
Brain Stem
Sagittal Midline MRI
Brain stem
pons
cerebellum
temporal lobe
cerebellar peduncle: middle
Medulla
Pons- CPA - IAC Middle Cerebellar Peduncle
Cerebellum
Cerebellar hemisphere Cerebellar vermis
Pons-Cerebellum
Infundibulum
Mid Brain
Third Ventricle Tectal Plate
Brain Parenchymal Anatomy
The cerebral hemispheres
1. Frontal lobes2. Parietal lobes3. Temporal lobes4. Occipital lobes5. Insular lobes6. Limbic lobes
Occipital lobe
frontal
Posterior FossaTemporal Lobes
Uncus: Temporal Horn
Hypothalamus Midbrain- Aqueduct
Frontal -Temporal Occipital Lobes
Frontal and Parietal Lobes
Centrum SemiovaleFronto-parietal lobes
Concept of Blood Brain BarrierNo C
+C
Central Sulcus:The Fronto-Parietal Boundary
No C
+C
BG- Pineal- Thalamus
Higher Sensitivity: fMRI
Finger tappingfMRI
Functional Brain Anatomy
1. Primary Motor cortex2. Primary Sensory Cortex3. Primary Visual Cortex4. Primary Auditory Cortex5. Language
1. Broca’s area2. Wernicke’s area
Functional Cortical Brain Mapping
Blood Oxygen Level Dectection :Bold Effect
Combined visualization of fMRI maps and EEG/MEG multiple
dipole models
Central sulcus
*
Hand motor area
Precentral gyrus
Postcentral gyrus
central sulcus
Cingulate sulcus**
Motor Cortical brain mapping:Glioma
Cognitive - Picture Encoding
Picture Encoding
Auditory cortexAuditory cortex
Internal Medicine Review November 11,2001
The Ventricular System
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
Concept of CSF-Brain Barrier
The Lateral Ventricle:frontal horn, body,
occipital horn, trigone & temporal horn
f
b
o
tr
t
trt
fo
t
tr
f
b
o
b
The Foramen of Monro
The Third Ventricle
3rd 3rd
3rd
Basal Ganglion Frontal Horn
Pulvinar
The aqueduct of Sylvius
Suprasellar CisternTemporal horns
Aqueduct of Sylvius
The Forth Ventricle
4th 4th
4th
4th
4th
4th
The Foramina of Magendie and Luschka
4th
4th
FM
FM
FL FL
Foramen of Lushka and Magendie
Fourth Ventricle
Frontal Horns Foramen of Monroe
Third VentricleGlomus of the choroid Plexus
Aqueduct of SylviusPineal Gland
Third Ventricle Aqueduct of Sylvius
Perimesencephalic Cistern
Frontal HornsTrigone
Occipital Horns
Body of The Lateral Ventricle
Corona Radiata
Centrum Semiovale
Pituitary FossaVisual Pathway
Sellar-suprasellar Region
Sellar tursica
Sellar tursica
Hypothalamus
Suprasellar cistern
Suprasellar cistern
Infundibulum
Infundibulum
Hypothalamus
Normal CT Anatomy
Pituitary Fossa
Suprasellar Cistern Optic Apparati
Hypothalamus opticTracts-Radiations
Optic RadiationCalcarine cortex
White Matter Tracts
Commisure fibers (corpus callosum)Projection fibers (internal capsule)Cortico-cortical association fibers (IFO)
Fiber tracking: DTI
Central sulcus
*
Hand motor area
Precentral gyrus
Postcentral gyrus
central sulcus
Cingulate sulcus**
Central Sulcus
Centrum Semiovale
Body of the Lateral Ventricle
Coronal Radiata
The Corpus Callosum
ThalamusBasal Ganglion Frontal Horn
Pulvinar
Suprasellar Cistern- Optic Chiasm
Mid pons
Pons
Medulla
Cervicomedullary Junction
Fornix
Meningies
Intracranial spaces
Normal Meningeal Enhancement: CT
NORMAL DURAL ENHANCEMENT: MRI
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.
Vascular SupplyAnd
Venous Drainage
Circle Of Willis
Cerebral Angiogram
CT Angiogram of the Brain and Neck
MRA: Pipe 2DTOF MRA: Neck 3DTOF MRA: Brain
Suprasellar Cistern
Circle of willis
Sylvian Fissure
Examples of “CE-TOFMRA”
Routine 2DTOFMRA of the neck: inplane flow
artifact is demonstrated.
Contrasted TOFMRA of the neck demonstrating no inplane flow artifact
2DTOFMRA with superior saturation band showed only RVA
2DPCMRA with all directions encoded (VENC 50 cm/sec) showed bilateral VA
RVA
LVA
VENC
2DPCMRA with SI encoding direction showed bilateral
VA with different flow directions
contrasted 3DTOFMRA showed bilateral VA,complete occlusion of the left CCA and SCA origins but well visualized LVA
DIAGNOSIS SUBCLAVIAN
STEAL SYNDROME
Takayasu’s arteritis: routine and contrasted MRA
Dural Venous Sinuses
Dural Venous sinuses
MRV
2DPC
2D PC MRV
3D PC MRV
2DTOFMRV: AVM
Superior Sagittal Sinus
SSS
Third VentriclePineal Gland
Internal Cerebral Vein
Basal Vein of Rosenthal
Straight Sinus
TransverseSigmoid Sinuses
Sigmoid SinusJugular foramen
Ramathibodi Hospital