neuro diagnosis
Transcript of neuro diagnosis
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NeurodiagnosticNeurodiagnostic
ProceduresProceduresJunchen ZhangJunchen Zhang
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Who is heWho is he
Bruce Lee is Hong Kong kungfuBruce Lee is Hong Kong kungfu
star. He was borned instar. He was borned in SanSanFrancisco in November 1940 .His firstFrancisco in November 1940 .His firstfilm was called The birth of Mankind,film was called The birth of Mankind,
his last film which was uncompleted athis last film which was uncompleted at
the time of his death in 1973 wasthe time of his death in 1973 was
called Game of Death(called Game of Death( ..
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There are and the numerous different theories on how he died.There are and the numerous different theories on how he died.Original cause of death listed as marijuana poisoning, later changed toOriginal cause of death listed as marijuana poisoning, later changed to
death by misadventure.death by misadventure.
Resently,some scholar think cerebral aneursym was the cause of leesResently,some scholar think cerebral aneursym was the cause of lees
death.death.
How to identify the cause of leesHow to identify the cause of lees
death?death?
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craniocerebral traumacraniocerebral trauma
brain tumorsbrain tumors
cerebral vascular diseasecerebral vascular disease infectioninfection
congenitalcongenital [k n'd enitl] [k n'd enitl]
diseasedisease
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How to diagnosis the CNSHow to diagnosis the CNS
disease?disease?
Neurodiagnostic ProceduresNeurodi
agnostic Procedures isisnecessary to diagnosis andnecessary to diagnosis and
guide the therapy of neurologicguide the therapy of neurologic
disordersdisorders..
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Plain film radiographyPlain film radiography
Computed tomography[t 'm gr fi] Computed tomography[t 'm gr fi]
MRIMRI DSADSA
MyelographyMyelography
PETPET Ultrasound(Ultrasound(
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1 Plain film radiography1 Plain film radiography
Are useful in the initial assessment ofAre useful in the initial assessment ofspinal traumaspinal trauma
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Are useful in suspected [s s'pektid]Are useful in suspected [s s'pektid]
infectioninfection
Are useless in cases with neurologicAre useless in cases with neurologic
deficitsdeficits
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2 Computed tomograthy2 Computed tomograthy
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The Basic principleThe Basic principle
the CT image is a computer-generatedthe CT image is a computer-generatedacross-sectional representation of anatomyacross-sectional representation of anatomy
crected by analysis of the attennuation of X-crected by analysis of the attennuation of X-
ray beams that have been passed throughray beams that have been passed through
various points around a section of the brainvarious points around a section of the brain
X-ray
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X-ray attenuation
(X- )X-ray
Greater x-ray attenuation caused by bone results inareas of high density
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CT
Canthomeatal line
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(150) (red line)
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CT is useful in imagingCT is useful in imaging
osseous-structuresosseous-structures
HemotomasHemotomas Cerebral atroophyCerebral atroophy
HydrocephalusHydrocephalus
cerebral infarctioncerebral infarction
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Because ofBecause of lesionslesions
situated nera the skull base are moresituated nera the skull base are more
difficult to delineate with CTdifficult to delineate with CT
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CTACTA
Multidetector CTMultidetector CT
(( CTCT
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3 Ultrasound(US)3 Ultrasound(US)
The US is the standard technique forThe US is the standard technique for
evaluating the premature infant forevaluating the premature infant for
hydruocephalus.hydruocephalus.
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Intraoperative ultrasound can also beIntraoperative ultrasound can also be
used to help position the ventricularused to help position the ventricular
catheter ['kit ] during shuntingcatheter ['kit ] during shunting
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4 Magnetic resonance4 Magnetic resonanceimaging(MRI)imaging(MRI)
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The Basic principleThe Basic principle
the imges that are created reflect the density ofthe imges that are created reflect the density ofhydreogen protons as well as their relaxation rates.hydreogen protons as well as their relaxation rates.
MRIMRI
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TT11 imagesimages
T2 imagesT2 images
FLAIR imagesFLAIR images are sensitve for corticalare sensitve for corticallesion and meningeal processes.lesion and meningeal processes.
EPI imagesEPI images is the most sensitive foris the most sensitive forindentifying aacute infarcion and perfusionindentifying aacute infarcion and perfusionimaging .imaging .
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T1 imagesT1 images T2 imagesT2 images FLAIR imagesFLAIR images
EPI imagesEPI images
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Gadolinium [gd 'lini m] are often Gadolinium [gd 'lini m] are often
used to increase the sensitivity of MRused to increase the sensitivity of MR
to various disease.to various disease.
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GD-DTPA
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MRA delineate the majorMRA delineate the major
extracranial and intracranial vesselsextracranial and intracranial vessels
without the need for contrastwithout the need for contrast
agents.agents.
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MRI is useful in imagingMRI is useful in imaging traumatrauma
tumortumor Cerebral vascular diseaseCerebral vascular disease
Spine and spinal cordSpine and spinal cord
infectioninfection
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5 myelography5 myelography
Is a radiographic studyIs a radiographic studythay outlines the spinalthay outlines the spinal
canal and its contents.canal and its contents.
Water-soluble nonionicWater-soluble nonionic
contrast material iscontrast material is
injected into theinjected into the
subarachniod space viasubarachniod space viaa lumber punctrea lumber punctre
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6 Digital aubtraction6 Digital aubtraction
angioraphy(DSAangioraphy(DSA))
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Definition[defi'ni n]Definition[defi'ni n] Radiographic visualization of theRadiographic visualization of the
arterial and venous systems of thearterial and venous systems of the
neck,brain,and spinal cord isneck,brain,and spinal cord isaccomplished by intra-arterial injectionaccomplished by intra-arterial injection
of a water-soluble iodinated contrastof a water-soluble iodinated contrast
agent.agent.
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MethodsMethods
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DSA is the best procedure forDSA is the best procedure for
characterizing aneurysms and AVM.characterizing aneurysms and AVM.
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MRA and CTA have improved inMRA and CTA have improved in
recent years,making possiblerecent years,making possible
noninvasive assessment of many ofnoninvasive assessment of many of
these vascular disorders.these vascular disorders.
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6 Radionuclide imaging6 Radionuclide imaging
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IntroductionIntroduction
NoninvasiveNoninvasive
Utilizes radiopharmaceuticalsUtilizes radiopharmaceuticals
(radioisotopes)(radioisotopes)
Evaluates pathophysiology ofEvaluates pathophysiology of
systemssystems
Most common systems scanned are:Most common systems scanned are:
skeleton, lungs, liver, thyroid andskeleton, lungs, liver, thyroid and
heartheart
Usually done in combination with X-Usually done in combination with X-ra CT or MRI
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Radionuclide ImagingRadionuclide Imaging
Several modalities of imaging systemsSeveral modalities of imaging systems
Bone scan/bone scintigraphyBone scan/bone scintigraphy
SPECT (single photon emission computedSPECT (single photon emission computed
tomography)tomography) Ventilation/perfusion scansVentilation/perfusion scans
Myocardial perfusion scansMyocardial perfusion scans
PET (positron emission tomography)PET (positron emission tomography)
Bone scan is the most commonlyBone scan is the most commonlyperformed procedureperformed procedure
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Pathological FindingsPathological Findings
Bone scans are useful for diagnosing the followingBone scans are useful for diagnosing the followingconditions:conditions: Metastatic diseaseMetastatic disease
TraumaTrauma
InfectionInfection Paget diseasePaget disease
Hypertrophic osteoarthropathyHypertrophic osteoarthropathy
Reflex sympathetic dystrophyReflex sympathetic dystrophy
Avascular necrosisAvascular necrosis
SpondylolysisSpondylolysis Venous obstructionVenous obstruction
ExtraosseousExtraosseous
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Normal Bone ScanNormal Bone Scan
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Prostate MetastasisProstate Metastasis
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NeuroblastomaNeuroblastoma
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SPECT ImagingSPECT Imaging
SPECT (single photon emission computedSPECT (single photon emission computedtomography)tomography)
Three dimensional imagesThree dimensional images Axial, coronal and sagittal slicesAxial, coronal and sagittal slices
Gamma camera is rotated around the patient in all threeGamma camera is rotated around the patient in all threeanatomical planesanatomical planes
Competing signal from overlying structures isCompeting signal from overlying structures iseliminatedeliminated
Accurate detection of subtle signal changes andAccurate detection of subtle signal changes and
better spatial resolution of signal changesbetter spatial resolution of signal changes Useful for detecting occult pars/spinous fracturesUseful for detecting occult pars/spinous fractures
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Spinous Process FracturesSpinous Process Fractures
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PETPET
PET (positron emission tomography)PET (positron emission tomography) Physiologic imaging methodPhysiologic imaging method
NeuroimagingNeuroimaging Oncological imagingOncological imaging
Radionuclide used is fluorodeoxyglucoseRadionuclide used is fluorodeoxyglucose((1818F-FDG)F-FDG)
Utilizes beta decayUtilizes beta decay Expensive studyExpensive study Utilized mostly in research settings butUtilized mostly in research settings but
PET is gaining acceptance outside ofPET is gaining acceptance outside ofresearchresearch
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PETPET
Positron is emitted by beta plus decayPositron is emitted by beta plus decay Electron is emitted by beta minus decayElectron is emitted by beta minus decay Positron collides with electronPositron collides with electron
2 gamma rays are emitted2 gamma rays are emitted Gamma rays are detected by a ring ofGamma rays are detected by a ring of
detectors around the patientdetectors around the patient PET is now commonly being combined withPET is now commonly being combined with
dual MRI/PET scanners and CT/PET,dual MRI/PET scanners and CT/PET,CT/PET Fusion scansCT/PET Fusion scans
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PET Scanner DiagramPET Scanner Diagram
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CNS Lymphoma-MRI/PET ScanCNS Lymphoma-MRI/PET Scan
CNS L h C l PETCNS L h C l PET
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CNS Lymphoma-Color PETCNS Lymphoma-Color PET
ScanScan