医学影像正常颅脑CT和MRI影像表.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,医学影像正常颅脑CT和MRI影像表,医学影像正常颅脑CT和MRI影像表医学影像正常颅脑CT和MRI影像表,NORMAL ANATOMY OF BRAIN,Brain is separated from calvarium by three meninges-dura mater,arachnoid membrane and pia mater.,Divided into supra tentorial and infra tentorial compartments containing:-,Supratentorium:Cerebral hemispheres,diencephalon,Infratentorium:Brain stem structures,cerebellum,E,ach cerebral hemisphere is further divided in to Frontal,Parietal,Temporal and Occipital lobes by fissures,BRAIN ANATOMY,Sagittal surface,Lat vent,Genu,Fornix,Pituitary gland,Mid brain,Pons,Medulla,Cingulate,gyrus,Quadrigeminal,cistern,Splenium,Colliculi,4,th,vent,Cerebellum,Thalamus,Sagittal,surface,Pineal gland,Sup.colliculi,Inf.,Colliculi,Aqueduct of,sylvius,Midbrain,Cerebellum,4,th,ventricle,Pons,Oculomotor,n,Inter thalamic,commissure,10,9,Inferior surface,Interhemispheric fissure,Temporal lobe,Mammillary,bodies,Frontal lobe,Olfactory tract,Optic tract,Pit.stalk,pons,Medulla oblongata,Cerebellum,Vermis,Brain stem structures,Mid brain,:divided into Cere,bral peduncles and colliculi.,Sup colliculi attached to med.,Geniculate&Inf to lateral,Geniculate body,Surrounded by Peri-,mesencephalic cistern.,Pons,:,divided in to tectum and,tegmentum,Connects mid brain to medulla,Medulla,:continues as spinal cord,Contains ascending and descending,Spinal tracts,Cerebellum,Divided into two hemispheres by falx cerebelli,Connected in the midline by a worm like structure-Vermis,Divided into,I.Anterior lobe,ii.Middle lobe,Iii.Flocculo-nodular lobe,Ventricles of brain,Lateral ventricle,:-C shaped cavity with body in the parietal lobe and extensions in the frontal temporal,occipital lobes,Connected to third ventricle by foramen of monro.,Third ventricle,:-lies b/w two thalami.connected to fourth ventricle by cerebral aqueduct.,Fourth ventricle,:-lies in the cerebellum,CSF Flow,:-Lat.vent-foramen of monro-3,rd,vent-cerebral aqueduct-4,th,vent-foramen of magindie and luschka-sub arachnoid space finally absorbed by the arachnoid granulations,Ventricles of brain,Blood supply of the brain,Blood supply of the brain,By Internal Carotid and Vertebral A,Internal carotid A,:Middle cerebral A,Ant cerebral A,Pmunicating A,Ant.Choroidal A,Vertebral As:-two Vertebral as join to form Basilar A,Branches:,Ant inf cerebellar A,Sup cerebellar A,Pontine As&labyrinthine As,Post cerebral A,Contd.,Divides into cortical and perforating A,Perforating As supply Basal ganglia,Thalami,internal capsule,Thalamus,:-,Perforating br of PCA,Internal cap,:-,Med&lat striate br of MCA,recurrent br of ACA,Ant choroidal A,Mid brain,:-,Post.cerebral and Sup cerebellar A,Pons,:-,Pontine br of Basilar A,Cerebellum,:-,Sup.cerebellar A,Ant.inf,cerebellar A,Post inf cerebellar A,Medulla,:-Ant&Post spinal A,PICA,Blood supply of the brain,Red:-MCA,Blue:-ACA,Green:PCA,Circle of willis,Venous sinuses of brain,Straight,sinus,Torcula,herophili,Occipital,sinus,Transverse,sinus,Sup.Sagittal,sinus,Inf.Sagittal,sinus,Venous sinuses,.,Transverse sinus,Straight,sinus,sigmoid,sinus,Pitutiary,gland,ICA,3rd CN,4th CN,6,th,CN,Sphenoid bone,Vi Vii br,Of 5,th,CN,Axial section,Cingulate,gyrus,Caudatehead,Pineal gland,Corpus callosum,Lentiform nucleus,trigone,Sup.cerebellar cistern,Int.capsule,Thalamus,Coronal section,CT Technique,Patient is kept in supine position and head is placed in the gantry under the cursors.Axial sections are taken at an angle of 10-13 degree to the canthomeatal line.,Slice thickness,:-,Posterior fossa:-5mm,Supra tentorial structures:-10mm,Pituitary gland and sellar region:-1-3mm(coronal sections),CONTRAST STUDIES:,done by injecting 100 ml of 60%iodinated contrast,contd.,Normal enhancement,:,Arterial&venous structures,Dural structures:-falx,tentorium,Choroid plexus,Pituitary gland,Indications of CECT,:,I.Infections:ring enhancing lesions eg tuberculoma,neurocysticercosis,Meningitis,Encephalitis,ii.Tumours:astrocytomas,meningiomas,iii.Vascular lesions:aneurysms,AV malformations,Contraindications of CECT,:,I.history of allergy,renal failure,ii.acute haemorrage,;,Axial sections-Topogram,For CT Axial sections,are taken at an angle of,10-13degree to the,Canthomeatal,line,For MRI sections are,parallel to the reference,line,CT Brain contd,Normal HU values in NCCT brain,Gray matter:-+36-42 HU,White matter:-+26-34 HU,CSF:-+4-11HU,Bone:-+200 to+1000 HU,Calcification:-+100 to+220 HU,Blood:-+56-80,MRI Imaging,Multiplanar modlity so sections can be taken in axial,coronal and sagittal planes,Slice thickness is same as CT imaging.Routinely applied sequences are,T1 Weigheted spin echo,T2 Weigheted spin echo,Proton density images,Anatomy of brain is better explained on T1W seq while pathologies are better studied on T2W and Proton density sequences.,TISSUE CHARACTERISTICS,Seq Parameters CSF Gray M WhiteM Fat,T1W,short TR Hypo iso hyper hyper,short TE,T2W,short TR hyper iso hypo iso/,long TE hypo,Proton,long TR iso Iso iso/hypo hyper,density,short TE,blood vessels appear signal void in all the sequences,calcification and fibrous tissue appear hypointense in all sequences,MRI Axial section above foramen magnum,Maxillary sinus,Basilar A.,Medulla,Cerebellar,hemisphere,Cisterna magna,Tonsils,Petrous bone,Sphenoid sinus,Nasal cavity,Zygomatic arch,CT Axial section above foramen magnum,Frontal sinus,Sphenoid sinus,Temporal lobe,Basilar A.,Mastoid cells,Cerebellar,hemisphere,Cisterna magna,Medulla,Optic nerve,Pituitary,Sphenoid bone,Temporal bone,Cerebellar tonsils,MRI Axial Section at 4,th,Ventricle,Lens,Optic nerve,Pituitary,Temporal lobe,Middle,cerebellar,peduncle,4,th,Ventricle,Medial rectus,Lateral rectus,Pons,Petrous,temporal,bone,Cerebellar,hemisphere,CT Axial section at 4,th,ventricle,Frontal sinus,Frontal bone,Mid.cerebral A,Basilar A.,Pons,4,th,vent,cerebellum,Mid cerebellar,peduncle,Petrous bone,Temporal horn,Ant.cerebral a,Sella turcica,Vermis,MRI Axial Section above 4,th,ventricle,Superior,oblique muscle,Pituitary stalk,Upper pons,Superior,cerebellar,peduncle,Optic chiasma,Ambient cistern,Cerebellar folia,CECT Axial section,above,4,th,ventricle,Frontal lobe,Ant cerebral A.,4,TH,vent,Cerebellum,Pons,Temporal horn,Infundibulum,Post.cerebral A.,Sphenoid bone,Frontal bone,Frontal sinus,Mid.cerebral A,MRI Axial section at midbrain,Frontal lobe,Interpeduncular,cistern,inferi,Vermis,Inferior colliculi,Confluence of,sinuses,Ambient cistern,Uncus,Optic tract,Mid cerebralA,Cerebral,peduncle,Ant cerebral A,MRI Axial section at 3,rd,ventricle,Genu of corpus,callosum,Caudate head,Lentiform nuleus,Thalamus,Splenium of,corpus callosum,Frontal horns,Int.capsule,Insula,3,rd,ventricle,Occipital horns,Optic radiation,CT Axial section at 3,rd,ventricle,Genu of corpus,callosum,Caudate nucleus,Int.capsule,3,rd,ventricle,Pineal gland,vermis,Occipital lobe,Choroid plexus,Thalamus,Lentiform nucleus,Frontal horn,Pericallosal A,MRI Axial section at mid ventricle,Cingulate gyrus,Body of lateral,ventricle,Corpus callosum,Central sulcus,Corpus callosum,Inter hemispheric,fissure,CT Axial section at mid ventricles,Cingulate gyrus,Body of lateral,ventricle,Corpus callosum,Falx cerebri,Occipital horns,Parietal lobe,Corona radiata,Frontal horns,Confluence of,Sinuses(torcula),MRI Axial section at centrum semiovale,Inter hemispheric,fissure,Centrum semiovale,Occipital lobe,Parietal lobe,Frontal lobe,CT Axial section at centrum semiovale,Falx cerebri,Centrum,semiovale,Occipital lobe,Parietal lobe,Frontal lobe,MRI Coronal section at 3,rd,ventricle,Frontal horns,Fornix,3,rd,ventricle,Clivus,Interpeduncular,cistern,Insula,Sylvian fissure,Temporal lobe,Parotid gland,Odontoid(dens),MRI Coronal section at suprasellar level,Inter hemispheric,fissure,Lat ventricle,Lat.Pterygoid Ms,Nasopharynx,Med.Pterygoid,Ms,.,Sylvian fissure,Sphenoid sinus,Pituitary gland,Optic chiasm,Ant cerebral a,Mid cerebral A,MRI Coronal section at post.ventricle,Parietal lobe,Splenium of corpus,callosum,Sup.cerebellar,cistern,Tentorium,Choroid plexus,Atria of lateral,ventricle,4,th,ventricle,MRI Sagittal section,Lat vent,Genu,3,rd,vent,Sphenoid,sinus,Nasopharynx,Body of CC,Splenium,Quadrigeminal,cistern,Pons,4,th,vent,Medulla,Cerebellum,Tonsil,Cingulate gyrus,Prepontine cistern,CT Coronal section for Pituitary gland,Patient is kept in prone position in sub mento vertical position,in the head rest of CT table,Topogram is taken in this position and planning is done so that cut sections parallel to the line passing from frontal bone to mentis is taken,For pituitary 1-3mm thick sections are taken in the coronal plane starting from anterior to posterior.,CT Coronal section for Pituitary gland,Lateral vent,Ant.cerebral A,Pituitary,gland,Optic chiasm,Sphenoid sinus,Lat.pterygoid,plate,Nasopharynx,Lat.Pterygoid,ms,Mid.cranial,fossa,CT Coronal section for Pituitary gland,Lat pterygoid,plate,Sphenoid sinus,Mid.cerebral a,Ant.cerebral a,Frontal sinus,Internal carotid a,Nasopharynx,Pituitary gland,CT Axial section(bone window),Petrous bone,Mastoid air,cells,Carotid canal,Foramen ovale,Sphenoid sinus,Base sphenoid,Eustachian,tube,Ext.acoustic,canal,Lambdoid,suture,Occipital bone,CT Axial sections(bone window),Ear ossicles,Mastoid air cells,cochlea,Int.acoustic,meatus,Aditus to antrum,Sq.temporal,bone,Facial n canal,Ethmoidal sinus,CT Axial sections(bone window),Occipital bone,Jugular foramen,Base sphenoid,Sphenoid sinus,Ext.acoustic C,Mastoid air cells,Carotid canal,Greater wing of,sphenoid,CT SCAN-Why do it?,Advantages of CT,:,I,.,Useful in diagnosis of intracranial bleed in acute head injury,ii.Better demarcation of bony pathology,iii Easy availability,iv.Cost effective,v.Less time consuming,vi.Easy interpretations,Disadvantages of CT,I.Poor demarcation between gray matter and white matter,ii.Less effective in very early and very late haemorrage and infarct,iii.Radiation hazard,MRI Why do it,Advantages,:,Multiplanar modality,Better gray and white matter differentiation or better spatial resolution,Better for evaluation of posterior fossa structures,No radiation hazard,Disadvantages:,Contraindicated in patients with claustrophobia,Contraindicated in patients having aneurysmal clips,metal fillings if these are not MRI compatible,Not useful in evaluation of bony pathologies,calcifications,Movement sensitive,谢谢大家！,