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Radiology
Introduction to Brain Imaging
Built from Fundamentals of Diagnostic Radiology
What’s inside
5 sections · 99 slides
Overview
- Brain imaging roadmap
Looking at the Brain
Midline, symmetry, cisterns, and ventricles — then the anatomy behind them
- Reading a brain scan safely
- Midline and symmetry
- Sulcal symmetry and the brain periphery
- Basal cisterns — the subtle warning signs
- Quadrigeminal plate cistern
- Suprasellar cistern
- Fourth ventricle and ventricular size
- Hydrocephalus versus atrophy
- Emergency CT checklist
- Beyond the five-question screen
- Midline structures — three regions to learn
- Suprasellar region
- Pineal region
- Craniocervical junction
- Brain anatomy — axial T2-weighted MR
- Cerebral hemispheres (axial T2)
- Lateral ventricle bodies (axial T2)
- Internal cerebral veins (axial T2)
- Foramina of Monro (axial T2)
- Third ventricle (axial T2)
- Suprasellar cistern (axial T2)
- Fourth ventricle (axial T2)
- Medulla (axial T2)
- Brain anatomy — coronal T1-weighted MR
- Frontal lobes (coronal T1)
- Pituitary infundibulum (coronal T1)
- Optic tracts (coronal T1)
- Third ventricle (coronal T1)
- Middle cerebellar peduncle (coronal T1)
- Fourth ventricle (coronal T1)
- Occipital horns of the lateral ventricles (coronal T1)
- Pituitary gland (coronal T1, magnified)
- Brain anatomy — sagittal T1-weighted MR
- Sagittal midline (T1)
- Pituitary infundibulum (sagittal T1)
- High-resolution cranial nerve imaging (FIESTA)
- Fifth cranial nerves (FIESTA)
- Internal auditory canals (FIESTA)
Current Neuroimaging Options
CT, MR, spectroscopy, angiography, diffusion, perfusion, and fMRI
- Choosing the first brain test
- A standard MR versus a standard CT
- CT for acute, MR for subacute and chronic
- Decision rules after the first scan
- When to give contrast
- Proton MR spectroscopy
- Choline as a tumor marker
- NAA and neuronal loss
- Abnormal metabolite peaks
- CT angiography (CTA)
- CTA views for aneurysms
- CTA for suspected infarct and stenosis
- MR angiography (MRA)
- Diffusion-weighted imaging (DWI)
- Reading DWI
- Diffusion tensor imaging and tractography
- Diffusion tensor imaging — white matter tracts
- Corticospinal tract tractography
- MR and CT perfusion
- Perfusion for brain tumors
- Hemorrhage-sensitive sequences: T2-star and SWI
- Basal ganglia microhemorrhages on SWI
- Functional MR imaging (fMRI)
- Functional MR — Wernicke area activation
Imaging Strategy for Common Clinical Syndromes
Which first test fits which presentation
- Preferred initial imaging by presentation
- Preferred initial imaging study by clinical presentation
- Acute trauma
- Posttraumatic encephalopathy and CTE
- Stroke
- Before thrombolysis or thrombectomy
- Acute stroke CT — key questions
- Stroke triage — CT versus MR
- Defining the ischemic penumbra
- The stroke imaging continuum
- CTA and mechanical thrombectomy
- Stroke imaging — penumbra to thrombectomy
- Seizure
- Infection and cancer
- Headache
- Coma and acute confusion
- Dementia
Analysis of the Abnormality
A systematic method to narrow the differential
- A systematic method for any lesion
- The lesion-analysis sequence
- Mass effect
- Atrophy or volume loss
- Diffuse cerebral atrophy
- Reversible cerebral atrophy
- Intra-axial or extra-axial mass
- Telling intra-axial from extra-axial
- Enhancement pattern of intra- and extra-axial masses
- Solitary or multiple lesions
- Gray matter or white matter
- Vasogenic versus cytotoxic edema
- Lesion distribution
- Contrast enhancement
- Signal and attenuation patterns
- Key takeaways
- References
- References
- Brant and Helms’ Fundamentals of Diagnostic Radiology