Anda di halaman 1dari 88

NEURO IMAGING

KEPALA

FOTO POLOS RUTIN VERTEBRA

FOTO POLOS
PROYEKSI KHUSUS
(BASIS-SELA-RHEESE-ORBITA
A. X-RAY TANGENSIAL-EISLER-TOWNE)

TOMOGRAFI

MIELOGRAFI
KONTRAS
ANGIOGRAFI
B. CT
C. NMR/MRI
D. MRA
E.SPECT/PET-SCAN
F. TCD/DUPLEX SONOGRAFI
Pada Trauma Kapitis

Dibuat :

 AP/Lateral

 Posisi Towne (dibuat bila curiga fraktur oksipital &

mengetahui MAI)

AP, tapi tabung Ro” arah kranio-kaudal (fronto oksipital)


Schedel dilakukan bila :
IGD  rutin AP/L
Cedera kepala tembus
CT Sken tidak ada

Penilaian :
Fraktur
Posisi kel. Pineal
Pnemosefalus/benda asing
Fraktur tl. wajah
 Mandibula satu
 Atap orbita super-imposed
 Mastoid Super-imposed
Fraktur (+) :
Mungkin kelainan intrakranial
Jenis/lokasi
Mediko-legal
Gawat : foto telentang
Fraktur
Linier di temporal
Melintasi sinus venosus
Meluas ke sinus/mastoid air-sel
Garis fraktur :
Lebih radiolusen dari sutura/p.darah,
lebar < 3 mm.
Lebar di tengah, sempit di ujung
Dapat halus, spt. rambut
Pada anak-anak sutura
tambahan di frontral/ oksipital
Hematom (sukar melihat garis
fraktur)  foto lebih keras
Fraktur Impresi
Ro tampak garis radio-opaque dari tulang sekitar
(bertumpuk)

Fraktur di fossa anterior


Mengenai atap orbita

Fraktur Basis
Sukar tampak pada foto polos, paling baik Dengan
CT SKEN (Thin Section High Resolution)
Fraktur di Sela Tursika
Lateral : diskontinuitas korteks Sela /
bayangan cairan(darah) dalam sinus
sfenoidal

Fraktur Petrosum
AP/Towne : garis fraktur tak terlihat
 Mastoid air-sel suram
Fraktur Diastase
Sendiri/bersama Fr. Liner

Pelebaran sutura (n < 2 mm)

Pada sutura Lambloidea

Pelebaran semua sutura (tanpa/dg fraktur)

Biasa pada anak

Pembesaran akut  hiperemia post trauma


Impressi fraktur
Motor cortex Sensory cortex Visual cortex
Nilai Atenuasi Jaringan Berbeda
Range
Tulang/kalsium +80 - +1000
Darah beku +40 - +95
Substansial kelabu +36 - +46
Substansial putih +22 - +32
Cairan serebrospinal 0 - +8
Air 0
Lemak -20 - -100
Udara -1000
1. Left globe
2. ethmoid sinus
3. Sphenoid sinus
4. Petrous ridge
5. Mastoid air cells
6. Fourth ventricle
7. Internal occipital protuberance
and upper limit of cisterna magna

a. T – Antrorior part of temporal lobe in


middle fossa. P – Pons. C – Cerebullum
b. The poles and superolateral parts of
the the temporal loobes are usually
supplied by the middle cerebral
arteries, the posterior cerebral artery
supplying the remainder
c. The motor (pyramidal) and sensory
tracts (medial lemnicus) are situated in
the anterior part of the pons

Motor tracts Sensory tracts


1. Optic nerve
2. Orbital fat
3. Cribriform plate of ethmoid bone
4. Pituitary fossa
5. Dorsum sellae
6. Basilar artery
7. Pontine cistern
8. Temporal horn of lateral ventricle
9. Cerebellumpontine angle
10. Vermis of cerebellum

a. T – Temporal lobe P – Pons C –


Cerebellum
b. The boundary between the
middle and posterior cerebral
territories is shown
c. The motor and sensory tracts
are situated anteriorly in the
brain stern

Motor tracts Sensory tracts


1. Frontal sinus
2. Gyrirecti
3. Hypothalamus in chiasmatic cistern
4. Third ventricle – anterior part
5. Sylvian fissure
6. Interpeduncular fossa
7. Quadrigeminal cistern
8. Cerebellar sulcus
9. Cisterna magna

a. F – Frontal lobe T – Temporal lobe C – Cerebellum


M – Midbrain The posterior limits of the frontal
lobes are shown extending lateral to the
chiasmatic cistern. The tentorial edge, is are also
shown. The chiasmatic cistern constains the
anterior recesses of the third ventricle and
hypothalamus
b. Three vascular territories are outlined
corresponding to the anterior middle and posterior
cerebral territories
c. In addition to the motor and sensory tracts in the
Motor tracts midbrain the origin of the visual tract is seen from
Visual tracts the lateral geniculate body. The lowermost extent
of the motor cortex is shown in the frontal lobe
Sensory tracts
adjacent to the anterior limit of the sylvian fissure
1. Frontal horn of lateral ventricle
2. Third ventricle
3. Sylvian fissure
4. Quadrigeminal bodies and cistern
5. Chroid plexus in trigone of lateral
ventricle
6. Superior cerebellar cistern

a. F – Frontal lobe D – Diencephalon (thalamus and


basal nuclei) T – Temporal lobe C – cerebelum
b. In addition to the anterior middle posterior
cerebral territories shown here, the diencephalon
and internal capsular region is shown to be
supplied by perforating arteries which arise from
the terminal internal carrotid and proximal
anterior and middle cerebral trunks. The
posterior cerebral supply includes the thalamus
c. Three tracts are again outlined in this diagram.
The ascendingmotor fibres constitute the internal
capsule at this level and are illustrated by the
angulated hatched area lateral to the thalami. The
Motor tracts thalamus is the main sensory nucleus and it is
connected to the posterior limb of the internal
Sensory tracts capsule as shown. The optic radiation is shown
pasing back towards the occipital lobe
Visual tracts
1. Falx cerebri
2. Interventricular septum (septum
pellucidum)
3. Head of caudate nucleus
4. Sylvian Fissure
5. Internal capsule
6. Thalamus
7. Calcified pineal gland
8. Occipital horn of the lateral ventricle
9. Straight sinus in faix

a. F – Frontal lobe P – Parietal lobe T –


Temporal lobe O – Occipital lobe D –
Diencephalon C – Apex of posterior fossa
b. The vascular territories are similar to the
subjacent scan. The middle cerebral artery
has the most extensive area of supply
c. The internal capsule is demonstrated lateral
to the sensory tracts in the posterior limb of
the internal capsule, and the optic radition
Motor tracts fibres sweep around throuhg the temporal
Visual tracts temporal lobe to the occipital cortex. The
Sensory tracts lower end of the pre-and post central gyri are
shown.
1. Body of corpus callosum
2. Body of the lateral ventricle
3. Body of the caudate nucleus
4. Corona radiata
5. Chroid plexus
6. Splenium of the corpus callosum
7. Faix cerebri

a. F - frontal lobe P – Parietal lobe T –


Temporal lobe O – Occipital lobe
b. Only three vascular territories are seen
at this level
c. At this level the motor and sensory fibres
in the corona radiata extend laterally to
reach their cortical projections. The most
superior part of the visual cortex is still
visible
Motor tracts Sensory tracts

Visual tracts
1. Falx and interhemispheric fissure
2. Lateral vanricles
3. Parieto – occipital sulcus

a. F – Frontal P – Parietal O – Occipital


b. The anterior cerebral artery territory
can be seen to extend back to the
territory to the posterior cerebral
artery
c. The motor and sensory radiations are
again shown

Motor cortex
Visual cortex
Sensory cortex
1. Interhemispheric fissure and falx
2. Corona radiata
3. Pre – central gyrus
4. Post – central gyrus
5. Parietal - occipital fissure

a. F – frontal lobe P – Parietal lobe O –


Occipital lobe
b. Vascular territories are similar to the
subjacent scan
c. The motor and sensory are still seen

Motor cortex
Sensory cortex
Visual cortex
1. Falx cerebri
2. Cingulate sulcus

a. F – Frontal lobe P – Parietal lobe


b. The anterior cerebral artery territory
extends throughout the lenght of
the scan flanked laterally by the
middle cerebral artery territories
c. The motor and sensory radiations
are shown

Motor cortex Sensory cortex


1. Superior frontal sulcus
2. Pre – central gyrus
3. Central sulcus (rolandic
fissure)
4. Post – central gyrus

a. F – Frontal lobe P – Parietal lobe


b. Cerebral tissue here is supplied
by the anterior cerebral artery
c. The motor and sensory cortices
are situated in pre and post
central gyri

Motor cortex Sensory cortex


Atenuasi jaringan abnormal
Efek Massa
Kehilangan Jaringan
Tempat Lesi
Karakteristik penyangatan kontras
Ukuran : Ekstensif – luas – kecil
Bentuk : Bulat – liner – tapal kuda
Pinggir : tegas – irregular – tidak tegas
Attenuasi : tinggi : darah – Ca
rendah : CSF – lemah
campuran
otak (isodens)
ringan – sedang
jelas – midline shift
kompresi
pendataran sulkus kortikal
herniasi transtentoral
Ventrikel
Sulkus Serebral / Serebelli
Fissur Sylvii / Interhemisfir
Sisterna Basalis
Supra / infra tentorial
Frontal – temporal – oksipital / parietal -
kombinasi
Brainstem / Serebelum
Kapsula interna
Tingkat : ringan – moderate – padat
Konfigurasi : ceplak ceplok – homogen –
ring - linear
Atenuasi abnormal dengan efek masa
Atenuasi abnormal tanoa efek masa
Atenuasi abnormal dengan tissu loss
Atenuasi normal dengan efek masa
Atenuasi normal tanpa efek masa
Atenuasi normal dengan tissu loss
Lesi multipel
Lesi perkapuran
Atenuasi rendah pada substansia alba
Lesi dengan penyangatan padat
Lesi dengan penyangatan cincin
Atenuasi rendah
sekelilingnya jelas sekelilingnya lebih tajam
Infark baru
Kista Arachnoid
Perdarahan yang membaik
Porensefali
Tumor (glioma, metastasis,
okasional glioma mikroglioma, meningioma
Dermoid, epidermoid Abses
Hidatid Trombosis vena
Ensefalitis
Atenuasi Campuran
Tumor Abses
Glioma Infark Perdarahan
Metastasis Memar perdarahan
Meningioma Hamartoma
Hemangioblastoma
Dermoid / teratoma
Kraniofaringioma
pinealoma
Atenuasi meningkat

Tumor Kraniofaringioma
Meningioma Koloid Kista
Metastasis
Haematoma
Mikroglioma
Aneurisma Besar –
Glioma
AVM
Medulloblastoma
Pinealoma Kordoma
Infiltrasi atau tumor kecil
Angiomatus Malformasi
Infark / porensefali
Encefalitis
Oklusi vena
Leukodistrofi
Progresif multifokal leukoensefalopati
Necrotizing Leukoensefalopati
Granulomatosa / meningitis neoplastik
Perdarahan Subarahnoid
Perdarahan Intraventikular
Infark dewasa
Porensefali
Post – rongga perdarahan
Post – ensefalitis (spesial herpes)
Post – traumatik termasuk bedah
Radioterapi
Rongga basal ganglia
Anoxia
Parkinsonism
Penyakit Wilson’s
Isodense bengkak : Trauma, inflamatori,
postoperatif, Infark akut
Koleksi Subdural : 7 – 20 hari
Penyelesaian Perdarahan
Tumor jarang – glioma, meningioma
Hidrosefalus
Infark serebral akut, infark serebellar dan
batang otak
Malformasi angiomatosa
Multipel sclerosis
Trombosis venosa
Perdarahan subarakhnoid
Atrofi difus
- Serebral
- Serebellar
- batang otak
Tumor Multipel Sklerosis
Metastase Infark
Mikroglioma Perdarahan multifokal
Kadang kadang Trauma, hipertensi maligna
giloma/meningioma Diskrasia darah
Radang Tubero sklerosis
Abses Toxoplasmosis
Granumalotosa Sistiserkosis
TBC Kalsifikasi Ganglia Basal
Sarkoid
Jamur
Kraniofaringioma Hamartoma
Astrositoma Sistikerosis
Oligodendroglioma Toxoplasmosis
Ependimoma Idiopatik
Pinealoma Hematoma subdural
Meningioma kronik
Metastasis Hematoma
AVM Intraserebral Old
Tubero Sklerosis Atheromatus Vesel,
Aneurisma
Normal

Pineal
Plexus Koroid
Gangglian Basal
Dura
Odema Penyakit
Perpanjangan tumor Binswanger’s
di substansi Alba Radionekrosis
Ensefalitis Renal / kegagalan
Trauma hepatik
Lusensi Leukoensefalopati
Periventrikular di Leukodistrofi
Hidrosefalus
Meningioma
Aneurisma
Ependimoma
Metastasis
Koroid plexus papiloma
Glioma (kadang kadang)
Malformasi arterivena
Infark Akut
Abses
Glioma
Metastasis
Infark Akut (kadang kadang)
Penyelesaian Perdarahan
Kraniofaringioma (kadang kadang)
Pituitari Tumor (Biasa)
Raksasa, Trombosid Sebagian, Aneurisma
Epidural Hematom
Pneumo encephal
NECT memperlihatkan daerah
dengan perdarahan fokal kecil
di bagian bawah frontal kiri
dan lobus temporal
NECT
memperlihatkan
daerah hiperdens
kresentik
ekstraaksial koleksi
dengan efek massa
(pendataran sulkus)
dan midline shift kiri
ke kanan
Edema cerebral diffuse
Kontusio Serebri
Hematom Subgaleal
Fraktur Impressi
Kontusio serebri
Meningitis TBC
T1 kontras menyangat MRI flair daerah
dengan daerah yang multipel udem
multipel berbentuk cincin vasogenik
Meningitis
Glioblastoma Multiforme
Meningioma
Medulloblastoma
CT scan menunjukkan
perdarahan difus di sisterna
basal, sisterna interhemisfer,
fissura sylvia bilateral.
Tanduk ventrikel temporal
keduanya melebar abnormal
Curiga ada hidrosefalus
Perdarahan Subaraknoid
MRI difus aksial weighted
memperlihatkan infark
sinyal tinggi.
NECT pada saat itu
normal
A. Perdarahan talamus kiri dengan ekstensi ke ventrikel
lateral kiri
B. CT scan setelah 6 jam, dengan perburukan neurologi.
Ekspansi hematom disertai edema otak difus,
perdarahan intraventrikuler masif dan hidrosefalus
Shift Biologic Disease
(ppm) Correlation Status

NAA 2.01 Neuronal Tumor,


marker stroke,
edema,demen
t.
Cr 3.03 Energetic Kidney or
liver failure
Cho 3.19 Membr. Tumor,
Turnover Inflammatio
n
Lac 1.31 Anaer. Tumor ,
metabolism ischaemic
condition
mI 3.52 Astrocytic Dementia,
marker tumor
Glu 3.75 Astrocyte Liver failure