Bimbingan Coass

BASIC NEUROIMAGING

Oleh:
David Noor Umam

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Merupakan pemeriksaan penunjang dalam kasus-kasus neurologi
Berupa:
1. Foto Polos
2. Ultrasonografi
3. Mielografi
4. Arteriografi
5. Magnetic Rensonance Immaging (MRI)
6. Computed Tomography (CT-scan)
1. Foto Polos
 2. Ultrasonografi
Diantaranya dapat berupa USG guiding, TCD (Trans Cranial
Doppler), USG Carotis
 3. Mielografi
 Media kontras dimasukkan ke dalam teka dengan prosedur lumbal pungsi
 Sejak MRI diperkenalkan metode ini mulai ditinggalkan
 4. Arteriografi
Diantaranya:
CTA (CT-Angiografi), MRA (MR-Angiografi), DSA (Digital Subtraction Angiografi)
 5. Magnetic Resonance Imaging (MRI)
Kelebihan:
 Lebih sensitif kelainan di jaringan otak (tumor, innfeksi, dll), medulla spinalis, lesi
hipofisis.
 Visualisasi lesi demielinisasi
Kekurangan:
 Mahal, tidak semua RS punya
 Butuh waktu lebih lama dan kooperatif dari pasien
 Tidak bisa dilakukan jika ada plat logam pada pasien
Brain Metastase
Toxoplasma Cerebri
Abses Cerebri
 Shift Biologic Disease Status
(ppm) Correlation

NAA 2.01 Neuronal marker Tumor, stroke,

edema,dement.

Cr 3.03 Energetic Kidney or liver

failure
Cho 3.19 Membr. Turnover Tumor,
Inflammation

Lac 1.31 Anaer. metabolism Tumor ,

ischaemic
condition
mI 3.52 Astrocytic marker Dementia, tumor

Glu 3.75 Astrocyte Liver failure

 6. Computed Tomography (CT-scan)

 Cepat
 Banyak dimiliki RS
 Digunakan pada kasus emergensi
 Membedakan densitas
 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 midbrain the origin
of the visual tract is seen from the lateral geniculate body. The
lowermost extent of the motor cortex is shown in the frontal lobe
adjacent to the anterior limit of the sylvian fissure
Motor tracts
Visual tracts
Sensory tracts
 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 thalamus
is the main sensory nucleus and it is connected to the posterior
limb of the internal capsule as shown. The optic radiation is shown
pasing back towards the occipital lobe
Motor tracts

Sensory tracts

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 fibres sweep around throuhg the temporal
temporal lobe to the occipital cortex. The lower end of the pre-
and post central gyri are shown.
Motor tracts
Visual tracts
Sensory tracts
 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

 Nilai Atenuasi
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
 Dilaporkan:
 Identitas (nama/ usia)
 Jenis pemeriksaan (serta kontras/tidak)
dan potongan
 Calvaria
 Subgaleal
 Sulkus dan girus
 Parenkim (ada tidaknya SOL, perdarahan,
infark)
 Ventrikel
 Kesimpulan
Blood
Cisterns
Brain
Ventricles
Bone

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 B is for Blood
• Acute blood is bright white on CT
(once it clots).

•Blood becomes isodense at

approximately 1 week.

 Blood becomes hypodense at

approximately 2 weeks.
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 Common Stroke /
Uncommon stroke?
 Location for common
stroke?
Blood
Cisterns
Brain
Ventricles
Bone

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Blood
Cisterns
Brain
Ventricles
Bone

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SOP (Space Occupying Process)
 Cerebral Abses
Intracranial Air
 Meningioma
Blood
Cisterns
Brain
Ventricles
Bone

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Blood
Cisterns
Brain
Ventricles
Bone

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If no blood is seen, all cisterns are
present and open, the brain is
symmetric with normal gray-white
differentiation, the ventricles are
symmetric without dilation, and there is
no fracture, then there is no emergent
diagnosis from the CT scan.

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