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NEURORADIOLOGY

dr. Farhan Anwary, Sp.Rad

Bagian/SMF Radiologi
FK Unpad / RS dr. Hasan Sadikin
Bandung
NEURORADIOLOGY (NEUROIMAGING)

 Plain Film
 CT Scan (Computed tomography)
 MRI (Magnetic Resonance
Imaging)
 Angiography / DSA (Digital
Subtraction Angiography)
 Sonography / USG / Color Doppler
 Nuclear Medicine
PLAIN FILM/CONVENTIONAL
RADIOLOGY

SKULL : - Lateral view


- Sella
- Straight posteroanterior view
- Caldwell view
- Towne view
- Basal (submentovertex) view
- Waters view

Normal, Radiographic, Anatomy


LATERAL VIEW

 Sutures
 Calvarium
 Sella
 Dorsum sellae
 Sinus sphenoidalis
STRAIGHT POSTEROANTERIOR
VIEW

Coronal - lamdoid suture


Orbital roof, petrus ridge,
internal auditory canal,
cribriform plate - crista galli,
maxillary sinus, nasal cavity,
upper lateral rim orbita
CALDWELL VIEW

 Lesser - greater wings


 Foramen rotundum ( V2 )
 Orbital rim
 Zygoma - zygomaticofrontal
suture
 Floor of anterior cranial fossa
 Frontal sinus
TOWNE VIEW

 Occipital, parietal, frontal


 Sagital suture
 Posterior clinoid processes -
dorsum sellae
 Internal auditory canal
WATERS VIEW

 Maxillary - frontal sinuses


 Orbital margin -
zygomaticofrontal suture
 Zygomatic process
 Body, ramus, condyle,
coronoid process
BASAL (SUBMENTOVERTEX)
VIEW

 Odontoid
 Middle fossa
 Foramen ovale ( V 3 )
 Foramen spinosum ( mma )
 Sphenoid sinus
I . SINGLE LUSCENT DEFECT IN
THE SKULL

DDX : Normal variant


 Pacchionian
granulation
 Parietal foramina
DDX : Abnormal solitary luscent skull
defect ( “Help Me” )
 Hemangioma
 Epidermoid, dermoid
 Leptomeningeal cyst
 Paget's : osteoporosis
circumscripta
 Post surgical
 Metastatic (solitary)
 Eosinophilic granuloma
 Encephalocele
II. MULTIPLE LUCENT DEFECTS
IN THE SKULL

DDX : - Metastases
- Myeloma
- Hystiocytocis
- Hyperparathyroidism
- Cushing's
- Osteomyelitis
- Radiation
III. INCREASED SKULL DENSITY

A. Diffuse increased skull density


DDX : - Osteopetrosis
- Hematologic; anemias,
myelofibrosis
- Fibrous dysplasia
- Paget's disease
- Acromegaly
- Metastasis
- Dilantin
- Hypervitaminosis D
B. Focal increased skull density

DDX : - Osteoma
- Hyperostosis frontalis
- Meningioma
- Fibrous dysplasia
- Paget's disease
- Metastasis
- Calcified cephalhematoma
IV. INTRACRANIAL CALCIFICATION
A. Physiologic can occur in

1. Pineal
2. Habenula
3. Basal ganglia
4. Choroid
5. Dura
B. Phatologic calcifications

1. Tumors
a. O1igodendriglioma (90%)
b. Craniopharyngioma (70%)
c. Ependymoma (60%)
d. Choroid plexus papilloma (25%)
e. Low-grade astrocytoma (20%)
f. Meningioma (10%)
g. Other (Dermoid, pineal tumor,
lipoma)
B. Phatologic calcifications

2. Infection : CMV, toxoplasmosis,


cysticercosis

3. Vascular :
a. Atherosclerotic disease
b. Aneurysm
c. Arteriovenous malformation

4. Pathologic basal ganglia


calcification
B. Phatologic calcifications

5. Neurocutaneous
syndromes
a. Neurofibromatosis
b. Sturge-Weber syndrome
c. Tuberous sclerosis

6. Post trauma
C. Basal Ganglia Calcifications

DDX :
 Endocrine : hypothyroidism,
pseudohypoparathyroidism
 Infectious : CMV, toxoplasmosis,
cysticercosis
 Toxic/Anoxic : CO, lead, radiation
 Congenital : Tuberosclerosis,
Fahr's disease
V. Large Sella

DDX :
 Tumor : Adenoma,
craniopharyngioma, optic nerve
glioma
 Aneurysm
 Increase intracranial pressure
 Empty sella
CEREBROVASCULAR DISEASE

I. Cerebral Infarction
a. Etiology
1. Atherosclerosis (large
vessels)
2. Atherosclerosis (small
vessels)
3. Hypoxia / anoxia
4. Dissection
CEREBROVASCULAR DISEASE

I. Cerebral Infarction
a. Etiology

5. Fibromuscular dysplasia
6. Vasculitis
7. Basal arteriovascular occlusiv disease
8. Venous thrombosis
9. Miscellaneous; vasospasm, trauma
b. Imaging in ischemia / infarction :

- Vascular distribution
- Evidence of cytotoxic edema
- Involvement of cortex
- Hemorrhagic transformation

c. IMAGING : CT, MR, MRA,


Angiography
II. Spontaneous Intracranial
Hematoma;

Intraparenchymal hematoma

DDX : Causes of intraparenchymal


hematoma
1. Aneurysm rupture
2. Arteriovenous malformation
rupture
3. Hypertension
4. Tumor
DDX : Causes of intraparenchymal
hematoma

5. Blood dyscrasia
6. Anticoagulant
7. Drug abuse
8. Infarct
9. Amyloid angiopathy
10. Idiopathic
III. Spontaneous Intracranial
Hemorrhage;
Subarachnoid and extra-axial
1. Subarachnoid hemorrhage (SAH)
2. Extra-axial hemorrhage (SDH, EDH)

IV. Intracranial Aneurysm


V. Cerebrovascular Malformations

1. Capillary telangiectasis
2. Cavernous angioma (hemangioma)
3. Venous angioma
4. Arteriovenous malformation (AVM)
5. Occult cerebrovascular malformation
(cryptic AVM)
6. Vein of galen aneurysm
CRANIAL TRAUMA

1. Imaging
Skull film, CT, MRI

2. Type of Injuries
a. Direct
b. Indirect
c. Skull fractures
CRANIAL TRAUMA

3. Types of the Hemorrhages


a. Appearance of hemorrhage by
CT
b. Appearance MR
c. Extra axial hemorrhage