Pocket tutor: Neuroimaging Rory Piper
INDEX
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
ABCDE approach, for trauma patient 77, 84
Acoustic neuroma see Vestibular schwannoma
Ageing, features of see Elderly patients
Air, presence of see Pneumocephalus
Anterior circulation, brain 17, 17
Anterior fossa, skull 3, 3
Anteroposterior view 21, 22
Antiplatelet therapy, after ischaemic stoke 103
Aqueduct of Silvius 18, 19
Artefact 72
beam hardening 73, 74
foreign bodies 72, 7374
motion 67, 74
starburst 73, 74
types of 7273
Arterial dissection 115
CT angiography for 115, 116
MRI for 115117, 116
Arterial stenting 115
Arteriovenous malformation 112114
bag of worms 112, 114
CT scan for 112, 113, 114
digital subtraction angiography 112, 114
MRI for 112, 113
multiple flow voids 112, 113
Atlanto-occipital joint 4
Atlas 4
Axial section 22, 23
Axis 5
B
Basal cisterns 59
Basal ganglia 9
Battle's sign 80
Bitemporal hemianopia 11
Blossoming of contusion 90
Bone window 40, 40
Brain
arterial supply to 16, 17, 17
herniation 68, 6869, 69
metastases 137, 148150, 149
venous system of 18, 18
ventricular system of 18, 19
Brainstem
functions of 12
structure of 12, 13
Brain tumour 137140
assessment in 140141
brain metastases 137, 148150
CT for 141
gliomas 142146
image-guided neurosurgery 154156
management of 142
medulloblastoma 152
meningioma 146148
MRI for 141
pituitary adenoma 150151
primary 137
secondary 137
vestibular schwannoma 152154
Broca's area 8, 9
Burst fractures 165166, 167
C
Carotid artery dissection 115117, 116
Cauda equina 15
Cauda equina syndrome 157159, 173
MRI scan 158
Central nervous system 1 see also Brain; Spinal cord
Central sulcus 8
Cerebellum 12, 13
Cerebral abscess 127132, 129, 141
CT for 128, 130
diffusion-weighted MRI scan 131, 131
MRI for 129, 130131
rim-enhancing effect 129, 130
vasogenic oedema 129, 131
Cerebral aqueduct see Aqueduct of Silvius
Cerebral contusions 8991, 91
burst lobe 90
contrecoup 90, 92
coup 90
CT for 90, 91, 92
haemorrhagic contusions 90, 91
MRI for 90
Cerebral laceration 89
Cerebral oedema 6263
types and features of 64, 65
Cerebritis 127, 130 see also Cerebral abscess
Cerebrospinal fluid 18
CT for 57
MRI for 58, 58, 59
Cerebrospinal fluid cleft sign 146, 147
Cerebrovascular disease 95
arteriovenous malformation 112114
carotid and vertebral artery dissection 115117
dural venous sinus thrombosis 117119
stroke 95112, 96
Cerebrum 8
cerebral cortex 89
hemispheres 8
lobes 8, 8, 9
pituitary gland 11, 11
subcortical structures 911, 10
vascular territories of 17
Cervical spine
CT scans of 4546, 47, 159
plain radiographs of 159
protection 160, 163
Cervical spine fractures 160164
CT scan 163
facet fractures 161, 164
flexion teardrop fracture 161, 163
hangman's fracture 160, 161
Jefferson's fracture 160
MRI for 163
odontoid fracture 160, 162
plain radiography 161163
Circle of Willis 16, 17, 55
Cisterns 7
Contrast-induced nephropathy 32
Computerised tomography (CT) 2425
appearance in 3536
brain 4850, 49
cerebrospinal fluid 57
cervical spine 4546, 47
contrast agent in, use of 25
CT angiography 27, 54
CT perfusion 27
CT venography 27
Hounsfield scale used in 36, 36
image acquisition in 25, 26
meninges 4647, 47, 48
and MRI, comparison of 25
orientation in 3435, 35
safety concerns 3031, 31
skull 40, 4041, 41
spine 4546
vascular system 5253, 54
window, creation of 36, 37
Contrast agents 29, 32, 53
Contrecoup contusions 90, 92 see also Cerebral contusions
Contusions see Cerebral contusions
Coronal section 22, 23
Coronal suture, skull 2, 3
Corpus callosum 9
Cortical atrophy 70, 71
Corticospinal tract 15
Coup contusions 90 see also Cerebral contusions
Craniotomy 85
CT see Computerised tomography (CT)
Cytotoxic oedema 64, 65
D
Denis’ three-column theory of stability 165, 165
Dexamethasone 138, 174
Diffuse axonal injury 91, 93
CT for 93
MRI for 93
Diffusion tensor imaging 29
Diffusion-weighted imaging 29
Digital subtraction angiography 24, 5556, 56, 57
Disc herniation 168169
Dorsal (posterior) column 15
Dural venous sinuses 7
Dural venous sinus thrombosis 117119, 118
CT for 117
CT venography for 118, 118
MRI for 119
MR venography for 118, 119
E
Elderly patients 70
cortical atrophy in 70, 71
small vessel disease in 71
ventriculomegaly in 70
Empty delta sign 117
Encephalitis 127
Endovascular coiling 110, 111
Ethmoid air cells 40, 41
Extradural empyema 132
Extradural haematoma 62, 8385, 84
CT scan 76, 84, 84
subdural and, differences between 89
F
Facet fractures 161, 164
Falx cerebri 7, 46, 47
Fibre tracking see Tractography
Flexion teardrop fracture 161, 163
Foramen magnum 3, 3
Foramen of Munro 18, 19
Frontal lobe 8, 9
Frontal sinus 41, 41
Functional MRI 2930, 155
G
Gadolinium 29
Glasgow Coma Scale (GCS) score 75, 77, 78
Glioblastoma 144, 145 see also Gli
Gliomas 137138, 139, 140, 142146
high-grade 143, 144146, 145
low-grade 142143, 143, 144
WHO classification of 142, 143
H
Haematoma 61, 62 see also Intracranial haemorrhage
Haemorrhage 61 see also Intracranial haemorrhage
Hangman's fracture 160, 161
Head injuries 75 see also Traumatic brain injury
Herniation 68, 6869
subfalcine 68, 6869
tonsillar 69, 69
transtentorial 68, 69
Horner's syndrome 115
Hounsfield units (HU) 36
Hydrocephalus 63, 66
communicating 63, 6566
non-communicating 66, 67
normal pressure 6566
Hypothalamus 10, 11
I
Image-guided neurosurgery 154156
frameless image guidance 154
functional MRI 155
stereotactic surgery 154
tractography 155, 155
Incidental findings, on imaging 71
Infections, of central nervous system 127 see also specific infection
Inflammatory disorders 121
multiple sclerosis 121124
sarcoidosis 124126
Internal capsule 11
Internal carotid artery 56
Intervertebral disc 4
herniation 168169
Intracerebral haemorrhage see Parenchymal brain haemorrhage
Intracranial haemorrhage 61
CT 61
extra-axial 61
intra-axial 61
MRI 62, 63
types of 62
Intracranial pressure, increased 66, 140141
and brain herniation 68, 6869, 69
features of 6667, 67
Intraparenchymal haemorrhage see Parenchymal brain haemorrhage
Intraventricular haemorrhage 62 see also Intracranial haemorrhage
Ischaemia 62
Ischaemic stroke 97103
CT perfusion scan 98, 99
CT scan 98, 99, 100
hyperdense artery sign 98, 99
hypodense area 97
malignant middle cerebral artery infarction 99100, 100101
MRI for 100101, 102
US imaging 103
J
Jefferson's fracture 160
L
Lacunar stroke 96
Lambdoid suture, skull 2, 3
Lateral sulcus 89
Lateral view 21, 22
Leptomeningitis 127
Log-rolling technique 159
Lumbar puncture 108
Lumbar sacral spine, MRI scans 52
Lumbar vertebra, MRI scan 53
M
Magnetic resonance imaging (MRI) 2730
advantages and limitations of 25
appearance in 37
assessment prior to 31
brain 50, 5051, 51
cerebrospinal fluid 58, 58, 59
contrast agents in, use of 29
diffusion tensor imaging 29
diffusion-weighted imaging 29
functional MRI 2930
image acquisition in 2729, 28
meninges 48
MR angiography and venography 29, 53, 55, 55
MRI perfusion 30
MRI spectroscopy 30
orientation in 37
safety concerns 3132
sequences 3738, 38, 39
spinal cord 5152, 52, 53
T1-weighted and T2-weighted MRI signals 39
vascular system 53, 55, 55
ventricular system 58
Malignant middle cerebral artery infarction 99100, 100101, 103
Mastoid air cells 41, 41, 81
Medulloblastoma 152
Meninges 6, 7
arachnoid mater 7
dura mater 67
pia mater 7
Meningiomas 146148
CT scan 147, 147
imaging findings 146147
MRI scan 147, 147, 148
Meningitis 48, 127
Metastatic spinal cord compression 172174, 173
Middle fossa, skull 3, 3
Missile effect 32
MRI see Magnetic resonance imaging (MRI)
MS see Multiple sclerosis (MS)
Multiple sclerosis (MS) 121124
clinically isolated syndrome 123
Dawson's fingers’ 123, 124
McDonald diagnostic criteria for, revised 121
MRI for 122123, 123124, 124
radiologically isolated syndrome 123
N
Neuroanatomy 1
brainstem 12
cerebellum 12
cerebrum 811
meninges 67, 7
scalp 1
skull 13, 2, 3
spinal cord 1415
spine 4, 45, 5, 6
Neurocranium 1, 2 see also Skull
Neurofibromatosis type 2 152
Neurosarcoidosis 124126
MRI in 125, 125
Nidus 112
Nimodipine 112
O
Obstructive hydrocephalus 152
Occipital lobe 8, 9
Odontoid fracture 160, 162
Optic chiasm 11, 11
Orientation terminology 20, 2021
anterior 21
contralateral 21
inferior 21
ipsilateral 21
lateral 21
medial 21
posterior 21
superior 21
Osmotic therapy 85
P
Pachymeningitis 127
Parenchymal brain haemorrhage 62, 103105 see also Intracranial haemorrhage
CT for 104, 105
deep bleeds 104
MRI for 105
primary 104
secondary 104
Parietal lobe 8, 9
Partial anterior circulation stroke 9596, 96
Patient safety 30
contrast agents 32
MRI 3132
radiography and CT 3031, 31
Pepper pot skull 39
Pituitary adenoma 150151
classification of 150
MRI for 150, 151
Pituitary fossa, skull 3, 3
Pituitary gland 3, 11, 11
Plain radiography 2324, 3334
attenuation 3334, 34
cervical spine 42, 4244, 43
orientation in 33
safety concerns 3031, 31
skull 3940
thoracic and lumbar spine 4445, 45, 46
Pneumocephalus 69, 70, 80, 82, 83
Posterior cerebral artery 57
Posterior circulation 17
stroke 96
Posterior communicating artery aneurysm 108
Posterior fossa, skull 3, 3
R
Radiography, plain see Plain radiography
S
Sagittal section 22, 23
Sagittal suture, skull 2, 3
SAH see Subarachnoid haemorrhage (SAH)
Sarcoidosis 124126, 125
Scalp 1
SCALP (mnemonic) 1
Sieverts (Sv) 31, 31
Sinuses of skull 4041, 41
Skull 1, 2
base 3, 3
CT for examination 40, 4041, 41
neurocranium 1, 2
pterion 2
radiographs 3940
splanchnocranium 1, 2
sutures of 2, 3
vault 2, 23
venous drainage of 18
Skull fractures 8083, 81, 82
bone window, hypodense lines on 81
comminuted fractures 81, 82
CT scan 81, 81, 82
depressed fractures 81, 82
pneumocephalus 80, 82, 83
Small vessel disease 71
Sphenoid sinus 40, 41
Spinal cord 1415
MRI for 51, 52, 53
Spinal degeneration 167169, 168
Spinal diffusion-weighted imaging 134
Spinal epidural abscess 133135
MRI for 134, 134
Spinal fractures 160
cervical 160164
thoracolumbar 164167
Spinal nerves 15
Spinal tracts 14, 15
Spinal trauma, approach in 159160
Spinal tumours 169170
classification of 170
ependymoma 171172, 172
intradural 169170
meningioma 170171, 171
metastatic spinal cord compression 172174, 173
primary 170
secondary 170
Spine
CT scans 4546, 47
plain radiography 4245, 4246
Spinocerebellar tract 15
Spinothalamic tract 15
Splanchnocranium 1, 2 see also Skull
Spondylolisthesis 169
Spondylolysis 169
Spondylosis 169
Stereotactic surgery 154
Stroke 95
haemorrhagic 103112
ischaemic 97103
Oxford (Bamford) classification of 96
parenchymal brain haemorrhage 103105
partial anterior circulation 9596, 96
subarachnoid haemorrhage 103, 105112
transient ischaemic attack 97103
Subarachnoid haemorrhage (SAH) 62, 103, 105112, 106 see also Intracranial haemorrhage
CT angiography for 109, 110
CT for 106, 107109
digital subtraction angiography for 109, 111
modified Fisher grading scale for 109, 109
MRA for 109110
non-traumatic 107, 108
World Federation of Neurosurgical Societies grading scale 107
Subarachnoid space 7
Subcutaneous emphysema 69
Subdural empyema 132, 133
Subdural haematoma 62, 8589, 8688, 89
acute 85, 86, 86
chronic 85, 86, 87
extradural and, differences between 89
isodense 86, 88
subacute 86, 88
Subfalcine herniation 68, 6869
Superior sagittal sinus 18, 18
T
Tattoo inks 31
Temporal lobe 8, 9
Tentorium cerebelli 7, 46, 48
Terminology, related to radiology 20
orientation 20, 2021
sections 2122, 23
views 21, 22
Thalamus 10, 11
Third cranial nerve palsy 108
Thoracolumbar fractures 164167
burst fractures 165166, 167
imaging findings 166
wedge fractures 165, 166
Thrombolytic therapy 97
Tonsillar herniation 69, 69
and Chiari malformation 69
Total anterior circulation stroke 96
Tractography 29, 155, 155
Transependymal oedema 63, 64, 65
Transient ischaemic attack 97
Trans-sphenoidal hypophysectomy 151
Transtentorial (uncal) herniation 68, 69
Traumatic brain injury 75, 76
assessment in 77
cerebral contusion 8991, 91, 92
CT head scan in 77, 78
differential diagnoses 79
diffuse axonal injury 91, 93
extradural haematoma 8385, 84
GCS score 75, 77, 78
prevention of 75
primary 75
secondary 75
severe 7577, 76
skull fractures 8083, 81, 82
subdural haematoma 8589, 8688, 89
V
Vascular system 52
CT 5253, 54
digital subtraction angiography 5556, 56, 57
MRI 53, 55, 55
Vasogenic oedema 64, 65
Ventricular system 18, 19, 57, 58
Ventriculitis 127
Ventriculomegaly 63, 66, 70
Vertebrae 4, 4, 5
cervical 45, 5, 6
coccygeal 4, 5
lumbar 4, 5
sacral 4, 5
structure of 4
thoracic 4, 5
Vertebral artery 57
Vertebral dissection 115117
Vestibular schwannoma 152154
cystic component 153, 153
MRI scan 153, 153154
solid component 153, 154
Virchow–Robin spaces 71
W
Wedge fractures 165, 166
Wernicke's area 8
X
X-rays see Plain radiography
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