IN THE NAME OF ALLAH THE MOST MERCIFUL, THE MOST KIND “Blessed is He in Whose hand is the Sovereignty, and He is Able to do all things Who hath created life and death that He may try you, which of you is best in conduct; and He is the Mighty, Forgiving,” ………………(67:1-2)
IMAGING of Head / Brain Dr. Rashed Nazir
IMAGING of Head / Brain What to image How to image / imaging modalities
RADIOGRAPHY
INDICATIONS The presence of a palpable vault abnormality which feels bony. As part of an imaging protocol for specific clinical problems after discussion with radiologists e.g. skeletal survey for myeloma. Facial views are of use following trauma to facial skeleton or mandible. Facial views may be of use following trauma to the orbit, or possibility of metallic foreign body
Linear fracture
Depress fracture
Fracture
Multiple myeloma
CT SCAN
MRI
Normal
INDICATIONS Trauma: haemorrhages, brain contusions and skull fractures. Stroke Brain tumors. Hydrocephalus Infections (encephalitis, abscesses)
White matter diseases (Demyelinating / dysmyelinating e.g. MS, leukodystrophy) Diseases of the temporal bone. Determine whether inflammation or other changes are present in the paranasal sinuses. Plan radiation therapy for cancer of the brain or other tissues. Guide biopsies. Assess aneurysms or AVM
Fracture frontal bone
Extradural Haematoma Occurs when vessel (middle meningeal artery) in the extradural space is torn by trauma.
Extra dural hematoma
Subdural Haematoma Also due to traumatic bleed into potential space between the dura and arachnoid mater, when a bridging vein is torn. Can extend into the interhemispheric fissure and the root of the sylvian fissure but not into other sulci.
Sub dural hematoa
Subarachnoid Haemorrhage Occurs into the subarachnoid space from spontaneous or traumatic rupture of, usually an artery, in this space. Blood can then be seen in the cisterns and extending into the sulci and fissures on the brain surface close to the site of bleeding.
Subarachnoid hemorrhage
Brain abscess
Abscess
ADEM
MS
Leukodystrophy
Tumour
Metastasis
Meningioma
Hydrocephalus
Stroke
PICA
ACA
MCA
PCA
ROLE OF MRI
Basal ganglia hematoma
Late Subacute bleed on MRI
ANGIOGRAPHY
MRA
CTA Head
CTA
Dense MCA sign
DST
Venography
Superior sagittal sinus thrombus
MR Venography
SPECT
PET
CEREBRAL PERFUSION SPECT Diagnosis and conformation of Alzheimer's disease and other forms of dementia. Localization of electrical and nonelectrical seizure foci. Evaluation of location, size, and prognosis of cerebral ischemia and stroke patients. Evaluation of AIDS dementia. Changing brain perfusion during various types of interventions.
Evaluation of brain injury. Evaluation of patients with psychiatric and mood disorders. Detection and localization of recurrent brain tumor (Tc-99m and Tl-201agents). Localization of Speech center Diagnosis of brain death.
CISTERNOGRAPHY Diagnosis of normal pressure hydrocephalus. Identification of cerebrospinal fluid (CSF) leaks.