SUMPH “N.

TESTEMITANU”
RADIOLOGY AND MEDICAL IMAGING
DEPARTMENT

NEURORADIOLOGY
CLINICAL CASES

M. Crivceanschii,
assistant professor
• Conventional Radiography
• IMAGING
Computed Tomography
MODALITIES
• Magnetic Resonance Imaging
• Ultrasonography
• Angiography
• Scintigraphy, Positron Emission Tomography, PET/CT
POSTEROANTERIOR SKULL
PROJECTION
Is used for documentation of skull and facial skeletal asymmetries.
LATERAL SKULL PROJECTION
Is used for documentation of skull and facial skeletal asymmetries.
 AXIAL SKULL PROJECTION
As an initial radiograph to check the condylar axes, or as a supplement to a
panoramic radiograph for localization of extremely laterally impacted maxillary third
molars.
 Computed Tomography
• The X-ray tube emits a sharply collimated fan beam of X-rays which passes
the patient and reaches an array of detectors. Tube rotates around the
patient.
 Computed Tomography

• Spiral CT – X-ray tube rotates continuously around the patient.

Computed Tomography
MAGNETIC RESONANCE
IMAGING
(MRI)
MRI
Uses magnetic fields and radio waves to produce images of thin slices of tissues
(tomographic images).
MRI
• Normally, protons within tissues spin to produce tiny
magnetic fields that are randomly aligned.
• When surrounded by the strong magnetic field of an MRI
device, the magnetic axes align along that field.
MRI
• A radiofrequency pulse is then applied, causing the axes of all
protons to momentarily align against the field in a high-energy
state.
• After the pulse, some protons relax and resume their baseline
alignment within the magnetic field of the MRI device.
• The magnitude and rate of energy release that occurs as the
protons resume this alignment (T1 relaxation) and as they wobble
(presses) during the process (T2 relaxation) are recorded as
spatially localized signal intensities by a coil (antenna).
• Computer algorithms analyze these signals and produce anatomic
images.
MRI
ADVANTAGES OF MR

• No ionizing radiation
• High contrast resolution
• Good spatial resolution
• Multiplanar capabilities
• Requires little patient preparation and is noninvasive.
• Lack of artifacts from adjacent bones
• Multi weighted sequences:
– Fluid attenuation (FLAIR)
– Fat suppression (STIR)
– Diffusion weighted (DWI), Diffusion Tensor (DTI)
– Functional MR (fMR: BOLD)
– Spectroscopy (MRS)
NORMAL MR
BRAIN

T1 Weighted Image T2 Weighted Image

SAGITTAL MR
BRAIN

T1 WI
• ANOMALII DE DEZVOLTARE
• TRAUMATISMUL CRANIOCEREBRAL
• ACCIDENTUL VASCULAR CEREBRAL
• PROCESE TUMORALE
• PROCESE INFECȚIOASE
ANOMALII DE DEZVOLTARE

CHIARI I
ANOMALII DE DEZVOLTARE

CHIARI III
ANOMALII DE DEZVOLTARE

• AGENEZIA CORPULUI
CALOS
ANOMALII DE DEZVOLTARE

• LIPOM
ANOMALII DE DEZVOLTARE

• MALFORMAȚIE DANDY WALKER

ANOMALII DE DEZVOLTARE

• HOLOPROSECEFAL
ANOMALII DE DEZVOLTARE

• MICROCEFAL
ANOMALII DE DEZVOLTARE

• HETEROTOPIA SUBSTANȚEI CENUȘII

TRAUMA
PLAIN X-RAY

Fracture Line

SKULL FRACTURE
EXTRADURAL
HEMATOMA
TRAUMATISMUL CRANIOCEREBRAL

• HEMATOM EPIDURAL
SUBDURAL
HEMATOMA
TRAUMATISMUL CRANIOCEREBRAL

• HEMATOM SUBDURAL
SUBARACHNO
ID
HEMORRHAGE
 TRAUMATISMUL CRANIOCEREBRAL

• HEMORAGIE SUBARAHNOIDIANĂ
TRAUMATISMUL CRANIOCEREBRAL

• CONTUZIE CEREBRALĂ
Soft Tissue Window Bone Window
DIGITAL
IMAGE
BRAIN CONTUSIONS

Hemorrhagic Contusions
 R
BRAIN
LACERATIONS

Gunshot Injury
AVC

• HEMORAGIE INTRACEREBRALĂ
AVC

• HEMORAGIE INTRACEREBELOASĂ
ACUTE
MIDDLE
CEREBRAL
INFARCT
AVC

• AVC ISCHEMIC ÎN FAZA ACUTĂ

AVC

• AVC ISCHEMIC CEREBELOS ÎN FAZA ACUTĂ

AVC

• AVC ISCHEMIC ÎN FAZA CRONICĂ

PROCESE TUMORALE

• Astrocitom
PROCESE TUMORALE

• Astrocitom fibrilar
• Glioblastom
GLIOMA

T1 WI T2 WI T1 WI Post-Contrast
PROCESE TUMORALE

• Oligodentrogliom
BRAIN STEM
GLIOMA
PROCESE TUMORALE

• Meningiom
PROCESE TUMORALE

• Meningiom
 PROCESE TUMORALE

• Meningiom
• Meningiom
PROCESE TUMORALE

• Meningosarcom
PITUITARY
ADENOMA
ACOUSTIC
NEURINOMA

T1 WI T1 WI Post Contrast

MRI
LEZIUNI NON-TUMORALE
 PROCESE INFECȚIOASE

• ENCEFALITĂ HERPETICĂ
PYOGENIC
BRAIN
ABSCESS
PROCESE INFECȚIOASE

• ABCES CEREBRAL
PROCESE INFECȚIOASE
 PROCESE INFECȚIOASE

• MENINGITĂ TB (postcontrast)
• TB CEREBRALĂ
PROCESE PARAZITARE

• NEUROCISTICERCOZĂ
PROCESE PARAZITARE

• CHIST HIDATIC
 CEREBRAL
ANGIOGRAPH
• Catheter
Y Angiography:
– Conventional
– Digital Subtraction
• Magnetic Resonance Angiography (MRA)
• Computed Tomography Angiography (CTA)
EMBOLIZATIO
N OF AVM

Before After
ANTERIOR COMMUNICATING ARTERY ANEURYSM

MR Angiography
MIDDLE CEREBRAL
ARTERY ANEURYSM

CT Angiography
SPINE
ANATOMY
PLAIN X-RAY

A-P view Lateral view Oblique view

MYELOGRAPH
Y
CT
DEGENERATIVE
SPONDYLOLISTHESIS
MRI

T1 WI T2 WI
 ANOMALII DE DEZVOLTARE

• CIFOZĂ
SAGITTAL VIEW

T1w T2wir
MRI
ANOMALII DE DEZVOLTARE

• HEMIVERTEBA
 ANOMALII DE DEZVOLTARE

• VERTEBRĂ ÎN FLUTURE
ANOMALII DE DEZVOLTARE

• BLOC VERTEBRAL
• LIPOM INTRADURAL
ANOMALII DE DEZVOLTARE

• SIRINGOMIELIA
ANOMALII DE DEZVOLTARE

• SCOLIOZĂ
TRAUMATIC
CORD
CONTUSION

T2 WI
DISC HERNIATION
MRI

T1 WI T2 WI
INFECTIVE
SPONDYLITIS

T1WI T1WI Post Contrast

PROCESE TUMORALE
GLIOMA

T1 WI POST CONTRAST
MENINGIOMA

T1 WI POST CONTRAST
Neurinoma
METASTASES

CT MRI

Soft tissue Window

Bone Window
PATIENT A.
 CLINICAL HISTORY

The patient presented with a 2-week

history of:
• purulent otitis media
• fever (39 degrees Celsius)

2-day - onset of acute right facial nerve

paralysis

High grade arterial hypertension

IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
 FINAL DIAGNOSIS

Cerebral abscess
PATIENT B.
 CLINICAL HISTORY

The patient presented with a 2-day history

of:
• Severe pulsating headache
• Fever (37 degrees Celsius)
• Neurological meningeal low positive
symptoms
• Nausea and vomiting
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
 FINAL DIAGNOSIS

AVM
(arteriovenous
malformation)
PATIENT C.
 CLINICAL HISTORY

• Female 45 y.o.

• peripheral lung cancer

• Screening for metastases
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
 FINAL DIAGNOSIS

Multiple intra-axial
metastases
PATIENT B. IN A 3 MONTHS
AFTER CHEMOTHERAPY
TREATMENT
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
PATIENT D.
 CLINICAL HISTORY

• Man 20 y.o.

• 2-month history of headache

IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
 FINAL DIAGNOSIS

Malignant glial
tumor
(glioblastoma?)
PATIENT E.
 CLINICAL HISTORY

• Female 34 y.o.

• Cognitive deterioration (dementia)

• Headaches more prominent in the
morning
• Blurred vision
• Difficulty in walking

• Congenital toxoplasmosis
IMAGING FINDINGS
IMAGING FINDINGS
IMAGING FINDINGS
 IMAGING FINDINGS
Endoluminal navigation
 FINAL DIAGNOSIS

Obstructive
Hydrocephalus