Neurodiagnostic Procedures

Junchen Zhang

Who is he ?

Bruce Lee is Hong Kong kungfu star. He was borned in San

Francisco in November 1940 .His first film was called The birth of Mankind, his last film which was uncompleted at the time of his death in 1973 was called Game of Death( 死亡游戏) .

There are and the numerous different theories on how he died. Original cause of death listed as “marijuana poisoning,” later changed to “death by misadventure.” Resently,some scholar think cerebral aneursym was the cause of lee’s death.

How to identify the cause of lee’s death?

神经外科疾病
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损伤 craniocerebral trauma 肿瘤 brain tumors 血管性疾病 cerebral vascular disease 感染性疾病 infection 先天性疾病 congenital [kɔn'dʒenitl] disease

How to diagnosis the CNS disease?
Neurodiagnostic Procedures is necessary to diagnosis and guide the therapy of neurologic disorders.

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Plain film radiography Computed tomography[tə'mɔgrəfi] MRI (核磁共振) DSA (脑血管造影) Myelography (脊髓造影) PET (正电子发射断层扫描) Ultrasound( 超声)

1 Plain film radiography

Are useful in the initial assessment of spinal trauma

Are useful in suspected [səs'pektid] infection Are useless in cases with neurologic deficits

2 Computed tomograthy

X-ray

The Basic principle the CT image is a computer-generated across-sectional representation of anatomy crected by analysis of the attennuation of Xray beams that have been passed through various points around a section of the brain

X-ray

X-ray attenuation (X- 光的 衰減 )

Greater x-ray attenuation caused by bone results in areas of high density

CT 切面的角度

Canthomeatal line 眼角 - 外耳道連線 (150) (red line)

CT is useful in imaging  osseous-structures (骨性结构)  Hemotomas  Cerebral atroophy  Hydrocephalus  cerebral infarction

Because of 颅底骨易造成伪影, lesions situated nera the skull base are more difficult to delineate with CT

CTA

Multidetector CT ( 多平面 CT )

3 Ultrasound(US)

The US is the standard technique for evaluating the premature infant for hydruocephalus.

Intraoperative ultrasound can also be used to help position the ventricular catheter ['kæθitə] during shunting

4 Magnetic resonance imaging(MRI)

The Basic principle
the imges that are created reflect the density of hydreogen protons as well as their relaxation rates. 利用磁场原理,把人体置于强大而均匀的静 磁场中,再利用特定的电波脉冲,激发人体组织 内的氢原子核。由于人体内的许多分子都含有氢 原子核,这些氢原子核又具有磁场特性,如同一 个小小的磁场。若使用仪器改变人体内的氢原子 核的旋转排列方向,原子核就会吸收释放能量, 能量激发后放出电磁波信号,再经过电脑分析组 合成影像,这就是一般所看到的 MRI 影像。

常用的序列有

T1 images T2 images FLAIR images are sensitve for cortical lesion and meningeal processes. EPI images is the most sensitive for indentifying aacute infarcion and perfusion imaging .

T1 images

T2 images

FLAIR images

EPI images

Gadolinium [gædə'liniəm] are often used to increase the sensitivity of MR to various disease.

GDDTPA 强化

MRA delineate the major extracranial and intracranial vessels without the need for contrast agents.

不用造影剂血管成像

MRI is useful in imaging  trauma  tumor  Cerebral vascular disease  Spine and spinal cord  infection

5 myelography

Is a radiographic study thay outlines the spinal canal and its contents. Water-soluble nonionic contrast material is injected into the subarachniod space via a lumber punctre

6 Digital aubtraction angioraphy(DSA)

Definition[defi'niʃən] Radiographic visualization of the arterial and venous systems of the neck,brain,and spinal cord is accomplished by intra-arterial injection of a water-soluble iodinated contrast agent.

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Methods

DSA is the best procedure for characterizing aneurysms and AVM.

MRA and CTA have improved in recent years,making possible noninvasive assessment of many of these vascular disorders.

6 Radionuclide imaging

Introduction
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Noninvasive Utilizes radiopharmaceuticals (radioisotopes) Evaluates pathophysiology of systems Most common systems scanned are: skeleton, lungs, liver, thyroid and heart Usually done in combination with Xray, CT or MRI

Radionuclide Imaging

Several modalities of imaging systems
• Bone scan/bone scintigraphy • SPECT (single photon emission computed tomography) • Ventilation/perfusion scans • Myocardial perfusion scans • PET (positron emission tomography)

Bone scan is the most commonly performed procedure

Pathological Findings

Bone scans are useful for diagnosing the following conditions:
• • • • • • • • • • Metastatic disease Trauma Infection Paget disease Hypertrophic osteoarthropathy Reflex sympathetic dystrophy Avascular necrosis Spondylolysis Venous obstruction Extraosseous

Normal Bone Scan

Prostate Metastasis

Neuroblastoma

SPECT Imaging
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SPECT (single photon emission computed tomography) Three dimensional images
• Axial, coronal and sagittal slices • Gamma camera is rotated around the patient in all three anatomical planes

Competing signal from overlying structures is eliminated Accurate detection of subtle signal changes and better spatial resolution of signal changes Useful for detecting occult pars/spinous fractures

Spinous Process Fractures

PET
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PET (positron emission tomography) Physiologic imaging method Radionuclide used is fluorodeoxyglucose (18F-FDG) Utilizes beta decay Expensive study Utilized mostly in research settings but PET is gaining acceptance outside of research
• Neuroimaging • Oncological imaging

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PET
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Positron is emitted by beta plus decay Electron is emitted by beta minus decay Positron collides with electron 2 gamma rays are emitted Gamma rays are detected by a ring of detectors around the patient PET is now commonly being combined with dual MRI/PET scanners and CT/PET, CT/PET Fusion scans

PET Scanner Diagram

CNS Lymphoma-MRI/PET Scan

CNS Lymphoma-Color PET Scan