Bimbingan Coass

BASIC
NEUROIMAGING

Oleh:
David Noor Umam

1
Merupakan pemeriksaan penunjang dalam kasus-
kasus neurologi
Berupa:
1. Foto Polos
2. Ultrasonografi
3. Mielografi
4. Arteriografi
5. Magnetic Rensonance Immaging (MRI)
6. Computed Tomography (CT-scan)
1. Foto Polos
 2. Ultrasonografi
Diantaranya dapat berupa USG guiding, TCD
(Trans Cranial Doppler), USG Carotis
 3. Mielografi
 Media kontras dimasukkan ke dalam teka dengan
prosedur lumbal pungsi
 Sejak MRI diperkenalkan metode ini mulai ditinggalkan
 4. Arteriografi
Diantaranya:
CTA (CT-Angiografi), MRA (MR-Angiografi), DSA (Digital Subtraction Angiografi)
5. Magnetic Resonance Imaging (MRI)
Kelebihan:
 Lebih sensitif kelainan di jaringan otak (tumor, innfeksi, dll),
medulla spinalis, lesi hipofisis.
 Visualisasi lesi demielinisasi
Kekurangan:
 Mahal, tidak semua RS punya
 Butuh waktu lebih lama dan kooperatif dari pasien
 Tidak bisa dilakukan jika ada plat logam pada pasien
Brain
Metastase
Toxoplasma Cerebri
Abses Cerebri
 Shift Biologic Disease
(ppm) Correlation Status

NAA 2.01 Neuronal Tumor, stroke,

marker edema,dement
.

Cr 3.03 Energetic Kidney or liver

failure
Cho 3.19 Membr. Tumor,
Turnover Inflammation

Lac 1.31 Anaer. Tumor ,

metabolism ischaemic
condition
mI 3.52 Astrocytic Dementia,
marker tumor
Glu 3.75 Astrocyte Liver failure
 6. Computed Tomography (CT-scan)

 Cepat
 Banyak dimiliki RS
 Digunakan pada kasus emergensi
 Membedakan densitas
 1. Optic nerve
2. Orbital fat
3. Cribriform plate of ethmoid bone
4. Pituitary fossa
5. Dorsum sellae
6. Basilar artery
7. Pontine cistern
8. Temporal horn of lateral ventricle
9. Cerebellumpontine angle
10. Vermis of cerebellum

a. T – Temporal lobe P – Pons C –

Cerebellum
b. The boundary between the
middle and posterior cerebral
territories is shown
c. The motor and sensory tracts
are situated anteriorly in the
brain stern

Motor tracts Sensory tracts

 1. Frontal sinus
2. Gyrirecti
3. Hypothalamus in chiasmatic cistern
4. Third ventricle – anterior part
5. Sylvian fissure
6. Interpeduncular fossa
7. Quadrigeminal cistern
8. Cerebellar sulcus
9. Cisterna magna

a. F – Frontal lobe T – Temporal lobe C – Cerebellum

M – Midbrain The posterior limits of the frontal
lobes are shown extending lateral to the
chiasmatic cistern. The tentorial edge, is are also
shown. The chiasmatic cistern constains the
anterior recesses of the third ventricle and
hypothalamus
b. Three vascular territories are outlined
corresponding to the anterior middle and posterior
cerebral territories
c. In addition to the motor and sensory tracts in the
Motor tracts midbrain the origin of the visual tract is seen from
Visual tracts the lateral geniculate body. The lowermost extent
of the motor cortex is shown in the frontal lobe
Sensory tracts
adjacent to the anterior limit of the sylvian fissure
 1. Frontal horn of lateral ventricle
2. Third ventricle
3. Sylvian fissure
4. Quadrigeminal bodies and cistern
5. Chroid plexus in trigone of lateral
ventricle
6. Superior cerebellar cistern

a. F – Frontal lobe D – Diencephalon (thalamus and

basal nuclei) T – Temporal lobe C – cerebelum
b. In addition to the anterior middle posterior
cerebral territories shown here, the diencephalon
and internal capsular region is shown to be
supplied by perforating arteries which arise from
the terminal internal carrotid and proximal
anterior and middle cerebral trunks. The
posterior cerebral supply includes the thalamus
c. Three tracts are again outlined in this diagram.
The ascendingmotor fibres constitute the internal
capsule at this level and are illustrated by the
angulated hatched area lateral to the thalami. The
Motor tracts thalamus is the main sensory nucleus and it is
connected to the posterior limb of the internal
Sensory tracts capsule as shown. The optic radiation is shown
pasing back towards the occipital lobe
Visual tracts
 1. Falx cerebri
2. Interventricular septum (septum
pellucidum)
3. Head of caudate nucleus
4. Sylvian Fissure
5. Internal capsule
6. Thalamus
7. Calcified pineal gland
8. Occipital horn of the lateral ventricle
9. Straight sinus in faix

a. F – Frontal lobe P – Parietal lobe T –

Temporal lobe O – Occipital lobe D –
Diencephalon C – Apex of posterior fossa
b. The vascular territories are similar to the
subjacent scan. The middle cerebral artery
has the most extensive area of supply
c. The internal capsule is demonstrated lateral
to the sensory tracts in the posterior limb of
the internal capsule, and the optic radition
Motor tracts fibres sweep around throuhg the temporal
Visual tracts temporal lobe to the occipital cortex. The
Sensory tracts lower end of the pre-and post central gyri are
shown.
 1. Body of corpus callosum
2. Body of the lateral ventricle
3. Body of the caudate nucleus
4. Corona radiata
5. Chroid plexus
6. Splenium of the corpus callosum
7. Faix cerebri

a. F - frontal lobe P – Parietal lobe T –

Temporal lobe O – Occipital lobe
b. Only three vascular territories are seen
at this level
c. At this level the motor and sensory fibres
in the corona radiata extend laterally to
reach their cortical projections. The most
superior part of the visual cortex is still
visible
Motor tracts Sensory tracts

Visual tracts
 1. Falx and interhemispheric fissure
2. Lateral vanricles
3. Parieto – occipital sulcus

a. F – Frontal P – Parietal O – Occipital

b. The anterior cerebral artery territory
can be seen to extend back to the
territory to the posterior cerebral
artery
c. The motor and sensory radiations are
again shown

Motor cortex
Visual cortex
Sensory cortex
 1. Interhemispheric fissure and falx
2. Corona radiata
3. Pre – central gyrus
4. Post – central gyrus
5. Parietal - occipital fissure

a. F – frontal lobe P – Parietal lobe O –

Occipital lobe
b. Vascular territories are similar to the
subjacent scan
c. The motor and sensory are still seen

Motor cortex
Sensory cortex
Visual cortex
 1. Falx cerebri
2. Cingulate sulcus

a. F – Frontal lobe P – Parietal lobe

b. The anterior cerebral artery territory
extends throughout the lenght of
the scan flanked laterally by the
middle cerebral artery territories
c. The motor and sensory radiations
are shown

Motor cortex Sensory cortex

 Nilai Atenuasi
Range
Tulang/kalsium +80 - +1000
Darah beku +40 - +95
Substansial kelabu +36 - +46

Substansial putih +22 - +32

Cairan 0 - +8
serebrospinal
Air 0
Lemak -20 - -100
Udara -1000
 Dilaporkan:
 Identitas (nama/ usia)
 Jenis pemeriksaan (serta
kontras/tidak) dan potongan
 Calvaria
 Subgaleal
 Sulkus dan girus
 Parenkim (ada tidaknya SOL,
perdarahan, infark)
 Ventrikel
 Kesimpulan
Blood
Cisterns
Brain
Ventricles
Bone

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 B is for Blood
• Acute blood is bright white
on CT (once it clots).

•Blood becomes isodense at

approximately 1 week.

 Blood becomes hypodense at

approximately 2 weeks.
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 Common Stroke /
Uncommon
stroke?
 Location for
common stroke?
Blood
Cisterns
Brain
Ventricles
Bone

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Blood
Cisterns
Brain
Ventricles
Bone

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SOP (Space Occupying Process)
 Cerebral
Abses
Intracranial Air
 Meningioma
Blood
Cisterns
Brain
Ventricles
Bone

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Blood
Cisterns
Brain
Ventricles
Bone

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If no blood is seen, all
cisterns are present and
open, the brain is symmetric
with normal gray-white
differentiation, the ventricles
are symmetric without
dilation, and there is no
fracture, then there is no
emergent diagnosis from the
CT scan. 59