Neuroradiology

Samir Kumar Praharaj

CT or MRI
Sections
Windows
Sequences
Godfrey Hounsfield
Hounsfield Scale - Radiodensity on CT
images
Scout Radiograph
CT Abnormalities
Reference density: Brain

Hyperdense Isodense Hypodense

Axial Sections on CT
 Above foramen
magnum level
A. Orbit
B. Sphenoid
Sinus
C. Temporal
Lobe
D. External
Auditory
Canal
E. Mastoid Air
Cells
F. Cerebellar
Hemisphere
A. Frontal Lobe Base of Fourth
B. Frontal Bone ventricle
(Superior
Surface of
Orbital Part)
C. Dorsum
Sellae
D. Basilar Artery
E. Temporal
Lobe
F. Mastoid Air
Cells
G. Cerebellar
Hemisphere
A. Frontal At Fourth
Lobe ventricle level
B. Sylvian
Fissure
C. Temporal
Lobe
D. Suprasellar
Cistern
E. Midbrain
F. Fourth
Ventricle
G. Cerebellar
Hemisphere
A. Falx Cerebri
At third ventricle
B. Frontal Lobe level

C. Anterior Horn
of Lateral
Ventricle
D. Third Ventricle

E. Quadrigeminal
Plate Cistern
F. Cerebellum
A. Anterior Horn of
the Lateral
Ventricle Frontal Horn of
B. Caudate Nucleus Lateral ventricle
C. Anterior Limb of
the Internal
Capsule
D. Putamen and
Globus Pallidus
E. Posterior Limb of
the Internal
Capsule
F. Third Ventricle
G. Quadrigeminal
Plate Cistern
H. Cerebellar Vermis
I. Occipital Lobe
A. Genu of the Frontal horn of
Corpus lateral ventricle
Callosum
B. Anterior Horn
of the Lateral
Ventricle
C. Internal Capsule
D. Thalamus
E. Pineal Gland
F. Choroid Plexus
G. Straight Sinus
A. Falx Cerebri
Lateral ventricle
B. Frontal Lobe level

C. Body of the
Lateral Ventricle
D. Splenium of the
Corpus
Callosum
E. Parietal Lobe

F. Occipital Lobe

G. Superior
Sagittal Sinus
 Above ventricle
A. Falx level
Cerebri
B. Sulcus
C. Gyrus

D. Superior
Sagittal
Sinus
Approach to CT Interpretation
• Bottom to top axial slices
• Look for gross asymmetries
• Ventricular system – morphology, size, position
• Lobes of cerebral hemispheres
• Normal GM-WM differentiation
• Localized mass effect – sulcal effacement
• Areas of pathologic enhancement
Cerebellar Hematoma
Acute bleed in
Chronic SDH
Subacute SDH
Midline shift
Sulcal effacement
Putaminal
Hemorrhagic Stroke
Hypodense lesion
Sulcal effacement

Ischemia
Malignancy
Abscess
Epidural Hematoma
Skull Fracture
Subarachnoid
Hemorrhage
Interpreting MRI
 MRI Sequences
  TR TE
(msec) (msec)
T1-Weighted
(short TR and TE) 500 14
T2-Weighted
(long TR and TE) 4000 90
Flair
(very long TR and TE) 9000 114
Fluid Attenuated Inversion Recovery
(FLAIR)
 Comparison of T1, T2, Flair
Tissue T1-Weighted T2-Weighted FLAIR
CSF Dark Bright Dark
White matter Light Dark Gray Dark Gray
Cortex Gray Light Gray Light Gray
Fat Bright Light Light

Inflammation 
(infection, Dark Bright Bright
demyelination)
T2 for Pathology
Post-contrast
Axial T1
Basal ganglia
Normal
structures
Sagittal
Sagittal T1
Limbic system
Sagittal T1
Coronal T2
Hippocampal atrophy
AD grading (MTA Scale)
Pituitary
WMH
FTD
Caudate atrophy
Left MCA infarct (FLAIR)
Thalamic infarcts (T2, FLAIR)
Pontine infarct (FLAIR)
Inferior Cerebellar Infarct (FLAIR)
Any questions