Brain Imaging: CT and MRI

Dr Anant Pachisia
CT Head
 Basic Physics of CT
• CT uses x-rays to generate cross-sectional, 2D
images of the body.

• Images are acquired by rapid rotation of the X-

ray tube 360 degrees around the patient.

• Transmitted radiation is then measured by a

ring of sensitive radiation detectors located on
the gantry around the patient
 What is a hounsfield unit or CT number?
• Every acquired CT slice is subdivided into a matrix of 1024 * 1024
volume elements (voxels)

• Each pixel is assigned a numerical value (CT number), which is

average of all the attenuation values (density of tissue) contained
within the corresponding voxel

• This no. is compared to the attenuation value of water and displayed

on a scale of arbitary units named HU after Sir Godfrey Hounsfield.

• Range of CT no. 2000HU.

• Each no. represents a shade of grey with +1000 (white) and -

1000(black) at either spectrum.
 Tissue Density Differences
• Lower density substances allow more photons pass
through to the detectors, resulting in a grayer or blacker
appearance on CT – like CSF

• X-ray beam is attenuated to a higher degree by calcium,

therefore less photons pass through bone to the
detectors, resulting in its ‘white’ appearance on CT

• White matter is less cellular, contains myelinated axons

(fat), and has a higher water content than gray matter,
resulting in slightly lower attenuation values or density
Different Window Levels
 CT Artifacts
• It is appearance or feature that is seen on an
image, which doesn't not actually exist.

• Types:
• Motion
• Streak (beam hardening)
• Partial voluming: different tissue densities within a
single voxel lead to “ averaging” of data e.g. A
small black object within a larger white space
would look like a shade of grey
 CT Neuroimaging
• The head is routinely scanned using sequential
imaging in the axial plane with each section
measuring 5 mm thick
 Head CT Approach
• First - evaluate normal anatomical structures, window for
optimal brain tissue contrast

• Second – assess for signs of underlying pathology such as:

mass effect, edema, midline shift, hemorrhage, hydrocephalus,
subdural or epidural collection/hematoma, or infarction

• Third – evaluate sinuses and osseous structures with bone

windows

• Fourth – use a soft tissue window to assess extracranial

anatomy – orbits, face, scalp
Anatomy
MRI BRAIN
 Basics
• MRI is based on the principle of nuclear magnetic
resonance (NMR)

• Two basic principles of NMR

1. Atoms with an odd number of protons have spin
2. A moving electric charge, be it positive or negative,
produces a magnetic field

• MRI utilizes this magnetic spin property of protons of

hydrogen to produce images.
• Hydrogen nucleus has an unpaired proton
which is positively charged

• Hydrogen is abundant in the body in the form

of water and fat

• Essentially all MRI is hydrogen (proton 1H)

imaging
• A powerful, uniform, external magnetic field is
employed to align the protons that are normally
randomly oriented within the water nuclei of the
tissue being examined.

• This alignment (or magnetization) is next

perturbed or disrupted by introduction of an
external Radio Frequency (RF) energy.

• The nuclei return to their resting alignment

through various relaxation processes and in
doing so emit RF energy.
 TR & TE
• TE (echo time) : time interval in which signals
are measured after RF excitation

• TR (repetition time) : the time between two

excitations is called repetition time.

• By varying the TR and TE one can obtain T1WI

and T2WI.
 BASIC MR BRAIN SEQUENCES
• T1

• T2

• FLAIR

• DWI

• ADC
 T1 IMAGES
• SHORT TE
• SHORT TR

• BETTER ANATOMICAL DETAILS

• FLUID: DARK
• GRAY MATTER: GRAY
• WHITE MATTER: WHITE
 BRIGHT ON T1
• Fat
• Haemorrhage
• Early Calcification
• Gadolinium
T1 IMAGES
 T2 IMAGES
• LONG TE
• LONG TR

• BETTER PATHOLOGICAL DETAILS

• FLUID BRIGHT
• GRAY MATTER RELATIVELY BRIGHT
• WHITE MATTER DARK
T1 AND T2 IMAGES
FLAIR – Fluid Attenuated Inversion Recovery
Sequences

• SIMILAR TO T2 EXCEPT FREE WATER

SUPRESSION (INVERSION RECOVERY)
• Most pathology is BRIGHT
• Especially good for lesions near ventricles or
sulci (eg Multilpe Sclerosis)
 WHICH SCAN BEST DEFINES THE
ABNORMALITY
• T1 W Images: Subacute Hemorrhage, Fat-
containing structures, Anatomical Details

• T2 W Images: Edema, Tumor, Infarction,

Hemorrhage

• FLAIR Images: Edema, Tumour, Periventricular

lesion
 DIFFUSION WEIGHTED IMAGES (DWI)
• Free water diffusion in the images is Dark
(Normal)

• Acute stroke, cytotoxic edema causes decreased

rate of water diffusion within the tissue i.e.
Restricted Diffusion (due to inactivation of Na K
Pump )

• Increased intracellular water causes cell swelling

• Areas of restricted diffusion are BRIGHT.

Restricted diffusion occurs in:

• Cytotoxic edema
• Ischemia (within minutes)
• Abscess
 Apparent diffusion coefficient (ADC) 
• To confirm true restricted diffusion - compare the
DWI image to the ADC.

• In cases of true restricted diffusion, the region of

increased DWI signal will demonstrate low signal
on ADC

• More specifically shows diffusion than

conventional DWI, by eliminating the T2 weighting
that is otherwise inherent to conventional DWI.
• DWI shows large area of restricted diffusuion
in the right thalamus/ deep white mater

• ADC shows high intensity signal indicating T2

shine through artifact
• Acute ischemic lesions can be divided into
Hyperacute lesions (low ADC and DWI-
positive) and Subacute lesions (normalized
ADC).

• Chronic lesions can be differentiated from

acute lesions by normalization DWI and ADC
becomes bright.
POST CONTRAST (GADOLINIUM ENHANCED)
• Post contrast images are always T1 W images

• Sensitive to presence of vascular or

extravascular Gd

Useful for visualization of:

• Normal vessels
• Vascular changes
• Disruption of blood-brain barrier
GRE Sequences (GRADIENT RECALLED ECHO)

• Blood, bone, calcium appear dark

• Areas of blood often appears much larger than

reality (BLOOMING)

• Useful for: – Identification of haemorrhage /

calcification

• Look for: DARK only

GRE Sequences (GRADIENT RECALLED ECHO)

• Form of T2-weighted image

• Blood, bone, calcium appear dark

• Areas of blood often appears much larger than reality

(BLOOMING)

• Useful for: Identification of haemorrhage / calcification

• Look for: DARK only

Thank you