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INTRODUCTION TO NEURO MR

Dr. Francis Neuffer USC School of Medicine Department of Radiology

MR IMAGING
• Based on behavior of protons exposed to a magnetic field and a radio wave
• T1, T2, FLAIR, Diffusion, Gadolinium enhanced, and Angiography are specific types of Neuro imaging sequences.

RF .

MR INTERPRETATION • Symmetry • Identify normal structures – Ventricles – Grey matter structures – White matter tracts – Language – Intensity/ Signal – Description of tissue signal on various different scanning sequences ie. – T1 T2 Flair Diffusion Gadolinium .

Metal artifact 1. Nephrogenic Systemic Fibrosisgadolinium toxicity in renal failure . RF Energy – pacemaker override 2.ocular metal -missile effect 3.MAGNETIC RESONANCE IMAGING Limitations 1.aneurysm clips . Magnetic field . ICU patients and Claustrophobia 2.

EDT A child undergoing an MRI exam received a fatal head wound when the machine’s powerful magnet pulled a metal oxygen canister inside.m. July 30. 2001: 2:42 p. .Child Dies in MRI Machine The Associated Press Monday.

GADOLINEUM TOXICITY .

Multiple signal sources 2.MAGNETIC RESONANCE IMAGING Advantages 1. No ionizing radiation issues . No iodine toxicity/allergy issues 3.

MR HAS ADVANTAGE OF MULTI PLANAR IMAGING .

MRI INDICATIONS • • • • • Ischemia Tumor Infection Dating blood products Congenital abnormalities .

(Fat.(Water. Methemoglobin= bright) − T2 weighted-.(Pathology bright.MRI INTERPRETATION • Pulse Sequences− T1 weighted-. Hemosiderin.recent infarction bright . Oxyhemoglobin. Hemosiderin= bright) − FLAIR-. CSF dark) − Diffusion Weighted. Melanin.

. Tissues recover their magnetization based on intrinsic T1 time.MR SIGNAL T1 SCAN T2 SCAN Tissues resonate a signal based on their intrinsic T2 time.

T1 SCAN Anatomic structures Fat = bright Water = hypo intense T2 SCAN Water weighted sequence Water = bright Fat = relatively hypo intense Good for identifying pathology .

MRI FINDINGS OF ACUTE ISCHEMIC STROKE T1 (hypo intense) T2 (hyper intense) FLAIR (hyper intense) FLAIR SCANS ARE T2 SCANS WITH THE FREE WATER SIGNAL NULLED. .

MRI FINDINGS OF ACUTE STROKE T1 (hypo intense) T2 (hyper intense) FLAIR (hyper intense) Diffusion (hyper intense) .

DIFFUSION IMAGING • DIFFUSION IMAGING SEPARATES INFARCTION ON ACUTE OR CHRONIC BASIS • THE ACUTE INFARCT HAS A DIFFERENT DIFFUSION SIGNAL DUE TO INTRACELLULAR EDEMA .

DIFFUSION IMAGING • Increased sensitivity for early changes of edema – Becomes abnormal within 30 mins. – Ischemia Cellular Dysfunction Increased Intracellular Space Restricted Diffusion of Water Increased signal • Distinguish b/w old and new stroke • New stroke = bright on DWI (diffusion weighted image) • Old stroke (encephalomalacia) = low SI on DWI .

MRI ACUTE STROKE T1 T2 Diffusion PCA DISTRIBUTION .

NEW ISCHEMIC INFARCT T1 T2 DIFFUSION .MRI OLD -VS.

ANATOMY Temporal lobe Pons Middle Cerebellar peduncle Temporal lobe Pons 4th ventricle 4th ventricle Basillar artery Occipital lobe .

ANATOMY Supracellar cistern Middle Cerebral artery Cerebral peduncle Temporal Horn lateral venticle Optic chiasm Aqueduct Of Sylvius .

ANATOMY ALIC ALIC Caudate head External capsule Thalamus Putamen Globus pallidus PLIC Middle Cerebral artery PLIC Corpus callosum .

ANATOMY Frontal lobe Middle Cerebral artery Corpus callosum Lateral ventricle Parietal lobe Occipital lobe Anterior Cerebral artery Corona radiata .

ANATOMY Centrum Semiovale .

GADOLINEUM IMAGING MR CONTRAST • ENHANCED SCANS BLOOD/BRAIN BARRIER DISRUPTION • IDENTIFY PATHOLOGY • ARTERIOGRAM EFFECTS .

CT WITH CONTRAST ENHANCEMENT ENHANCING RING LESION NON ENHANCED .

SCAN MR .SCAN – WITHOUT GADOLINEUM T1 – SCAN WITH GADOLINEUM T2.T1.

PITUITARY ADENOMA NORMAL ABNORMAL .

T1 SAGITTAL MR WITHOUT GADOLINEUM WITH GADOLINEUM .

ACOUSTIC NEUROMA WITHOUT GADOLINEUM WITH GADOLINEUM .

VASCULAR ANATOMY MR ARTERIOGRAM Anterior cerebral Cavernous Carotid Basilar artery Middle cerebral ICA ECA ECA ICA Vertebral artery Carotid bulb CCA CCA .

VASCULAR ANATOMY Anterior cerebral TIME OF FLIGHT MRA TOF-MRA MCA Basilar artery Cavernous carotid ECA ICA MCA Vertebral ACA BA Cavernous carotid .

VASCULAR ANATOMY ACA MCA ACoA ICA PCA PCoA Basilar Artery Circle of Willis .

VASCULAR DISTRIBUTIONS ACA MCA PCA .

STROKE • Ischemic – Large artery atherosclerosis • Higher mortality – Cardioembolism • Recurrence – Small vessel ischemia • Occlusion of small end arteries • Predilection for BG. IC. Pons. Corona Radiata • Hemorrhagic .

IMAGING OF STROKE • CT – Better identification of acute hemorrhage – Availability – Decrease expense – Decrease time – Less contraindications • MRI – More sensitive to early changes of stroke ie. edema .

CT FINDINGS SAH .

STROKE INTERVENTION • THROMBOLYTIC THERAPY TO SALVAGE ISCHEMIC BRAIN AT THE BORDER OF THE INFARCT ZONE • WHO BENEFITS AND HOW SELECT? .

STROKE INTERVENTION • • • • TIME CONSTRAINTS 3-6 HOUR WINDOW RISK OF HEMORRAGIC CONVERSION WITH THROMBOLYTIC THERAPY .

RT LT .

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MR PERFUSION Gadolineum Injection .

CT PERFUSION Iodine Injection .

GOAL FOR IMAGING COMPARISON OF INFARCT ZONE AND ISCHEMIC ZONE TO IDENTIFY TREATMENT CANDIDATES .

MRI FINDINGS OF ACUTE STROKE T1 (hypointense) T2 (hyperintense) FLAIR (hyperintense) Diffusion (hyperintense) .

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