Download - Aging
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Aging
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Central Nervous System Processes
• Age related brain atrophy• Non-age related brain atrophy• Cerebrovascular disease• Cerebral infarction• Hypertensive hemorrhage• Carotid artery stenosis and occlusion
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Brain Atrophy
• CT brain sections
• Loss of brain parenchyma
• Enlargement of ventricles
• Widened sulci
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Brain Atrophy
• MRI T2 axial image
• Cerebral atrophy• High signal areas
(white) cerebrospinal fluid in dilated sulci
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Brain Atrophy
• T1 Sagittal (CSF Black)
• Shrinkage of brain parenchyma with enlarged sulci
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Aging Brain• Scattered high
signal lesions• Found in
people over 50• Small ischemic
lesions or edema or gliosis
• More sensitive than CT PD T2
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Acute Ischemic Infarction• Axial CT• Wedge shaped
area of decreased attenuation
• Mass effect on left lateral ventricle
• Left to right shift
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Acute Cerebral Infarction• Acute left
parietal-occipital infarct
• Wedge shape• Brain edema
caused by decreased blood supply
PD T2
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Hypertensive Hemorrhage
• CT non-contrast• Small rounded focus
of increased attenuation posterior limb of left internal capsule
• Represents blood
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Encephalomalacia
• Large area of low signal occipito-temporal
• Evidence for old infarction
T1
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CT Angiography
• Multi-planar imaging possible
• Excellent delineation of vessel lumen and placque
• Note: atherosclerosis at the carotid bulb (arrow)
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MR Angiography
• Contrast and non-contrast techniques
• Excellent evaluation of vasculature
• Limitations in presence of pacemakers
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Right Internal Carotid Occlusion
• MR Angiogram• Complete
occlusion of RICA
• Left carotid is normal (arrow)
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Carotid Ultrasound
• Plaque in carotid artery
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Doppler Ultrasound
• Dynamic imaging study using frequency shift of returning sound
• Can detect blood flow (including very small vessels)
• Can observe abnormal blood flow such as–Left-to-right shunt in heart disorders–Turbulent flow in aneurysms and dilated
post-stenotic vessels• Can evaluate and estimate the degree of
stenosis
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Doppler Ultrasound• Color Doppler – Evaluate flow direction
and velocity
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Carotid Stenosis• Color Doppler US• Severe stenosis left
internal carotid (yellow arrow red vessel)
• Turbulent flow due to atherosclerosis beyond stenotic segment (green arrow blue vessel area)
• Jugular vein (blue vessel more superficial)
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Aging of the Skeletal System
• Osteoporosis• Osteoarthritis• Other arthritis
– Rheumatoid arthritis– Gout
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Osteoporosis• Lateral T-spine elderly
female• White line of cortical bone
around the bodies• Scanty and coarse trabecula• Compression fracture
(Arrow)• In osteoporosis, quantity of
bone decreased, composition normal
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Dual Photon Scanning of Osteoporosis
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Osteoporosis
• World Health Organization Definitions:–Osteoporosis= BMD –2.5–Osteopenia= BMD –2.49 through –1.0–Normal= BMD >-1.0
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Normal Hand
• AP hand• Note normal bone
density and trabecula
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Osteoporosis
• Thinned cortex from inside out
• Scanty trabecula
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Osteoarthritis
• Wide spread or local joint involvement• Loss of joint space due to cartilage
dehydration and degeneration• Subchondral eburnation (sclerosis) and
subchondral cyst formation• Osteophyte formation• Hebeden’s nodes• Location: hip, knee, spine, hand, post-
trauma
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Osteoarthritis• AP hands• Reactive
sclerosis• Sharp ridges
or points (osteophytes) extending from IP joints
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Osteoarthritis• Lateral hand• Reactive sclerosis• Sharp ridges or points
(osteophytes or Hebeden’s nodes) extending from IP joints
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Osteoarthritis• AP knee• Medial joint narrowing• Subchondral sclerosis
medial femoral condyle and medial tibial plateau
• Moderate marginal osteophyte medial tibial plateau
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Osteoarthritis
• Lateral knee• Osteophyte
both anterior and posterior distal femur
• Spurring from articular margins of the patella
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Rheumatoid Arthritis (RA)
• Systemic disturbance• Loss of joint space by pannus destroying
cartilage• Local osteoporosis• Diffuse soft tissue swelling• Marginal erosions• Location: any synovial joint, wrist, hand,
foot, etc.
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Rheumatoid Arthritis• AP hands• Early
rheumatoid changes
• Juxta-articular
• Narrowing of the joints
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Rheumatoid Arthritis• Osteoporosis
most prominent at the metacarpal-carpal joints and IP joints
• Marginal erosions several joints (arrow)
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Rheumatoid Arthritis• Magnified view• Bony erosions of
distal metacarpals• Caused by
synovial inflammation and synovial proliferation
• Initially at the margin of the articular cartilage
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Rheumatoid Arthritis• Late changes• Juxta-articular
osteoporosis• Ulnar
dislocation
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Gout
• Metabolic disorder• Bone destruction secondary to urate
deposits• Loss of joint space• Lumpy soft tissue swelling • Primary location: first metatarsal-
phalangeal joint
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Gout• AP view• Erosion medial
head of 1st metatarsal away from joint
• Soft tissue swelling in adjacent soft tissues
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Cardiovascular System
• Coronary artery disease (Ischemic heart disease)–Cardiac Catheterization–Radionuclide study–PET Scanning–MRI
• Congestive heart failure• Future Modalities
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Ischemic Heart Disease
• PA chest• Normal
findings on chest x-ray
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Coronary Arteriogram
• Normal left coronary
• Right Anterior Oblique projection
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Coronary Arteriogram
• Normal right coronary
• Right Anterior Oblique projection
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Coronary Stenosis
• Left coronary • RAO projection • Severe stenosis
proximal circumflex (yellow arrow)
• LCX= L Circumflex, LMCA = left main coronary, LAD = left anterior descending
LMCA LAD
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Coronary CTA
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CT Cardiac Scoring• Non-invasively
evaluate coronary calcification loading
• May be proportional to the amount of ‘soft’ plaque that is present in vessels
• Future developments: CT coronary angiograms
Calcification in wall of coronary artery
Left Main
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Thallium and Sestamibi Cardiac Scanning
• Radionuclide agents for scanning to identify cardiac perfusion
• Thallium functions as a Potassium analogue and demonstrates perfusion at the time of injection and shortly thereafter
• Sestamibi provides a snapshot of cardiac perfusion at the time of injection that persists
• Compare Stress and Rest images
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Stress – Rest Thallium
• Normal study• Homogeneous
uptake• Short axis,
vertical long axis, horizontal long axis
• Stress and rest
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Stress Rest Thallium Scan
• Reversible defect septum = ischemia
• Persistent defect apex = infarction
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Cardiac PET
• PET requirement for cyclotron access to radioactive N-13
• PET less widely available than SPECT
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Cardiac PET at MSU
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Cardiac MRI
• Evaluation of morphology and function is possible
• Evaluation may be possible without using contrast
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Congestive Heart Failure
• PA chest• Interstitial
pulmonary edema• Cardiomegaly• Redistribution of
pulmonary blood to upper lungs
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Congestive Heart Failure• Indistinct hilar
margins and blurring of pulmonary vessels
• Kerley B lines at costophrenic angles
• Increased central interstitial markings
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Kerley B Lines• Magnified view• Short, horizontal
lines • Close to lateral
chest wall represent thickened interlobular septa
• Thickening due to fluid
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Congestive Heart Failure• Interstitial and
alveolar pulmonary edema
• Large upper lobe vessels
• Hilar blurring• Prominent interstitial
markings• Peri-hilar fluffy
infiltrates