IN THE NAME OF ALLAH THE MOST MERCIFUL,THE MOST KIND

• “Blessed is He in Whose hand is the Sovereignty, and He is Able to do all things

• Who hath created life and death that He may try you, which of you is best in conduct; and He is the Mighty, Forgiving,”

………………(67:1-2)

IMAGING of Head / Brain

Dr. Rashed Nazir

IMAGING of Head / Brain

• What to image• How to image / imaging modalities

RADIOGRAPHY

INDICATIONS

• The presence of a palpable vault abnormality which feels bony.

• As part of an imaging protocol for specific clinical problems after discussion with radiologists e.g. skeletal survey for myeloma.

• Facial views are of use following trauma to facial skeleton or mandible.

• Facial views may be of use following trauma to the orbit, or possibility of metallic foreign body

Linear fracture

Depress fracture

Fracture

Multiple myeloma

CT SCAN

MRI

Normal

Normal

INDICATIONS

• Trauma: haemorrhages, brain contusions and skull fractures.

• Stroke

• Brain tumors.

• Hydrocephalus

• Infections (encephalitis, abscesses)

• White matter diseases (Demyelinating / dysmyelinating e.g. MS, leukodystrophy)

• Diseases of the temporal bone.

• Determine whether inflammation or other changes are present in the paranasal sinuses.

• Plan radiation therapy for cancer of the brain or other tissues.

• Guide biopsies.

• Assess aneurysms or AVM

Fracture frontal bone

Extradural Haematoma

Occurs when vessel (middle meningeal artery) in the extradural space is torn by trauma.

Extra dural hematoma

Subdural HaematomaAlso due to traumatic bleed into potential space between the dura and arachnoid mater, when a bridging vein is torn.Can extend into the interhemispheric fissure and the root of the sylvian fissure but not into other sulci.

Sub dural hematoa

Subarachnoid HaemorrhageOccurs into the subarachnoid space from spontaneous or traumatic rupture of, usually an artery, in this space.Blood can then be seen in the cisterns and extending into the sulci and fissures on the brain surface close to the site of bleeding.

Subarachnoid hemorrhage

Brain abscess

Abscess

ADEM

MS

Leukodystrophy

Tumour

Metastasis

Meningioma

Hydrocephalus

Stroke

http://www.radiologyassistant.nl/images/4ac4f1dfa9f5e_Territory.jpg

PICA

ACA

MCA

PCA

ROLE OF MRI

Basal ganglia hematoma

Late Subacute bleed on MRI

ANGIOGRAPHY

MRA

CTA Head

CTA

Dense MCA sign

DST

Venography

Superior sagittal sinus thrombus

MR Venography

SPECT

PET

CEREBRAL PERFUSION SPECT

• Diagnosis and conformation of Alzheimer's disease and other forms of dementia.

• Localization of electrical and nonelectrical seizure foci.

• Evaluation of location, size, and prognosis of cerebral ischemia and stroke patients.

• Evaluation of AIDS dementia.

• Changing brain perfusion during various types of interventions.

• Evaluation of brain injury.

• Evaluation of patients with psychiatric and mood disorders.

• Detection and localization of recurrent brain tumor (Tc-99m and Tl-201agents).

• Localization of Speech center

• Diagnosis of brain death.

CISTERNOGRAPHY

• Diagnosis of normal pressure hydrocephalus.

• Identification of cerebrospinal fluid (CSF) leaks.