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2/3/20232CommunicationforBetterPatientCareCommunicatingwithPatientsCommunicatingwithColleaguesCommunicatingwithStudentsCommunicatingwiththePublicRadiology2005;234:13–142/3/20233TechniquesplainfilmofskullcerebralangiographyCTnon-enhancedCTenhancedCT腦池造影CT(CTcisternography)CTA2/3/20234TechniquesMRInon-enhancedMRIDWI,DTI,SWIenhancedMRIPWI(perfusion)MRAMRSfMRI2/3/20235NormalImagingAnatomyskullandbrain2/3/20236Normalheadplainfilm;A-Pandlateralview2/3/20237PlainFilmofSkull顱板顱縫與囟門顱板壓跡腦回壓跡腦膜中動脈壓跡板障靜脈壓跡蛛網(wǎng)膜顆粒壓跡蝶鞍內(nèi)耳道顱內(nèi)生理性鈣斑松果體鈣化大腦鐮鈣化床突間韌帶鈣化脈絡(luò)叢鈣化2/3/20238松果體鈣化Calcificationofpinealgland2/3/20239床突間韌帶鈣化2/3/202310Normalchildheadplainfilm;A-Pandlateralview2/3/202311CerebralAngiography頸內(nèi)動脈internalcarotidartery頸外動脈externalcarotidartery椎動脈vertebralartery2/3/202312internalcarotidarterymiddlecerebralAanteriorcerebralA

2/3/202313

anteriorcerebralAmiddlecerebralAinternalcarotidartery2/3/202314ComputedTomographyoftheHead(HCT)OftenthefirstimagingexamofthebrainFirstlineimagingoftraumapatientsEasytoobtainQuickstudyIntravenouscontrastadministrationUsuallynotindicatedintraumapatients,whereitcanobscurehemorrhageAllowsforfurtherlesioncharacterizationinotherclinicalsettings2/3/202315CT切面的角度Canthomeatalline眼角-外耳道連線(150)(redline)2/3/202316NormalaxialCT顱底層面（levelofthebaseoftheskull）第四腦室層面（thefourthventricularlevel）鞍上池層面（suprasellarcisternlevel）第三腦室前部層面（anteriorthethirdv.)第三腦室后部層面(posteriorthethirdv.)側(cè)腦室體部層面(midventricularlevel)側(cè)腦室頂部層面(highventricularlevel)側(cè)腦室上層面(abovetheventricularlevel)2/3/202317AxialbrainCTscan2/3/202318正常垂體冠狀位增強(qiáng)Normalcoronalpituitaryglandenhancement2/3/202319CerebralparenchymaCortex,medulla,brainstem,cerebellumCSF(cerebrospinalfluid)ventricle池(cistern)、裂(fissure)、溝(sulcus)中線結(jié)構(gòu)(interhemisphericstructure)生理性鈣化(pinealglandcalcification)ContrastEnhancement,CE2/3/202320CT

“TheWorkhorse”TraumaAcutesubarachnoidhemorrhageCVADetectionofcalcificationsSinusdiseaseTemporalbonedisease2/3/202321DensFracture2/3/202322EpiduralHematomafracture2/3/202323SubarachnoidHemorrhage2/3/202324TuberousSclerosiscalcification2/3/202325MRIoftheBrainAmorecomprehensiveexamthanCTforvirtuallyallclinicalindicationsBetterresolution&contrastNoradiationCanimageinmultipleplanes2/3/202326MRICerebralParenchymacortex,medullaCSFFatCortexofbone,calcification,meningesCerebralvesselsCranialnerve2/3/202327T1WI,T2WIMRI2/3/202328冠狀位、矢狀位T1WIMRI2/3/202329High-ResolutionMRAat3T2/3/2023302/3/202331異常MRI影像水腫呈長T1長T2；出血因血腫期齡而異，梗塞急性期呈長T1長T2；梗塞纖維修復(fù)期呈長T1

短T2或長T2；腫塊呈略長T1略長T2；脂類呈短T1長T2；骨化鈣化呈長T1短T2；黑色素瘤（順磁物多）呈短T1短T22/3/202332病理組織信號強(qiáng)度組織CT密度T1WIT2WI水腫低低高含水囊腫低低高瘤結(jié)節(jié)等、高低高亞急性出血高高高鈣化高低低脂肪低高高膽固醇低中、高高三酸甘油脂黑色素瘤低高高高低低2/3/202333glioblastoma2/3/2023342/3/2023352/3/2023362/3/202337DiffusionTensorImagingTractographyFunctionalBoldMRIPerfusionMRImagingMRSpectroscopyMRAngiographyAdvancedNeuroImagingMagneticResonanceImaging1.5to8Tesla2/3/202338PERFUSIONRapidimagingisperformedduringabolusinjectionofaparamagneticcontrastagentAstheagentpassesthecerebralvasculature,thereisadropinthemeasuredsignalduetotheT2*effectsoftheagentIdentifysalvageabletissueinCVAorperfusionchangesintumorsGadolinium-DTPA2/3/202339ConventionalMRimagesandrCBVmapin37-year-oldmanwithbiopsy-provedWorldHealthOrganizationgradeIIIastrocytoma.(a)Transversecontrast-enhancedT1WIshowsinhomogeneousmassinrightfrontallobe.Anteriorportionofthemass(arrowhead)showscontrastenhancement;posteriorhalfofthemassdoesnot.(b)BaselinetransverseEPIT2*WIefromDSCsequence(precontrast)showshomogeneoushyperintensesignalthroughoutthemass.(c)

rCBVmapshowsthatanteriorportionofthemass(correspondingtocontrast-enhancedportionina)hashighrCBV(redandyellow),andposteriorportionhaslowrCBV(blue).Radiology:Volume2392/3/202340DIFFUSIONSensitivetothemicroscopicmotionofH2OmoleculesIsdirectiondependentT2shine-throughMostsensitiveindicatorofischemiaAcuteCVAlooklikeLIGHTBULBS2/3/202341CVA2/3/202342DiffusionImagingBeyondStrokeNeoplasmsDemyelinatingdiseasesInfectionHemorrhageDiffuseaxonalinjury(DAI)2/3/202343Abscess2/3/202344Epidermoid2/3/202345MRSpectroscopy1H(proton),23Na,31PProvidesspectralandmetaboliteinformationbydeterminingthelevelsofselectneurochemicalsIdentifyareasofneuronallossand/ormetabolicabnormalityComplimentarywithMRIfordiagnosis2/3/202346LongTEProtonBrainSpectrumHealthyvolunteer

NAA 2.02ppm

Cr 3.02ppm

3.90ppm

Cho 3.20ppm

lipids* 1.3ppm

whenpresentlactate* 1.3ppm

whenpresent*notseeninnormalbrainspectraMetabolitesNormalvsTumorAngleRev