正常顱腦CT和MRI影像表現(xiàn)英文版-課件

CTANDMRIIMAGING

OF

NORMALBRAINNORMALANATOMYOFBRAINBrainisseparatedfromcalvariumbythreemeninges-duramater,arachnoidmembraneandpiamater.Dividedintosupratentorialandinfratentorialcompartmentscontaining:-Supratentorium:CerebralhemispheresdiencephalonInfratentorium:BrainstemstructurescerebellumEachcerebralhemisphereisfurtherdividedintoFrontal,Parietal,TemporalandOccipitallobesbyfissuresBRAINANATOMYSagittalsurfaceLatventGenuFornixPituitaryglandMidbrainPonsMedullaCingulate

gyrusQuadrigeminalcisternSpleniumColliculi4thventCerebellumThalamusSagittal

surfacePinealglandSup.colliculiInf.ColliculiAqueductofsylviusMidbrainCerebellum4thventriclePonsOculomotornInterthalamiccommissure109InferiorsurfaceInterhemisphericfissureTemporallobe

Mammillary

bodiesFrontallobeOlfactorytractOptictractPit.stalkponsMedullaoblongataCerebellumVermisBrainstemstructuresMidbrain:dividedintoCerebralpedunclesandcolliculi.Supcolliculiattachedtomed.Geniculate&InftolateralGeniculatebodySurroundedbyPeri-mesencephaliccistern.Pons:dividedintotectumand

tegmentum

ConnectsmidbraintomedullaMedulla:continuesasspinalcordContainsascendinganddescending

SpinaltractsCerebellumDividedintotwohemispheresbyfalxcerebelliConnectedinthemidlinebyawormlikestructure-VermisDividedintoI.Anteriorlobeii.MiddlelobeIii.Flocculo-nodularlobeVentriclesofbrainLateralventricle:-Cshapedcavitywithbodyintheparietallobeandextensionsinthefrontaltemporal,occipitallobesConnectedtothirdventriclebyforamenofmonro.Thirdventricle:-liesb/wtwothalami.connectedtofourthventriclebycerebralaqueduct.Fourthventricle:-liesinthecerebellumCSFFlow:-Lat.vent->foramenofmonro->3rdvent->cerebralaqueduct->4thvent->foramenofmagindieandluschka->subarachnoidspace>finallyabsorbedbythearachnoidgranulationsVentriclesofbrainBloodsupplyofthebrainBloodsupplyofthebrain

ByInternalCarotidandVertebralAInternalcarotidA:MiddlecerebralAAntcerebralAPmunicatingAAnt.ChoroidalA

VertebralAs:-twoVertebralasjointoformBasilarABranches:AntinfcerebellarASupcerebellarAPontineAs&labyrinthineAsPostcerebralAContd….DividesintocorticalandperforatingAPerforatingAssupplyBasalganglia,Thalami,internalcapsuleThalamus:-PerforatingbrofPCAInternalcap:-Med&latstriatebrofMCA,recurrentbrofACA,AntchoroidalAMidbrain:-Post.cerebralandSupcerebellarAPons:-PontinebrofBasilarACerebellum:-Sup.cerebellar

A,Ant.inf

cerebellarA,PostinfcerebellarAMedulla:-Ant&PostspinalA,PICABloodsupplyofthebrainRed:-MCABlue:-ACAGreen:PCACircleofwillisVenoussinusesofbrainStraightsinusTorculaherophiliOccipitalsinusTransversesinusSup.Sagittal

sinusInf.SagittalsinusVenoussinuses..TransversesinusStraightsinussigmoidsinusPitutiary

glandICA3rdCN4thCN6thCNSphenoidboneViViibr

Of5thCNAxialsectionCingulategyrusCaudateheadPinealglandCorpuscallosumLentiformnucleustrigoneSup.cerebellarcisternInt.capsuleThalamusCoronalsectionCTTechniquePatientiskeptinsupinepositionandheadisplacedinthegantryunderthecursors.Axialsectionsaretakenatanangleof10-13degreetothecanthomeatalline.Slicethickness:-Posteriorfossa:-5mmSupratentorialstructures:-10mmPituitaryglandandsellarregion:-1-3mm(coronalsections)CONTRASTSTUDIES:donebyinjecting100mlof60%iodinatedcontrast

contd..Normalenhancement:

Arterial&venousstructuresDuralstructures:-falx,tentoriumChoroidplexusPituitaryglandIndicationsofCECT:I.Infections:ringenhancinglesionsegtuberculoma,

neurocysticercosis,Meningitis,Encephalitis

ii.Tumours:astrocytomas,meningiomasiii.Vascularlesions:aneurysms,AVmalformationsContraindicationsofCECT:I.historyofallergy,renalfailureii.acutehaemorrage

;Axialsections-TopogramForCTAxialsectionsaretakenatanangleof10-13degreetotheCanthomeatallineForMRIsectionsareparalleltothereferencelineCTBraincontd…NormalHUvaluesinNCCTbrainGraymatter:-+36-42HUWhitematter:-+26-34HUCSF:-+4-11HUBone:-+200to+1000HUCalcification:-+100to+220HUBlood:-+56-80MRIImagingMultiplanarmodlitysosectionscanbetakeninaxial,coronalandsagittalplanesSlicethicknessissameasCTimaging.RoutinelyappliedsequencesareT1WeighetedspinechoT2WeighetedspinechoProtondensityimagesAnatomyofbrainisbetterexplainedonT1WseqwhilepathologiesarebetterstudiedonT2WandProtondensitysequences.TISSUECHARACTERISTICSSeqParametersCSFGrayMWhiteMFatT1WshortTRHypoisohyperhypershortTET2WshortTRhyperisohypoiso/longTEhypoProtonlongTRiso

Iso

iso/hypohyperdensityshortTEbloodvesselsappearsignalvoidinallthesequencescalcificationandfibroustissueappearhypointenseinallsequences

MRIAxialsectionaboveforamenmagnumMaxillarysinusBasilarA.MedullaCerebellar

hemisphereCisternamagnaTonsilsPetrousboneSphenoidsinusNasalcavityZygomaticarchCTAxialsectionaboveforamenmagnumFrontalsinusSphenoidsinusTemporallobeBasilarA.MastoidcellsCerebellar

hemisphereCisternamagnaMedullaOpticnervePituitarySphenoidboneTemporalboneCerebellartonsilsMRIAxialSectionat4thVentricleLensOpticnervePituitaryTemporallobeMiddlecerebellar

peduncle4thVentricleMedialrectusLateralrectusPonsPetrous

temporalboneCerebellar

hemisphereCTAxialsectionat4thventricleFrontalsinusFrontalboneMid.cerebralABasilarA.Pons4thventcerebellumMidcerebellarpedunclePetrousboneTemporalhornAnt.cerebralaSella

turcicaVermisMRIAxialSectionabove4thventricleSuperiorobliquemusclePituitarystalkUpperponsSuperiorcerebellar

peduncleOpticchiasmaAmbientcisternCerebellarfoliaCECTAxialsectionabove4thventricle

Frontallobe

AntcerebralA.4THventCerebellumPons

TemporalhornInfundibulum

Post.cerebralA.SphenoidboneFrontalboneFrontalsinusMid.cerebralAMRIAxialsectionatmidbrainFrontallobeInterpeduncularcisterninferiVermisInferiorcolliculiConfluenceofsinusesAmbientcistern

UncusOptictractMidcerebralACerebralpeduncleAntcerebralAMRIAxialsectionat3rdventricleGenuofcorpuscallosum

CaudateheadLentiform

nuleusThalamusSpleniumofcorpuscallosumFrontalhornsInt.capsuleInsula3rdventricleOccipitalhornsOpticradiationCTAxialsectionat3rdventricleGenuofcorpuscallosumCaudatenucleusInt.capsule3rdventriclePinealglandvermisOccipitallobeChoroidplexusThalamusLentiformnucleusFrontalhornPericallosalAMRIAxialsectionatmidventricleCingulate

gyrusBodyoflateralventricleCorpuscallosumCentralsulcusCorpuscallosumInterhemisphericfissureCTAxialsectionatmidventriclesCingulate

gyrusBodyoflateralventricleCorpuscallosumFalx

cerebriOccipitalhornsParietallobeCoronaradiataFrontalhornsConfluenceofSinuses(torcula)MRIAxialsectionatcentrumsemiovaleInterhemisphericfissureCentrumsemiovaleOccipitallobeParietallobeFrontallobeCTAxialsectionatcentrumsemiovaleFalx

cerebriCentrum

semiovaleOccipitallobeParietallobeFrontallobeMRICoronalsectionat3rdventricleFrontalhornsFornix3rdventricleClivusInterpeduncularcisternInsulaSylvianfissureTemporallobeParotidglandOdontoid(dens)MRICoronalsectionatsuprasellarlevelInterhemisphericfissureLatventricleLat.PterygoidMsNasopharynxMed.Pterygoid

Ms.SylvianfissureSphenoidsinusPituitaryglandOpticchiasmAntcerebralaMidcerebralAMRICoronalsectionatpost.ventricleParietallobeSpleniumofcorpuscallosumSup.cerebellar

cisternTentoriumChoroidplexusAtriaoflateralventricle4thventricleMRISagittalsectionLatventGenu3rdventSphenoidsinusNasopharynxBodyofCCSpleniumQuadrigeminalcisternPons4thventMedullaCerebellumTonsilCingulate

gyrusPrepontinecisternCTCoronalsectionforPituitaryglandPatientiskeptinpronepositioninsubmentoverticalposition,intheheadrestofCTtableTopogramistakeninthispositionandplanningisdonesothatcutsectionsparalleltothelinepassingfromfrontalbonetomentisistakenForpituitary1-3mmthicksectionsaretakeninthecoronalplanestartingfromanteriortoposterior.CTCoronalsectionforPituitaryglandLateralventAnt.cerebralAPituitaryglandOpticchiasmSphenoidsinusLat.pterygoid

plateNasopharynxLat.PterygoidmsMid.cranialfossaCTCoronalsectionforPituitaryglandLatpterygoid

plateSphenoidsinusMid.cerebralaAnt.cerebralaFrontalsinusInternalcarotidaNasopharynxPituitaryglandCTAxialsection(bonewindow)PetrousboneMastoidaircellsCarotidcanalForamenovaleSphenoidsinusBasesphenoidEustachiantubeExt.acousticcanalLambdoid

sutureOccipitalboneCTAxialsections(bonewindow)EarossiclesMastoidaircellscochlea