Neuroimaging Techniques Quiz

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Questions and Answers

What was a significant advancement in CT technology compared to the first scanners?

  • Scanners have eliminated the need for patient movement.
  • Scanners no longer require any reconstruction of data.
  • Scanners can acquire data in seconds instead of hours. (correct)
  • Scanners can now operate without x-ray beams.

What differentiates T1 weighted images from T2 weighted images in MRI?

  • T1 images are more sensitive to acute hemorrhage than T2 images.
  • T1 images provide better contrast for anatomical details, while T2 images are better for pathology. (correct)
  • T1 images highlight water content, while T2 images highlight fat content.
  • T1 images are used exclusively for brain imaging, while T2 images are for other body parts.

How does the density of tissue affect x-ray absorption in CT imaging?

  • Tissue density has no impact on x-ray absorption.
  • Denser tissues absorb x-rays more than less dense tissues. (correct)
  • All tissues absorb x-rays at the same rate regardless of density.
  • Less dense tissues absorb x-rays more than denser tissues.

What is a feature of helical CT compared to traditional CT?

<p>It combines continuous gantry rotation with table motion. (C)</p> Signup and view all the answers

What is a primary advantage of FLAIR imaging in detecting multiple sclerosis lesions?

<p>FLAIR imaging suppresses the signal from cerebrospinal fluid, enhancing lesion detection. (B)</p> Signup and view all the answers

What is reconstructed mathematically in a CT scan to represent tissue density?

<p>The differential absorption rates of x-rays. (A)</p> Signup and view all the answers

Which type of intracranial hemorrhage is typically characterized by blood accumulation between the skull and the outer layer of the dura mater?

<p>Epidural hemorrhage (A)</p> Signup and view all the answers

What role does diffusion tensor imaging (DTI) play in neuroimaging?

<p>DTI measures the integrity of white matter tracts. (C)</p> Signup and view all the answers

What determines the amount of x-ray absorption in CT imaging?

<p>The density of the tissue traversed by the beam. (C)</p> Signup and view all the answers

Which of the following imaging techniques is specifically referred to as a method of interventional neuroradiology?

<p>Catheter Angiography (D)</p> Signup and view all the answers

What is the primary component that MRI uses to generate images?

<p>Hydrogen nuclei (A)</p> Signup and view all the answers

What does the magnetic field strength in MRI machines use as a measurement unit?

<p>Tesla (B)</p> Signup and view all the answers

What occurs immediately after the radiofrequency wave is turned off in MRI?

<p>Tissue emits a signal that is detected. (C)</p> Signup and view all the answers

Who completed the first whole body MRI construction in 1977?

<p>Dr. Damadian with two post doc students (A)</p> Signup and view all the answers

What is a sequence in the context of MRI imaging?

<p>A set of parameters for a specific type of image (C)</p> Signup and view all the answers

Which of the following planes can an MRI sequence be obtained?

<p>Sagittal, axial, or coronal planes (D)</p> Signup and view all the answers

When was the first commercial MRI scanner installed?

<p>1983 (A)</p> Signup and view all the answers

What does the term 'homogenous magnetic field' refer to in MRI technology?

<p>A consistent and uniform magnetic field (A)</p> Signup and view all the answers

Which MRI sequence specifically shows hyperintensity in water (CSF) for pathology evaluation?

<p>T2W images (C)</p> Signup and view all the answers

What is a characteristic of T1W images regarding signal intensity?

<p>Water (CSF) is hypointense (B)</p> Signup and view all the answers

What does the FLAIR sequence allow for in evaluation related to multiple sclerosis?

<p>Enhanced visibility of white matter adjacent to ventricles (A)</p> Signup and view all the answers

In Diffusion Weighted Imaging (DWI), what is indicated by hyperintensity?

<p>Acute ischemic infarcts (B)</p> Signup and view all the answers

What distinguishes T2W images from T1W images in terms of gray matter intensity?

<p>Gray matter is isointense in both T1W and T2W images (D)</p> Signup and view all the answers

Which term describes the appearance of vessels and areas of blood-brain barrier breakdown when using Gadolinium-based contrast in MRI?

<p>Hyperintensity (A)</p> Signup and view all the answers

What is a key distinction in T1W images compared to T2W images regarding edema?

<p>Edema is hypointense in T1W (A)</p> Signup and view all the answers

What sequence is primarily used for detecting ischemic infarcts in MRI?

<p>Diffusion Weighted Image (D)</p> Signup and view all the answers

What is the Hounsfield Unit value for water?

<p>0 (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of CT scans?

<p>Sensitivity to small lesions (B)</p> Signup and view all the answers

Which term describes an imaging result that demonstrates an intermediate density similar to that of brain tissue?

<p>Isodense (A)</p> Signup and view all the answers

What is the typical appearance of an epidural hematoma on a CT scan?

<p>Biconvex shape (B)</p> Signup and view all the answers

Which condition would NOT typically require the use of intravenous contrast during imaging?

<p>Acute intracranial hemorrhage (D)</p> Signup and view all the answers

What is the characteristic density of acute subdural hematoma on a CT scan within the first week?

<p>High density (B)</p> Signup and view all the answers

Which type of imaging is considered more effective for detecting small lesions compared to CT?

<p>MRI (D)</p> Signup and view all the answers

What imaging technique is typically used for assessing bone lesions?

<p>CT (D)</p> Signup and view all the answers

Which type of hematoma is characterized by being lens-shaped and does not cross sutures?

<p>Epidural hematoma (A)</p> Signup and view all the answers

What is the typical characteristic of late subacute blood products on a CT scan?

<p>Isodense (C)</p> Signup and view all the answers

What is the common cause of acute cerebellar infarction?

<p>Thromboembolic events (B)</p> Signup and view all the answers

What type of imaging is most effective for detecting intrinsic brain tumors?

<p>MRI (B)</p> Signup and view all the answers

What is a significant disadvantage of MRI compared to other imaging modalities?

<p>It can cause claustrophobia in some patients. (B)</p> Signup and view all the answers

For which of the following conditions is MRI considered the most effective imaging technique?

<p>Intracranial tumor (C)</p> Signup and view all the answers

Which of the following tumors is classified as a benign extra-axial mass arising from the meninges?

<p>Meningioma (A)</p> Signup and view all the answers

What imaging technique is primarily used to assess white matter tracts based on water diffusion characteristics?

<p>Diffusion Tensor Imaging (C)</p> Signup and view all the answers

Which condition is characterized by a loss of myelin and associated with an autoimmune process?

<p>Multiple sclerosis (A)</p> Signup and view all the answers

What imaging technique is specifically useful for imaging intracranial blood vessels?

<p>MR Angiography (D)</p> Signup and view all the answers

In a Basilar Tip Aneurysm, which symptom is most commonly reported upon rupture?

<p>The 'worst headache of life' (A)</p> Signup and view all the answers

What is the primary imaging modality used to assess Chiari I malformation?

<p>MRI (C)</p> Signup and view all the answers

Which advanced MRI technique is utilized to evaluate brain metabolic activity?

<p>Functional MRI (A)</p> Signup and view all the answers

Which condition is specifically noted for having a characteristic abnormal signal in the medial temporal and inferior frontal lobes on MRI?

<p>Herpes encephalitis (B)</p> Signup and view all the answers

What is a primary use of Magnetic Resonance Spectroscopy (MRS)?

<p>Measuring brain neurotransmitters (D)</p> Signup and view all the answers

Which MRI finding is associated with cytotoxic edema conforming to vascular territories?

<p>Acute infarct (C)</p> Signup and view all the answers

Which feature of an Arteriovenous Malformation (AVM) is notable during imaging?

<p>Arteriovenous shunting without intervening capillary bed (B)</p> Signup and view all the answers

What advantage does MRI have over CT imaging in evaluating posterior fossa structures?

<p>Minimized artifact presence (B)</p> Signup and view all the answers

Flashcards

Computed Tomography (CT)

A medical imaging technique that uses X-rays to create cross-sectional images of the body.

CT Density

A type of CT image where different tissues have different shades of gray based on their density. Fluid appears dark, bone appears bright.

Magnetic Resonance Imaging (MRI)

A Nobel Prize-winning technique that uses magnetic fields and radio waves to create detailed images of the brain and other tissues.

FLAIR (Fluid-Attenuated Inversion Recovery)

A type of MRI image that highlights fluid in the brain, making it easier to see abnormalities like MS lesions.

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Diffusion Weighted Imaging (DWI)

A type of MRI image that measures the movement of water molecules in the brain, helping to detect brain injury or stroke.

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Collimated X-ray Beam

A highly focused beam of X-rays used in CT scans.

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Differential Absorption

X-rays are absorbed differently by different tissues in the body. This difference in absorption is used to create a CT image.

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Data Reconstruction

The process of converting the raw data collected during a CT scan into a 3D image.

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Helical CT

A type of CT scan that combines continuous gantry rotation with table motion, allowing for faster and more efficient imaging.

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T1-weighted MRI

A type of MRI sequence where water (CSF) appears dark, while fat (white matter) appears bright. This sequence is used to visualize anatomy.

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T2-weighted MRI

A type of MRI sequence where water (CSF) appears bright, while fat (white matter) appears dark. This sequence is particularly sensitive to abnormalities like edema and inflammation.

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Gadolinium

A contrast material used in MRI to enhance the visibility of blood vessels and areas where the blood-brain barrier is broken.

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Signal Intensity

A measure of the brightness of a tissue on an MRI image. It indicates how much signal is being emitted by that tissue.

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Hypointensity

Low signal intensity on MRI images.

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Hyperintensity

High signal intensity on MRI images.

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What is hydrogen's composition?

The simplest and most abundant element in the human body, consisting of one proton and one electron.

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How is magnetic field strength measured?

The strength of a magnetic field is measured in Tesla (T), where 1 Tesla equals 10,000 Gauss. The Earth's magnetic field is approximately 0.5 Gauss.

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What are the primary components of an MRI machine?

MRI uses a strong magnetic field, radiofrequency pulses, and a computer to create detailed images of the body.

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How does MRI work at a basic level?

In MRI, protons in the body are aligned by the strong magnetic field, then excited by radiofrequency pulses. When the pulses are turned off, these protons release energy, creating a detectable signal.

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What is an MRI sequence?

One MRI study, such as a brain scan or cervical spine scan, is composed of multiple sequences. Each sequence uses specific parameters to create different types of images.

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What are the main MRI sequences?

The main types of MRI sequences include T1, T2, FLAIR, and Diffusion Weighted Imaging (DWI). Each sequence highlights specific aspects of the tissue.

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What are the different MRI acquisition planes?

A sequence is acquired in one of three planes: sagittal (side view), axial (horizontal slice), or coronal (front view).

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What are the signals detected by MRI?

MRI works by detecting and processing signals from protons, which are the positively charged particles in the nucleus of hydrogen atoms.

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Hounsfield Units (HU)

A numeric scale used in CT scans to represent the density of different tissues. Air has a value of -1000, while bone has a value of +1000. Other tissues fall between these extremes.

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Hyperdense

Describes a tissue that appears brighter than normal on a CT scan, indicating increased density compared to surrounding tissues.

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Hypodense

Describes a tissue that appears darker than normal on a CT scan, indicating decreased density compared to surrounding tissues.

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Isodense

Describes a tissue that appears similar in density to surrounding tissues.

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Mixed Density

Describes a tissue that appears with varying densities on a CT scan, indicating multiple different tissue types.

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CT Advantages

Rapid, cost-effective imaging modality that is particularly sensitive to detecting bleeding (hemorrhage), bony structures, and calcium deposits. Offers excellent detail of bone and calcium.

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CT Disadvantages

Exposure to radiation, limited sensitivity to small structures and soft tissue, metal artifacts can obscure the image. Less sensitive to soft tissues like the spinal cord or pituitary than MRI.

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Intracranial Hemorrhage

Bleeding within the brain tissue, typically appearing hyperdense on a non-contrast CT scan.

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Contrast Enhanced CT

A type of CT scan that involves injecting iodine-based contrast material into the bloodstream. It enhances the visibility of blood vessels and tissues.

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Epidural Hematoma

A collection of blood that forms between the skull and the dura mater, appearing as a lens or bicovex shape on CT.

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Subdural Hematoma

A collection of blood that forms between the dura mater and the arachnoid mater, appearing as a crescent shape on CT.

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Subarachnoid Hemorrhage

Bleeding into the space surrounding the brain, appearing as wispy densities in the sulci and cisterns on CT.

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Cerebral Infarct (Stroke)

Damage to brain tissue due to lack of blood flow, typically appearing as low density on CT scan. It may take several hours for the low density to develop.

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CT Perfusion

A type of CT scan that measures blood flow in the brain, providing information about brain perfusion (the amount of blood reaching the brain).

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What is MRI?

MRI produces detailed images of the brain and other tissues using strong magnetic fields and radio waves.

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MRI Advantages & Disadvantages

MRI offers excellent anatomical detail, sensitivity to subtle changes, and is radiation-free. However, it can be time-consuming, claustrophobic, and has limitations with pacemakers or metal implants.

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Key Areas for MRI Use

MRI excels in visualizing intracranial tumors, stroke, infections, demyelinating disorders, epilepsy, dementia, hearing loss, pituitary gland, and cranial nerve abnormalities.

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What is Magnetic Resonance Angiography (MRA)?

Magnetic Resonance Angiography (MRA) uses MRI to visualize blood vessels in the brain and spine, offering a non-invasive way to assess blood flow.

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How does Lymphoma appear on MRI?

Lymphoma, a type of cancer, can affect the brain either as primary or metastatic disease. On MRI, it often appears as a solid or ring-shaped lesion with surrounding inflammation.

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What is the MRI appearance of Herpes Encephalitis?

Herpes Encephalitis, caused by HSV-1, shows up on MRI with abnormal signals and enhancement in the medial temporal and inferior frontal lobes, often affecting the limbic system bilaterally, but asymmetrically.

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Describe the MRI appearance of a Meningioma.

Meningiomas are benign brain tumors typically situated on the surface of the brain. They appear as extra-axial masses on MRI, often with calcification present.

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How does an Acute Infarct look on MRI?

Acute brain infarcts (strokes) show up on MRI with diffusion-weighted imaging (DWI) as a region of restricted diffusion, indicating cell death.

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What does MRI show in Multiple Sclerosis (MS)?

Multiple Sclerosis (MS) is an autoimmune disorder where the protective covering of nerve fibers (myelin) is damaged. MRI reveals lesions in the white matter, often appearing as bright spots in the periventricular region.

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What is a Chiari I Malformation on MRI?

A Chiari I malformation involves the downward displacement of the cerebellum into the spinal canal. On MRI, this is seen as a descent of the cerebellar tonsils more than 5mm below the foramen magnum.

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How does a Parieto-Occipital AVM appear on MRI?

Parieto-Occipital Arteriovenous Malformation (AVM) is a tangle of abnormal blood vessels in the brain. On MRI and MRA, it appears as a cluster of abnormal vessels with rapid blood flow.

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How does a Basilar Tip Aneurysm present on MRA?

Basilar Tip Aneurysm, an outpouching of the basilar artery, looks like a round or lobulated bulge on MRA images.

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What is Magnetic Resonance Spectroscopy (MRS) used for?

Magnetic Resonance Spectroscopy (MRS) analyzes brain chemicals, allowing for non-invasive evaluation of brain tumors, radiation necrosis, infections, and metabolic disorders.

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What is Diffusion Tensor Imaging (DTI) used for?

Diffusion Tensor Imaging (DTI) tracks the movement of water molecules in the brain, enabling visualization of white matter tracts. This helps assess neurological conditions like MS, seizures, and brain injury.

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What is Functional MRI (fMRI) used for?

Functional MRI (fMRI) measures brain activity by detecting changes in blood flow, indicating areas of increased neural activity. This is used to understand brain function and map areas involved in specific tasks.

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Study Notes

Introduction to Neuroimaging

  • Neuroimaging is a presentation by Sandip Basak, M.D.
  • He is a Clinical Professor and Attending Neuroradiologist.
  • His email address is [email protected].

Objectives

  • Describe computed tomography (CT) physics.
  • Distinguish CT densities of fluid, brain, calcification and fat.
  • Describe the use and indications for basic CT and MRI, emphasizing suspected acute hemorrhage.
  • Describe the appearance of blood in CT.
  • Identify different types of intracranial hemorrhage (subdural, epidural, subarachnoid).
  • Explain magnetic resonance imaging (MRI) physics.
  • Identify T1, T2, and FLAIR images.
  • Detail the benefits of FLAIR imaging for multiple sclerosis (MS) lesion detection.
  • Describe the role of diffusion-weighted images.
  • Discuss the advantages and disadvantages of CT and MRI.
  • Describe advanced MRI techniques (spectroscopy, diffusion tensor imaging (DTI), function MRI (fMRI)).
  • Define catheter angiography and interventional neuroradiology.

Techniques in Neuroimaging

  • Plain Films
  • Ultrasound
  • Nuclear Medicine
  • CT
  • MRI
  • MR Angiography
  • Catheter Angiography
  • Interventional Neuroradiology

Radiologic Convention for Right and Left

  • CT image views are consistent with a patient lying at the foot of the bed.
  • Right and left are reversed in the axial plane of the image.

Computed Tomography

  • Developed by Godfrey Hounsfield and Allan Cormack between 1972 and 1973
  • Later awarded the Nobel Peace Prize.
  • First scanners took hours to acquire data for a single slice and days to reconstruct data, but now the entire brain can be imaged in seconds.
  • CT uses a highly collimated x-ray beam that rotates around the patient.
  • Detects differential absorption rates of the x-ray beam; different tissues absorb x-rays at varying rates.
  • Mathematically reconstructs density values based on locations the x-ray beams pass through in the body.
  • Patient lies on table that moves.
  • Thin x-ray beam passes through the patient with detectors located on opposite sides.
  • Image density depends on tissue density.
  • Many rows of detectors (e.g., 256) can be used.
  • Helical CT combines continuous gantry rotation with table motion to generate images more efficiently.

CT

  • Different tissues attenuate the x-ray beam differently.
  • Density is expressed in Hounsfield Units (HU).
  • The scale for HU ranges from -1000 to +1000.
  • Different tissues, such as air, fat, water, brain, acute blood, and calcification, have different HU values.
  • Terminology related to density includes hyperdense, hypodense, and isodense.

CT Advantages and Disadvantages

  • Advantages: Fast, less costly than MRI, very sensitive to hemorrhage, and produces high-quality images of calcium and bone.
  • Disadvantages: High radiation dose, not as sensitive to small lesions or certain anatomic structures compared to MRI, and metal artifacts can be significant.

CT Most Effective Uses

  • Intracranial hemorrhage
  • Acute trauma (head, neck, body, and spine)
  • Stroke imaging
  • Fractures
  • Sinusitis
  • Bone lesions
  • Dental imaging
  • Myelography
  • CT angiography
  • CT perfusion
  • Temporal bone

Sagittal Plane

  • Divides the body into right and left halves.
  • Other relevant planes for body imaging include coronal and horizontal planes.

MRI

  • Developed by Raymond Damadian in 1970.
  • Discovers abnormal cells are different.
  • First whole body MRI scan completed in 1977.
  • First commercial MR scanner installed in 1983.

MRI Imaging of Hydrogen Nuclei

  • Hydrogen is the simplest and most abundant element in the human body.
  • All current MRI techniques are based on receiving and processing signals from protons.
  • MRI utilizes a magnetic field, radiofrequency pulses, and a computer to create images.

MRI T1 and T2 Weighting

  • T1 and T2 weighting depends on differences in hydrogen ions (protons) in fat and water.
  • MRI uses signal intensity instead of density.
  • Signal intensity is dependent on water and fat.

MRI T1W and T2W Images

  • T1W images show anatomy and are used to determine anatomy.
  • Water (CSF) shows up hypointense.
  • Edema shows up as hypointense.
  • White matter (fat) shows up hyperintense.
  • Gray matter shows up isointense.
  • T2W images show pathology.
  • Water (CSF) shows up hyperintense.
  • Edema shows up as hyperintense.
  • White matter shows up hypointense.
  • Gray matter shows up isointense.

FLAIR (Fluid Attenuation Inversion Recovery)

  • Similar to T2 weighting.
  • CSF shows up hypointense.
  • Allows for evaluation of white matter adjacent to ventricles, such as in multiple sclerosis.

Diffusion Weighted Imaging (DWI)

  • Primary sequence for detecting ischemic infarcts (not hemorrhage infarcts).
  • Shows hyperintensity with acute or subacute infarcts (up to 14 days).
  • Abnormal signal is hyperintense.

MRI Intravenous Contrast

  • Uses Gadolinium (a rare earth element) based agents.
  • Produces hyperintensity in vessels/areas of blood/brain barrier breakdown.

MRI Advantages and Disadvantages

  • Advantages: Excellent delineation of anatomy, excellent for detecting small lesions, very sensitive to pathology (edema, certain forms of blood, small lesions), excellent for evaluating posterior fossa structures, no radiation, and in utero imaging.
  • Disadvantages: Can be a long exam (routine noncontrast brain scan = 15 minutes), claustrophobia can be an issue, pacemaker contraindication and metallic foreign bodies relative contraindication, and expensive.

MRI Most Effective Uses

  • Intracranial tumor, TIA/stroke, infection, demyelination, Epilepsy, Dementia, Hearing loss, Pituitary gland, Cranial nerve abnormalities, Pediatrics, metabolic disease, developmental delay, congenital anomalies, fetal brain and spine, trauma of brain or spine, spine degenerative change, cord abnormality, spine lesions, spine tumors, evaluation of arteries or veins in brain or spine, head and neck tumors, and infections.

Specific Findings, Conditions, and Treatments in Neuroimaging

  • The slides reference many entities in neuroimaging, including, but not limited to, Chiari I Malformation, AVM, Parieto-Occipital AVM, Basilar Tip Aneurysm, Intracranial Lymphoma, Herpes Encephalitis, Meningioma, Acute Infarct, and Multiple Sclerosis.
  • Specific treatments are also mentioned, such as embolization, coiling, and angioplasty.
  • The details for each are in the notes.

Advanced Techniques in MRI

  • Magnetic Resonance Spectroscopy (MRS): Measures brain neurotransmitters and biochemicals.
  • Diffusion Tensor Imaging (DTI): Evaluates white matter tracts based on water diffusion.
  • Functional MRI (fMRI): Measures brain metabolic activity (an indirect measure of neural discharge).

Catheter Angiography

  • Invasive procedure uses catheter insertion via femoral artery; fluoroscopy locates the catheter in the Aorta, then contrast material is injected to visualize blood vessels.
  • It is considered the gold standard for imaging blood vessels.

Interventional Neuroradiology

  • Minimally invasive treatments for brain, head, neck and spine conditions. Includes micro-catheter, micro-guidewire, balloon catheters, embolic materials, detachable coils, detachable balloons and stents (to mention a few of the techniques and instruments).

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