CentralNervousSystem南京醫(yī)科大學(xué)一附院放射科洪汛寧hongxunning@2/3/20231ContinuingEducation/

Learn:

RadiologyTextbooks|RadiologyTeachingFiles|AnatomyandEmbryologyAtlases|MEDLINEandRadiologyJournals|ContinuingEducation|ForHandheldComputers|Podcasts|ForResidents|ForMedicalStudents|ForPatients|Miscellaneous-Create:

TeachingFileCreation-Communicate:

RadiologyCommunication|AboutRadiologyE|RadiologyEducationNews-anewsletter

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(dòng)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(dòng)脈internalcarotidartery頸外動(dòng)脈externalcarotidartery椎動(dòng)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(hào)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