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BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University

BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University. Patient Preparation Patient position Technique Scanogram [frontal, lateral] Scan intervals. Patient Preparation Fasting 4- 6 hours Contrast material [ Urographin, Telebrix,…] 1-2 ml/kg Anesthesia

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BRAIN IMAGING CT & MRI Mamdouh Mahfouz MD Professor of Radiology Cairo University

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  1. BRAIN IMAGINGCT & MRIMamdouh Mahfouz MDProfessor of RadiologyCairo University

  2. Patient Preparation Patient position Technique Scanogram [frontal, lateral] Scan intervals

  3. Patient Preparation Fasting 4- 6 hours • Contrast material [ Urographin, Telebrix,…] 1-2 ml/kg • Anesthesia Children, Uncooperative patients

  4. Contrast material administration Traumatic cases, CVS Cold cases [headache, epilepsy, signs of increased ICT, …] NO YES

  5. Vallecula

  6. Ventricular anatomy

  7. Quadrigeminal Cistern

  8. Vellum interpositum Retro-thalamic Cistern Retro-thalamic Cistern Sup.cerebellar Cistern Quadrigeminal Cistern

  9. F T T O F F F F P T P P P O O O

  10. Corona Radiata

  11. Corona Radiata

  12. CT Vascular Anatomy

  13. Strong magnetic field andRadiofrequency (RF) coils BRAIN MRI • Imaging are created by the motion of hydrogen protons in response to the applied radiofrequency • Multiplanar imaging [ axial, sagittal, coronal ] • Any MR examination should include T1 and T2 Weighted images

  14. CLOSED MAGNET

  15. CLOSED MAGNET

  16. OPEN MAGNET

  17. OPEN MAGNET

  18. EXTERMITY MAGNET

  19. MR advantages • Multiplanar imaging • Tissue characterization • No bone artifacts • Shows blood vessels without contrast

  20. BRAIN MRI • T1 WIs(TR< 800 msec TE 20 msec) • T2 WIs(TR> 1000 msec TE> 80 msec) • PD WIs(TR> 1000 msec TE= 20 msec) • T1 WIs [CSF BLACK ] • T2 WIs [CSF BRIGHT ] • FLAIR WIs [ CSF BLACK ]

  21. BRAIN MRI PROTOCOL

  22. T1 T2 FLAIR

  23. Signal intensity • Low signal lesion = hypointense = dark • High signal lesion = hyperintense = bright • Intermediate signal = isointense = Gray

  24. How to interpret MR Images ?! • Identify T1 weighted images (CSF low signal) and T2 Weighted images (CSF high signal) • Assess the signal intensity of the structure or lesion in both T1 and T2 weighted images • Follow the well known common signal behavior

  25. T1[lowsignal]T2[lowsignal][Non mobile protons] • Cortical bone • Mature fibrous tissue ( ligaments and tendons) • Calcifications ( physiological, pathological) Flowing blood in the vessels ( fast moving protons) (signal void) Air in the sinuses, lungs,…( minimal hydrogen protons) Others……..

  26. T1[Highsignal]T2[Highsignal] • Subacute blood [met Hb] • Others…. T1[Highsignal]T2[Lowsignal] • Fat ( subcutaneous fat, dermoid cyst,…) • Others….

  27. T1[Lowsignal]T2[Highsignal] Any structure or lesion not listed before • Fluids ( CSF, urine, pleural effusion, ascites.,…) • Edema and infarctions • Most of tumors • Contrast injection [ Gd- DTPA] ++

  28. Gadolinium – DTPA 0.1 – 0.2 mmol/kg body weight Only T1 weighted images are obtained after Gd- DTPA injection • Differentiate SOLs • Assess activity of some lesions like MS • Assess post operative tumour recurrence

  29. Gyrus rectus Optic tract ,mamillary body, cerebral peduncle, substantia negra

  30. Amegdala , hippocampus, superior vermis

  31. Hippocampal region

  32. Mesial temporal sclerosis

  33. Choroidal fissure , Hippocampal tail , Vein of Galen

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