Conventional Neuroradiological Examinations

1. Conventional Neuroradiological Examinations Başar Sarıkaya, M.D. Associate Professor of Radiology Yeditepe University

2. What is neuroradiology? • Neuroradiology is a subspecialty of radiology which deals with imaging of the nervous system disorders using various imaging modalities.

3. What is neuroradiology? • Plain X-rays, [contrast enhanced X-rays (myelogram, cisternogram, etc)] • Computed Tomography (CT) • Magnetic Resonance Imaging (MRI) • DSA (Digital Subtraction Imaging)

4. What is neuroradiology? • Current practice focuses on advanced imaging methods such as perfusion MRI, MR tractography, functional MRI, MR spectroscopy etc as well as noninvasive cerebrovascular imaging such as MRA and CTA.

6. Unfortunately I am not going to talk about these fancy stuff!!!

7. What do we mean by conventional? “used and accepted by most people : usual or traditional” Meriam-Webster

8. Conventional Neuroradiological Examinations • Herein this lecture, we will mostly talk about plain X-ray films. • Already partially representing history and soon to be totally historical. OUTDATED!!!

9. Wilhelm Conrad Roentgen (27 March 1845 – 10 February 1923) Nobel Prize in Physics 1901

10. December 22, 1895

11. Plain X-ray Films • Widely available and easy to obtain • Image obtained is a superposition of tissues (3D is converted into 2D) and mainly reflects bone because of penetration issues of X-ray.

12. Plain films of the head PA and lateral views 2 view series 4 view series Towne and Waters

13. DON’T FORGET: One view is no view!!!

14. Plain Films of the Spine AP and lateral R and L oblique Special positions (Swimmer’s view for the cervicothoracic junction)

15. When do we obtain? • For routine preoperative imaging (neurosurgery, ENT...) • Trauma • Sinus disease • Headache?

17. Waters Caldwell

19. F m e O M Infc

20. AP, lateral and oblique views of the spine Cervical Thoracic Lumbar

21. How many vertebrae do we have? • Cervical: 7 • Thoracic: 12 • Lumbar: 5 • Sacral: 5 • Coccyx: 3-4

22. Plain Films for Spine Imaging • First line of imaging for back or cervical pain or in case of trauma. • To see any misalignment, lytic or destructive lesions or congenital issues. • If negative: most of the time, MRI is required. • In the trauma setting: CT is preferred over MRI.

23. Plain Films for Spine Imaging • Routine views are AP and lateral • Oblique views are required to see the neural foramina of the C spine and the pars interarticularis region of the lumbar level. • Lateral views can be obtained in flexion and extension positions

25. Anatomy T12 12th L1 12th L2 L3 L4 L5 I I S si si C

26. Anatomy D B P P T T s

27. D f P B D sap iap

30. Quiz-1 27 year-old male is brought to ER after motor vehicle accident. Patient suffers from intense head neck pain with bruises over the occipital bone. What is the preferred imaging method? • Ultrasound • X-ray of the C-spine • MRI • Computed Tomography • None of the above

31. Quiz-2 Which X-ray view best demonstrates the acute sinusitis involving the maxillary sinuses? • Waters • Caldwell • Towne • Lateral • AP

32. Quiz-3 Pedicle Inferior articular process Superior articular process Transverse process Pars interarticularis • Regarding the “Scotty dog” of the oblique lumbar view, what structure represents neck of the dog?