kuliah unpad dr. farhan
DESCRIPTION
neuroimaging: CT Scan, MRITRANSCRIPT
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NEURORADIOLOGYdr. Farhan Anwary, Sp.Rad
Bagian/SMF RadiologiFK Unpad / RS dr. Hasan SadikinBandung
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NEURORADIOLOGY (NEUROIMAGING)
Plain FilmCT Scan(Computed tomography)MRI(Magnetic Resonance Imaging)Angiography / DSA (Digital Subtraction Angiography)Sonography / USG / Color DopplerNuclear Medicine
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PLAIN FILM/CONVENTIONAL RADIOLOGY
SKULL : - Lateral view- Sella- Straight posteroanterior view- Caldwell view- Towne view- Basal (submentovertex) view- Waters view
Normal, Radiographic, Anatomy
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LATERAL VIEW
Sutures Calvarium Sella Dorsum sellae Sinus sphenoidalis
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STRAIGHT POSTEROANTERIOR VIEW
Coronal - lamdoid suture Orbital roof, petrus ridge, internal auditory canal, cribriform plate - crista galli, maxillary sinus, nasal cavity, upper lateral rim orbita
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CALDWELL VIEW
Lesser - greater wings Foramen rotundum ( V2 ) Orbital rim Zygoma - zygomaticofrontal suture Floor of anterior cranial fossa Frontal sinus
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TOWNE VIEW
Occipital, parietal, frontal Sagital suture Posterior clinoid processes - dorsum sellae Internal auditory canal
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WATERS VIEW
Maxillary - frontal sinuses Orbital margin - zygomaticofrontal sutureZygomatic process Body, ramus, condyle, coronoid process
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BASAL (SUBMENTOVERTEX) VIEW
Odontoid Middle fossa Foramen ovale ( V 3 ) Foramen spinosum ( mma ) Sphenoid sinus
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I . SINGLE LUSCENT DEFECT IN THE SKULL
DDX : Normal variant Pacchionian granulation Parietal foramina
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DDX : Abnormal solitary luscent skull defect ( Help Me ) Hemangioma Epidermoid, dermoid Leptomeningeal cyst Paget's : osteoporosis circumscripta Post surgical Metastatic (solitary) Eosinophilic granuloma Encephalocele
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II. MULTIPLE LUCENT DEFECTS IN THE SKULL
DDX : - Metastases - Myeloma - Hystiocytocis - Hyperparathyroidism - Cushing's - Osteomyelitis - Radiation
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III. INCREASED SKULL DENSITY
A. Diffuse increased skull density
DDX : - Osteopetrosis - Hematologic; anemias, myelofibrosis- Fibrous dysplasia- Paget's disease- Acromegaly - Metastasis - Dilantin - Hypervitaminosis D
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B. Focal increased skull density
DDX : - Osteoma- Hyperostosis frontalis- Meningioma- Fibrous dysplasia- Paget's disease- Metastasis- Calcified cephalhematoma
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IV. INTRACRANIAL CALCIFICATION
A. Physiologic can occur in
1. Pineal2. Habenula3. Basal ganglia4. Choroid5. Dura
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B. Phatologic calcifications
1. Tumorsa. O1igodendriglioma (90%)b. Craniopharyngioma (70%)c. Ependymoma (60%)d. Choroid plexus papilloma (25%)e. Low-grade astrocytoma (20%)f. Meningioma (10%)g. Other (Dermoid, pineal tumor, lipoma)
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B. Phatologic calcifications
2. Infection : CMV, toxoplasmosis, cysticercosis3. Vascular :a. Atherosclerotic disease b. Aneurysm c. Arteriovenous malformation4. Pathologic basal ganglia calcification
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B. Phatologic calcifications
5. Neurocutaneous syndromesa. Neurofibromatosisb. Sturge-Weber syndromec. Tuberous sclerosis
6. Post trauma
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C. Basal Ganglia Calcifications
DDX :Endocrine : hypothyroidism, pseudohypoparathyroidismInfectious : CMV, toxoplasmosis, cysticercosisToxic/Anoxic : CO, lead, radiationCongenital : Tuberosclerosis, Fahr's disease
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V. Large Sella
DDX :Tumor : Adenoma, craniopharyngioma, optic nerve gliomaAneurysmIncrease intracranial pressureEmpty sella
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CEREBROVASCULAR DISEASE
I. Cerebral Infarction a. Etiology1. Atherosclerosis (large vessels)2. Atherosclerosis (small vessels)3. Hypoxia / anoxia4. Dissection
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CEREBROVASCULAR DISEASEI. Cerebral Infarction a. Etiology
5. Fibromuscular dysplasia6. Vasculitis7. Basal arteriovascular occlusiv disease8. Venous thrombosis9. Miscellaneous; vasospasm, trauma
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b. Imaging in ischemia / infarction :
- Vascular distribution- Evidence of cytotoxic edema- Involvement of cortex- Hemorrhagic transformation
c. IMAGING : CT, MR, MRA, Angiography
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II. Spontaneous Intracranial Hematoma;Intraparenchymal hematoma
DDX : Causes of intraparenchymal hematoma 1. Aneurysm rupture 2. Arteriovenous malformation rupture 3. Hypertension 4. Tumor
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DDX : Causes of intraparenchymal hematoma 5. Blood dyscrasia 6. Anticoagulant 7. Drug abuse 8. Infarct 9. Amyloid angiopathy 10. Idiopathic
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III. Spontaneous Intracranial Hemorrhage;
Subarachnoid and extra-axial1. Subarachnoid hemorrhage (SAH)2. Extra-axial hemorrhage (SDH, EDH)
IV. Intracranial Aneurysm
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V. Cerebrovascular Malformations
1. Capillary telangiectasis2. Cavernous angioma (hemangioma)3. Venous angioma4. Arteriovenous malformation (AVM)5. Occult cerebrovascular malformation (cryptic AVM)6. Vein of galen aneurysm
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CRANIAL TRAUMA
1. ImagingSkull film, CT, MRI
2. Type of Injuries a. Directb. Indirectc. Skull fractures
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3. Types of the Hemorrhagesa. Appearance of hemorrhage by CTb. Appearance MRc. Extra axial hemorrhageCRANIAL TRAUMA
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Extra Axial Hemorrhage
1. Epidural hematomas2. Sub dural hematomas3. Sub arachnoid hemorrhage (S.A.H)4. Intra ventricular hemorrhage5. Intra parenchymal hemorrhage
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DDX : Parenchymal Hematoma
Aneurysm rupture AVM rupture Hypertension Hemorrhagic infarct Hemorrhagic tumor Bleeding diathesis Amyloid angiopathy
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INTRACRANIAL MASSES
1. Radiografic Characteristic of Lesiona. Intrinsic CT densityb. Contrast enhancement BBB (ring, gyriform, homogenous)c. Multiple lesionsd. MR appearance
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DDX : Intracranial Mass (TEACH )
Tumor Edema Abcess, AVM, aneurysm Cyst Hematoma
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A. Primary Tumor
1. Gliomaa. Astrocytomab. Ependymomac. Oligodendrogliomad. Ganglioglioma 2. Meningioma 3. Lymphoma
B. Metastatic Tumor
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DIFFERENTIAL DIAGNOSIS BY LOCATIONDDX : Enhancement pattern of focal cerebral parenchymal lesionsA. Cerebral parenchymal lesion Ring : - Glioma- Meta- Abcess- Resolving hematoma- Resolving infarction Homogenous :- Lymphoma- Aneurysm
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DDX : Intraventicular Mass Lesion
Meningioma, Astrocytoma, Choroid plexus papilloma, Colloid cyst, Meta, Ependymoma, Subependymoma, AVM, Oligo, Lymphoma
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DDX : Pineal Region Mass
Germ cell tumor, Pineal cell tumorGerminoma, Pineoblastoma, Teratoma, Glial cell tumor, Dermoid, Epidermoid, Choriocarcinoma, Meta
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DDX : Juxta Sellar and Supra Sellar
AdenomaCraniopharyngiomaAneurysmMeningiomaUncommon : Meta, Arachnoid cyst, Glioma
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DDX : CPA Mass
Acoustic neurinoma Trigeminal neurinoma Meningioma Arachnoid cyst Epidermoid Aneurysm Meta
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INTRACRANIAL INFECTIONS DISEASE
I. Focal LesionsA. Pyogenic brain abcessB. Atypical brain abcessC. AIDS : Toxo, Lympho, TB, Abcess
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II. EncephalitisCongenital : TORCH Toxo, CMV, Rubella, Herpes
III. Meningitis
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WHITE MATTER DISEASE
A. Demyelinating Diseases
DDX : - Primary : MS- Viral- Toxic and Metabolic- Post therapy- Vascular / SAE
B. Dysmyelinating Diseases - Leucodystrophies
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IMAGING OF THE SPINEI. Approach1. Primarily a bony lesion2. Primarily a joint-space lesion3. Primarily a lesion involving the soft tissues with the neural canal or exit foramina4. Congenital abnormality may involve dysplastic changes of both osseous and neural components
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II. Primarily an Osseous Lesion
1. Primary bone tumor2. Secondary bone tumor3. Inflammatory bone disease4. Hematologic or vascular5. Trauma6. Metabolic7. Congenital anomaly
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III. Primarily a Joint-space Lesion
1. Degenerative disc disease2. Trauma (iatrogenic)3. Disc-space infection
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IV. Primarily a Lesion Involving Soft Tissues of Canal or Foramina
1. Intramedullary2. Intradural and extramedullary3. Extradural
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V. Congenital Anomalies1. Scoliosis2. Vertebral anomalies3. Dysraphism4. Syrinx5. Tumors6. Neurofibromatosis7. Spinal stenosis
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dr. Farhan Anwary, Sp.RadTERIMA KASIH