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OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University of Oklahoma Health Sciences Center January 16, 2015

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Page 1: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Introduction to MRI Head Imaging

Ryan Hakimi, DO, MSDirector, Critical Care Neurology

Assistant ProfessorDepartment of Neurology

The University of Oklahoma Health Sciences CenterJanuary 16, 2015

Page 2: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

DISCLOSURES

FINANCIAL DISCLOSURENothing to disclose

UNLABELED/UNAPPROVED USES DISCLOSURENothing to disclose

Page 3: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Objectives Describe the pros and cons of MRI versus CT when

imaging the head Discuss some common MRI sequences Illustrate the appearance of acute ischemic stroke on

various MRI head sequences Present MRI head imaging of other common

neurological diagnoses

Page 4: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Principles of Magnetic Resonance Imaging

Uses a magnet and radio waves to create an image based on changes in alignment of protons in the tissue

TerminologyHyperintense (bright, white)Hypointense (dark, black)

Page 5: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Advantages of MRI over CT Head

No radiationCan image in multiple planes (axial, sagital,

coronal, oblique)Superior soft tissue imagingCan image some vessels without contrast

(MRA head)Many different sequences allow for

specialized imagingCan image the brainstem and cerebellum

Page 6: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Disadvantages of MRI vs CT Head

Inferior bone imagingCostLonger study timeImages degraded by motionCan not image patient with pacemaker,

claustrophobia, metallic foreign bodies (bullet)

Page 7: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Axial T1

T1 looks like a CT

CSF is black

(hypointense)

orbit

pons

Page 8: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Sagital T1

atrophy

corpus collosum

pons

cerebellum

Page 9: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Coronal with contrast (gadolinium)

With contrast can see

hyperintensity of the blood

vessels

Good for visualization of

hyppocampi

Page 10: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Axial T2

T2 has white

(hyperintense)CSF

lateral ventriclesfrontal horn

occipital horn

Page 11: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

DWI brainstem

Breakdown of blood brain barrier

acute ischemic stroke

acute demyelination

acute trauma

Right pontine ischemic infarction

T2 shine through

Page 12: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

T2* acute ICH

(gradient echo)

Blood will appear black

(hypointense)

Page 13: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Acute Ischemic StrokeDWI T1

Page 14: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Acute Ischemic StrokeT2 FLAIR (fluid-attenuated inversion

recovery)

Page 15: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Acute Ischemic StrokeT2*

petechial hemorrhages within the ischemic tissue

Page 16: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

MRA (LMCA patent)

Image can be rotated, left is not always on the right side of the screen, must look at labels

L R

internal corotid artery

anterior cerebral artery

middle cerebral artery

Page 17: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Normal Pressure Hydrocephalus

Central atrophy (large

ventricles) out of proportion to

peripheral atrophy (minimal

atrophy)

Page 18: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Meningioma

Extraaxial brain tumor

(outside of the brain) displacing

The brain)

Enhances with gadolinium

Has a dural tail

Page 19: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Multiple Sclerosis

Periventricular white matter hyperintensities, some of which enhance, from National MS Center

Page 20: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

GAD with NSF

Puts patients at risk for nephrogenic systemic fibrosisFibrosis of skin, eyes, organs

Gadolinium can not be administered in patients:Glomerular filtration rate (GFR) of 30 or lessOn dialysis

Page 21: OU Neurology Introduction to MRI Head Imaging Ryan Hakimi, DO, MS Director, Critical Care Neurology Assistant Professor Department of Neurology The University

OU NeurologyOU Neurology

Questions

OU NeurologyOU Neurology

Thank you


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