skull radiography
DESCRIPTION
slide ini berisikan pemeriksaan radiogragi pada tengkorakTRANSCRIPT
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SKULL RADIOGRAPHY
dr. Sianny Suryawati, Sp.Rad
Bagian Radiologi Fakultas KedokteranUniversitas Wijaya Kusuma Surabaya
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PENDAHULUAN Skull (tulang kepala) struktur yang
sangat kompleks Tdd > 20 tulang yang berbeda Evaluasi rutin 4 proyeksi standar
› Lateral view› Posteroanterior/anteroposteriorview› Towne’s view› Basal view (submentovertical)
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AP Projection
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PA Projection
Pada posisi PA, X-ray masuk dari belakang kepala tegak lurus film, dan posisi ini memungkinkan visualisasi petrous pyramids, yang terproyeksi melalui orbita.
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Lateral Projection
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Tampak gambaran seluruh calvaria dan sella turcica serta tulang belakang cervical
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Towne Projection
Posisi ini digunakan untuk evaluasi tulang occipital bone dan foramen magnum, dan merupakan posisi terbaik untuk evaluasi fraktur basis kranii.
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Submentovertical Projection
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Facial Bones
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INDIKASI PEMERIKSAAN RO SKULL
Trauma Peningkatan tekanan intrakranial atau
pembesaran lingkar kepala Abnormalitas bentuk dan ukuran
kepala
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TRAUMA >50% hematoma epidural & subdural
fraktur skull (-) Foto polos skull :
a) depressed fractureb) diastatic fracture atau fraktur pada growing
skullc) fraktur melalui sinus paranasalisd) fraktur yang melalui perjalanan arteri
meningea media CT deteksi luasnya kerusakan intrakranial
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Nasal Bones
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Left lateral radiograph of the skull reveals a sharply marginated, angular, linear lucency in the posterior parietal-occipital region at the site of a previous linear skull fracture.
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Fraktur Le Fort tipe III
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Peningkatan TIK & Lingkar KepalaTanda radiologis peh TIK a.l : Increased vascular markings Widening of the sella turcica Erosion of the sella turcica Gyri make prominent markings on the
skull The pineal gland is displaced from the
midline
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Abnormalitas Bentuk / Ukuran Kepala
Konfigurasi kepala abnormal Rö penutupan dini sutura (craniosynostosis)
Sutura yang paling umum menutup dini sutura sagitalis
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Caldwell view penutupan dini sutura sagitalis
Lateral view scaphocephaly
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Axial CT trigonocephaly 3D CT metopic craniosynostosis & cleft lip and palate (panah)
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Pada anak dengan pembesaran kepala, foto polos skull tidak spesifik.
Fontanella masih terbuka USG kelainan kongenital dan hidrosefalus
Anak yang lebih besar CT scan.
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Lacunar skull
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PROYEKSI LAIN
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Schuller projection
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TMJ : lateral 25° caudad
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Mouth open Mouth closed
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PARANASAL SINUSES
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PENGANTAR NEURORADIOLOGIModalitas Pemeriksaan :Foto polosUltrasonografiCT ScanMRIArteriografiMielografi
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Foto Polos Saat ini tidak digunakan untuk
mendiagnosa kelainan intracranial. Dapat menunjukkan:
* Calsifikasi : Tumor, AVM, post inf.* Pelebaran fossa pituitaria.* Lesi2 pada tulang: Fraktur, tumor primer, metastase, infeksi, kelainan congenital.
Pada spine: Untuk evaluasi trauma.
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ULTRASONOGRAFI Digunakan pada neonatus. Imejing bisa dilakukan melalui
fontanella anterior , fontanella posterior, temporal window, mastoid fontanella atau daerah dengan sutura yang masih terbuka.
Untuk melihat :› ICH, IVH.› Hydrocephalus.› Patologi intracranial lainnya.
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CT (Computed Tomography)
Semua dugaan kelainan intracranial : Trauma Capitis. Cerebro Vascular Disease (CVD). Kelainan Vascular : Aneurysma, AVM. Tumor. Infeksi. Cerebral Atrophy, degenerative
disease. Kelainan Congenital.
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Dilakukan Pemeriksaan Tanpa kontras Media Trauma Capitis. Cerebro Vascular Disease (CVD). Cerebral Atrophy. Hydrocephalus, bukan mencari tumor. Kontrol VP Shunt.
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Dilakukan Pemeriksaan dengan Kontras Media Tumor. Infeksi. Kelainan Vascular :
* Aneurysma.* AVM.
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MRI
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Perbedaan CT scan dan MRI
CT Scan X Ray. Irisan : Axial & Cor. Bisa Rekonstruksi. Tissue characteristic
dengan menentukan densitas.
Baik untuk melihat kelainan tulang.
MRI Medan magnit. Multiplanar imaging. Perbedaan sequence
membantu menentukan tissue characterization.
Soft tissue contrast .
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CT Scan MRI Diffusion
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T1WI T2WI
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AVM
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MRA
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Myelography
Pemeriksaan dengan menggunakan injeksi kontras intrathecal.
Dibuat foto dengan proyeksi: AP, lateral dan oblique.
Untuk melihat kelainan: Spinal cord dan nerve root.
Sejak ditemukan MRI, myelography tidak banyak digunakan.
Digunakan untuk penderita dengan kontraindikasi MRI.
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Thank You