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Weber State University

Radiologic Technology 4633

MRI of the Central Nervous System - Brain

Instructor: Rex T. Christensen MHA R.T. (R) (MR) (CT) (ARRT) CIIP

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1. Pia Mater

2. Bridging veins

3. Arachnoid

4. Dura Mater

5. Subdural space

6. Subarachnoid space

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1. Hypothalamus

2. Mammilary Body

3. Thalamus

4. Insula

5. Internal Capsule

6. Septum Pellucidum

7. Falx Cerebri

8. Cerebrum

9. Corpus Callosum

10. Lateral Ventricle

11. Caudate Nucleus

12. Putamen

13. Globus Pallidus

14. Third Ventricle

15. Optic Tract

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1. Third Ventricle

2. Splenium of Corpus Callosum

3. Fourth Ventricle

4. Spinal Cord

5. Medulla Oblongata

6. Pons

7. Tongue

8. Clivus

9. Sphenoid Sinus

10. Cerebral Peduncles

11. Pituitary Gland

12. Frontal Sinus

13. Genu of Corpus Callosum

1. Corpus Callosum

2. Thalamus

3. Cerebellar Peduncle

4. Ethmoid Sinus

5. Frontal Sinus

6. Anterior Horn of Lateral Ventricle

7. Caudate Nucleus

8. Lateral Ventricle

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1. Corpus Callosum

2. Septum Pellucidum

3. Optic Chiasm

4. Pituitary Gland

5. Sphenoid Sinus

6. Internal Carotid Artery

7. Caudate Nucleus

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1. Posterior Horn of Lateral Ventricle

2. Fourth Ventricle

3. Medulla Oblongata

4. Cerebellum

5. Pineal Gland

6. Straight Sinus

1. Falx Cerebri

2. Occipital Lobe

3. Cerebellum

4. Cerebellar Tonsil

5. Cisterna Magna

6. Tentorium

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Gray and White Matter

• Cerebral Cortex = The outer covering of

the cerebrum. It is often referred to as

gray matter.

• White matter is deeper in the brain, except

for the thalamus and some basal ganglia

(putamen, caudate nucleus) were given as

an example of "deep gray matter".

Gray and White Matter

1. Cerebral hemisphere (right side) 2. Gray matter. 3. White matter

Hearing loss, tinnitus, and dizziness are

symptoms of which of the following:

• A. glosspharyngeal neuroma

• B. trigeminal neuralgia

• C. pituitary adenoma

• D. acoustic neuroma

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Hearing loss, tinnitus, and dizziness are

symptoms of which of the following:

• A. glosspharyngeal neuroma

• B. trigeminal neuralgia

• C. pituitary adenoma

• D. acoustic neuroma

ans: D

Which of the following is a condition in which

part of the Cerebellar tonsil is displaced

below the foramen magnum?

• A. Simmonds' disease

• B. Chiari malformation

• C. syringomyelia

• D. hydrocephalus

Which of the following is a condition in which

part of the Cerebellar tonsil is displaced

below the foramen magnum?

• A. Simmonds' disease

• B. Chiari malformation

• C. syringomyelia

• D. hydrocephalus

ans: B

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All of the following techniques should be

employed EXCEPT __________ when

imaging the pituitary gland.

• A. increase in matrix (high resolution)

• B. fat saturation

• C. thin slices

• D. small field of view (FOV)

All of the following techniques should be

employed EXCEPT __________ when

imaging the pituitary gland.

• A. increase in matrix (high resolution)

• B. fat saturation

• C. thin slices

• D. small field of view (FOV)

ans: B

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In order to visualize the internal auditory

canal, high resolution images are acquired

in which planes?

• A. sagittal and coronal

• B. sagittal and axial

• C. off axis oblique

• D. axial and coronal

In order to visualize the internal auditory

canal, high resolution images are acquired

in which planes?

• A. sagittal and coronal

• B. sagittal and axial

• C. off axis oblique

• D. axial and coronal

ans: D

In order to visualize the pituitary gland,

which planes are most useful?

• A. sagittal and coronal

• B. sagittal and axial

• C. off axis oblique

• D. axial and coronal

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In order to visualize the pituitary gland,

which planes are most useful?

• A. sagittal and coronal

• B. sagittal and axial

• C. off axis oblique

• D. axial and coronal

ans: A

Intracranial Hemorrhage

5 stages based on the break down of

blood products:

1. Hyperacute (<12 h)

2. Acute (12 h to 2 days)

3. Early Subacute (2-7 days)

4. Late Subacute (8 days to 1 month)

5. Chronic (> 1 month to years)

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Hyperacute Stage (<12 h)

Intracranial Hemorrhage is a liquid composed of 99% intracellular oxygenated hemoglobin.

The intracellular hemoglobin moves toward a deoxygenated state.

A heterogeneous clot develops that comprises blood cells, platelets, and protein-rich serum.

Acute Stage (12 h to 2 days)

Intracellular hemoglobin is progressively

deoxygenated.

Early Subacute Stage

(2-7 days)

Oxidative denaturation of hemoglobin

(deoxyhemoglobin)

Deoxyhemoglobin is gradually converted

to methemoglobin (heme of hemoglobin is

converted to ferric iron).

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Late Subacute Stage

(8 days to 1 month)

Lysis of the red blood cells results in the

release of methemoglobin into the

extracellular space.

Chronic Stage

(> 1 month to years)

Macrophages and astroglial cells surround

and slowly phagocytise the hemotoma.

Extracellular methemoglobin is stored in

the macrophages and is converted to

hemosiderin and ferritin.

Hemorrhage CT vs. MRI

CT – Imaging characteristics of intracranial

hemorrhage are determined by the degree that

the x-rays are attenuated by the blood products.

Density of the hemorrhage is determined by the:

• Hematocrit

• Degree of blood clot retraction

• Hemoglobin content

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Hemorrhage CT vs. MRI

CT – Imaging characteristics by stage:

Hyperacute – hyperdense (bright)

Acute – hyperdense (bright)

Early Subacute – hyperdense (bright)

Late Subacute – isodense (homogeneous)

Chronic – hypodense (dark)

Hemorrhage CT vs. MRI

MRI – Imaging characteristics of

intracranial hemorrhage are determined by

the:

• Paramagnetic effects of the break down

products of hemoglobin

• The magnetic field strength

• The pulse sequence.

Blood appearance by stage

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Which of the following describes the reason it is very difficult to define gray/white matter structures on pediatric patients?

• A. pediatric patients lack water content

• B. pediatric patients must be sedated, sedation sometimes interferes

• C. pediatric patients are too uncooperative, image motion

• D. pediatric patients have a low development of myelin

Which of the following describes the reason it is very difficult to define gray/white matter structures on pediatric patients?

• A. pediatric patients lack water content

• B. pediatric patients must be sedated, sedation sometimes interferes

• C. pediatric patients are too uncooperative, image motion

• D. pediatric patients have a low development of myelin

ans: D

Which of the following tumors has these

characteristics on MR? 1. grows slowly 2.

originates from arachnoid tissue 3. is isointense

on T1-weighted images 4. usually the size of a

quarter 5. enhances with contrast injection.

• A. Neurofibroma

• B. Meningioma

• C. Astrocytoma

• D. Chiari malformation

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Which of the following tumors has these characteristics on MR? 1. grows slowly 2. originates from arachnoid tissue 3. is isointense on T1-weighted images 4. usually the size of a quarter 5. enhances with contrast injection.

• A. Neurofibroma

• B. Meningioma

• C. Astrocytoma

• D. Chiari malformation

ans: B

With a history of seizures, the patient can be imaged using cardiac gating:

• A. to avoid taking talking to the patient throughout the study

• B. to make vessels appear black

• C. to monitor the patient for potential seizures

• D. to minimize pulsatile flow motion artifact in the temporal lobes

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With a history of seizures, the patient can be

imaged using cardiac gating:

• A. to avoid taking talking to the patient

throughout the study

• B. to make vessels appear black

• C. to monitor the patient for potential seizures

• D. to minimize pulsatile flow motion artifact in the

temporal lobes

ans: D

When patients arrive at the imaging center with a cranial scar, the technologist must:

• A. ignore the scar

• B. cover the head with a sterile drape

• C. screen the patients, their doctor and/or family to find out what type of surgery they have had

• D. immediately perform the MRI scan to find out what surgery they underwent

When patients arrive at the imaging center with a

cranial scar, the technologist must:

• A. ignore the scar

• B. cover the head with a sterile drape

• C. screen the patients, their doctor and/or family

to find out what type of surgery they have had

• D. immediately perform the MRI scan to find out

what surgery they underwent

ans: C

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When scanning patients to rule out brain

tumors, which of the following images is

acquired to evaluate the extent of the

lesion after injection of gadolinium?

• A. proton density

• B. gradient echo

• C. T2

• D. T1

When scanning patients to rule out brain tumors, which of the following images is acquired to evaluate the extent of the lesion after injection of gadolinium?

• A. proton density

• B. gradient echo

• C. T2

• D. T1

ans: D

The ACR (American College of Radiology) guidelines for brain imaging suggest that the minimum imaging procedure should include:

• A. Proton Density and T2 weighted coronal and axial images

• B. gradient echo imaging

• C. T1 weighted pre- and post-contrast enhancement axial images

• D. T1 weighted sagittal, proton density and T2 weighted axial images

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The ACR (American College of Radiology) guidelines for brain imaging suggest that the minimum imaging procedure should include:

• A. Proton Density and T2 weighted coronal and axial images

• B. gradient echo imaging

• C. T1 weighted pre- and post-contrast enhancement axial images

• D. T1 weighted sagittal, proton density and T2 weighted axial images

ans: D

For most brain imaging procedures, which of

the following best describes the patient

position and centering landmark?

• A. supine/external auditory meatus

• B. none of the above

• C. supine/nasion

• D. prone/acantho-meatal line

For most brain imaging procedures, which of

the following best describes the patient

position and centering landmark?

• A. supine/external auditory meatus

• B. none of the above

• C. supine/nasion

• D. prone/acantho-meatal line

ans: C

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Which of the following pathologies enhance

with the use of gadolinium? 1. metastatic

disease 2. active multiple sclerosis lesions

3. infectious disorders such as AIDS

• A. 2 and 3 only

• B. 1, 2, and 3

• C. 1 and 2 only

• D. 1 only

Which of the following pathologies enhance with the use of gadolinium? 1. metastatic disease 2. active multiple sclerosis lesions 3. infectious disorders such as AIDS

• A. 2 and 3 only

• B. 1, 2, and 3

• C. 1 and 2 only

• D. 1 only

ans: B

Which of the following should be of concern when using gadolinium enhancement while imaging the central nervous system?

• A. flow motion artifacts increase (are more prevalent)

• B. flow motion artifacts decrease (are less prevalent)

• C. a longer TR is required

• D. a longer TE is required

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Which of the following should be of concern when using gadolinium enhancement while imaging the central nervous system?

• A. flow motion artifacts increase (are more prevalent)

• B. flow motion artifacts decrease (are less prevalent)

• C. a longer TR is required

• D. a longer TE is required

ans: A

On a non-contrast T1-weighted, spin echo

image, intracranial lesions such as MS

plaques will have which of the following

signal intensities?

• A. isointense to the brain

• B. increased

• C. decreased

• D. none of the above

On a non-contrast T1-weighted, spin echo image, intracranial lesions such as MS plaques will have which of the following signal intensities?

• A. isointense to the brain

• B. increased

• C. decreased

• D. none of the above

ans: C

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Gadolinium enhances lesions associated

with disruption of the blood brain barrier

such as:

• A. abscesses

• B. gliomas

• C. metastasis

• D. All of the above

Gadolinium enhances lesions associated

with disruption of the blood brain barrier

such as:

• A. abscesses

• B. gliomas

• C. metastasis

• D. All of the above

ans: D

?

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What type of image sequence would be

useful in demonstrating and characterizing

hyperintense lesions such as hemorrhage

or fat containing tumors?

• A. inversion recovery

• B. gradient echo

• C. T2-weighted spin echo

• D. T1-weighted spin echo

What type of image sequence would be useful in demonstrating and characterizing hyperintense lesions such as hemorrhage or fat containing tumors?

• A. inversion recovery

• B. gradient echo

• C. T2-weighted spin echo

• D. T1-weighted spin echo

ans: D

Which of the following are/is TRUE regarding periventricular hyperintense lesions (PVH)?

1. PVH lesions are non-specific findings seen with normal aging 2. PVH lesions can be seen with neurodegenerative processes such as Alzheimer's 3. PVH lesions can be seen with hydrocephalus

• A. 1 and 2 only

• B. 1, 2, and 3

• C. 2 and 3 only

• D. 1 only

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Which of the following are/is TRUE regarding periventricular hyperintense lesions (PVH)?

1. PVH lesions are non-specific findings seen with normal aging 2. PVH lesions can be seen with neurodegenerative processes such as Alzheimer's 3. PVH lesions can be seen with hydrocephalus

• A. 1 and 2 only

• B. 1, 2, and 3

• C. 2 and 3 only

• D. 1 only

ans: B

Cerebrospinal fluid is produced by:

• A. corpus callosum

• B. ventricles

• C. choroid plexus

• D. the blood brain barrier

Cerebrospinal fluid is produced by:

• A. corpus callosum

• B. ventricles

• C. choroid plexus

• D. the blood brain barrier

ans: C

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• Which of the following is a medium for

exchange of nutrients and waste products

between the blood and nervous tissue?

• A. cerebrospinal fluid

• B. venous system

• C. blood

• D. meninges

• Which of the following is a medium for

exchange of nutrients and waste products

between the blood and nervous tissue?

• A. cerebrospinal fluid

• B. venous system

• C. blood

• D. meninges

ans: A

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Anatomy Learning Tools

http://www.meddean.luc.edu/lumen/MedEd/

GrossAnatomy/x_sec/mainx_sec.htm

http://www.med.wayne.edu/diagradiology/An

atomy_Modules/brain/brain.html

Questions?