Transcript Conventional Neuroradiological Examinations

Conventional Neuroradiological
Examinations
Başar Sarıkaya, M.D.
Associate Professor of Radiology
Yeditepe University
What is neuroradiology?
Neuroradiology is a subspecialty of
radiology which deals with imaging of the
nervous system disorders using various
imaging modalities.
What is neuroradiology?
Plain X-rays, [contrast enhanced X-rays
(myelogram, cisternogram, etc)]
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
DSA (Digital Subtraction Imaging)
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.
Unfortunately I am not going to talk about
these fancy stuff!!!
What do we mean by
conventional?
“used and accepted by most people : usual
or traditional”
Meriam-Webster
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 OUTDATED!!!
Wilhelm Conrad Roentgen
(27 March 1845 – 10 February 1923)
Nobel Prize in Physics 1901
December 22, 1895
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.
Plain films of the head
PA and lateral views
2 view series
4 view series
Towne and Waters
DON’T FORGET: One view is no view!!!
Plain Films of the Spine
AP and lateral
R and L oblique
Special positions (Swimmer’s view for the
cervicothoracic junction)
When do we obtain?
For routine preoperative imaging
(neurosurgery, ENT...)
Trauma
Sinus disease
Headache?
Waters
Caldwell
F
e
O
M
Infc
m
AP, lateral and oblique views of the spine
Cervical
Thoracic
Lumbar
How many vertebrae do we have?
Cervical: 7
Thoracic: 12
Lumbar: 5
Sacral: 5
Coccyx: 3-4
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.
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
Anatomy
T12
12th
L1
12th
L2
L3
L4
L5
I
I
S
si
si
C
Anatomy
D
T
P
B
s
P
T
D
f
P
B
D
sap
iap
Quiz-1
a.
b.
c.
d.
e.
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
Quiz-2
a.
b.
c.
d.
e.
Which X-ray view best demonstrates the
acute sinusitis involving the maxillary
sinuses?
Waters
Caldwell
Towne
Lateral
AP
Quiz-3
Regarding the
“Scotty dog” of
the oblique
lumbar view,
what structure
represents neck
of the dog?
a. Pedicle
b. Inferior articular
process
c. Superior articular
process
d. Transverse
process
e. Pars interarticularis