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Head and neck radiology > Introduction to brain imaging > Flashcards

Introduction to brain imaging Flashcards

1
Q

basal cisterns include

A

quadrigeminal plate and suprasellar cistern

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2
Q

basal cistern that appears like a symmetric smile in axial plane

A

quadrigeminal cistern

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3
Q

basal cistern that looks like a pentagon, Jewish star or the Hindu Shatkona

A

suprasellar cistern

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4
Q

5 corners of suprasellar cistern

A

anterior- interhemispheric fissure
anterolateral- Sylvian fissure
posterolateral- ambient cisterns

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5
Q

6th point of the suprasellar cistern

A

posterior-interpeduncular fossa

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6
Q

what to look at in the brain on a first cursory look

A

midline, symmetry, basal cisterns, ventricles

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7
Q

emergency cranial CT checklist

A

is the middle of the brain in the middle of the head?
Do the 2 sides of the brain look alike?
Can you see the smile and the pentagon or Jewish star/Shatkona?
IS the 4th ventricle in the midline and more or less symmetrical?
Are the lateral ventricles huge, with effaced sulci?

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8
Q

anterior cerebral arteries travel in what fissure

A

interhemispheric fissure

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9
Q

cranial nerve that travels in parallel with the posterior communicating artery

A

3rd cranial nerve

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10
Q

marks the anterior lip of foramen magnum

A

inferior edge of clivus

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11
Q

posterior lip of foramen magnum is marked by

A

cortical margin of occipital bone

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12
Q

cerebellar tonsils should project no more than ___ mm below a line drawn between the anterior and posterior lips of the foramen magnum

A

5 mm

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13
Q

most posterior projection of the dorsal medullar that should lie above the imaginary line drawn between the anterior and posterior lips of the foramen magnum

A

obex

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14
Q

only structures visible in the craniocervical junction

A

cervical medullary junction and a tiny bit of cerebellar tonsillar tissue

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15
Q

these scans are useful in certain specialized settings, such as medically refractory epilepsy, movement disorders and dementia

A

nuclear medicine, PET scans

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16
Q

if the onset of neurologic symptoms is within 24-48 hours, imaging preferred is

A

CT

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17
Q

MRI is recommended if neurologic symptoms are older than how many days

A

2 days

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18
Q

best for screening of AVMs

A

MRA

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19
Q

best for problem solving and aneurysm treatment planning

A

CTA

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20
Q

if the CT or MR fails to demonstrate an acute infarct and the symptoms suggest a transient ischemic attack or stroke, do a

A

carotid Doppler US, or MRA or CTA

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21
Q

shows the distribution of brain metabolities based by the chemical shift of protons within themm which is a property determined by the chemical environment of the protons in question

A

proton MR spectroscopy

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22
Q

marker for cell membranes and hence a marker for cellular turnover

A

choline

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23
Q

compound found in neurons and therefore a marker of neuronal density

A

N-acetyl aspartate

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24
Q

this is evenly distributed in many types of cells and serves as a reference standard

A

creatine

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25
Q

helps distinguish radiation necrosis from recurrent tumor or infection

A

elevation of choline-to-creatine ratio

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26
Q

if choline peak is sky high, think of

A

meningioma, demyelinating processes such as MS

27
Q

decrease in NAA-to-creatine ratio are associated with

A

neuronal death

28
Q

focally decreased NAA is seen in

A

mesial temporal sclerosis and infarcts

29
Q

global depletion of NAA can be seen in

A

MS, Alzheimer disease

30
Q

elevated myoinositol is seen in

A

Alzheimer disease

31
Q

abscesses and metastatic lesions will have low or high NAA-to-creatine ratio

A

lower

32
Q

markedly elevated NAA levels are seen in

A

Canavan disease, due to a specific defect in the enzyme that metabolizes NAA

33
Q

Amino acid peaks can be seen in

A

intracranial infections

34
Q

characteristic doublet peak of lactic acid can help make the diagnosis of

A

ischemia

35
Q

sagittal MIP in CTA is useful in

A

carotid ophthalmic aneurysm, Pcomm and PICA

36
Q

coronal MIP in CTA is useful in

A

Acomm, carotid “T” and basilar tip

37
Q

axial MIP in CTA is useful in

A

Acomm and Pcomm

38
Q

this tool, exploits the fact that within the elongated cell processes such as axons, water can diffuse more freely “down the tube” than “sideways”, allowing for reconstruction of white matter tracts or “tractography”

A

diffusion tensor imaging

39
Q

in acute stroke patient, a delay of time to peak that is greater than __ seconds strongly suggest ischemia in MR perfusion technique

A

6 seconds

40
Q

refers to studies of the brain using blood exygen level-dependent imaging

A

Functional MR imaging

41
Q

imaging study of choice from chronic headache

A

MR without contrast

42
Q

imaging study of choice for dementia

A

MR without contrast

43
Q

imaging study of choice for coma patients

A

CT without contrast

44
Q

True or false: loss of gray/white distinction, low attenuation in basal ganglia, poor definition of insula on CT may contraindicate thrombolytic therapy

A

true

45
Q

acute stroke questions

A

Are there signs of an acute infarct? How big?
Is there acute blood?
Is there a hyperdense artery, for example, MCA, suggesting a large vessel clot?

46
Q

diffusion-perfusion mismatch can be calculated to identify the penumbra of potentially salvageable brain thru

A

subtracting the volume of abnormal diffusion from the volume of abormal perfusion

47
Q

freq indication for imaging of the brain

A

Headache

48
Q

recognized by the displacement of normal structures away from the abnormality

A

mass

49
Q

recognized by widening of the ipsilateral sulci or enlargement of the ventricle adjacent to the lesion

A

atrophy or volume loss

50
Q

shift ipsilateral to an atrophic lesions is very unusual and is only seen commonly in

A

congenital hemiatrophy

51
Q

3 common causes of reversible atrophy

A

dehydration and starvation, Addison disease, High-dose steroid therapy

52
Q

may also occasionally result in reversible atrophy but its neurotoxic effects are not reversible

A

alcoholism

53
Q

most reliable sign of an extra-axial mass in the posterior fossa

A

widening of the ipsilateral subarachnoid space

54
Q

common pattern of enhancement of extra-axial masses

A

homogeneous enhancement

55
Q

common pattern of enhancement of intra-axial masses

A

ring-like of irregular fashion

56
Q

True or false: intra-axial masses have more surrounding edema than extra-axial masses of same size

A

true

57
Q

lesions involving the gray matter are usually of

A

infarct, trauma or encephalitis

58
Q

this form of edema results from disturbances in tight capillary junctions that occur in association with cerebral tumors, abscesses or hematomas

A

vasogenic edema

59
Q

edema that results from increased tissue water content following the neuropathologic response to cell death. in these cases, infarct, trauma, or encephalitis should be considered

A

cytotoxic edema

60
Q

if ischemia of the deep gray matter structures bilaterally are involved, what can be considered

A

pure anoxia owing to carbon monoxide poisoning or respiratory arrest

61
Q

traumatic lesions tend to occur at what areas in acceleration/deceleration injuries

A

orbital and frontal polar regions, temporal poles and occipital poles

62
Q

this disease spreads from the oral and nasal mucosa to the trigeminal and olfactory ganglion cells and then transdurally to the brain. most common location are medial temporal lobes, adjacent to the trigeminal ganglia and orbital frontal regions adjacent to the olfactory bulbs

A

Herpes simplex encephalitis

63
Q

Mass lesion questions

A 
Intra or extra-axial?
solitary or multiple?
Gray matter or white matter?
pattern of contrast enhancement
SI or attenuation pattern in MRI

Head and neck radiology (15 decks)

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