Neuroanatomy and Cases

Question 1

CT uses _____ radiation and can get what two planes of xray?

Answer 1

Iodination

get coronal and sagittal

Question 2

Use this to get Fast scan, unfortunately its expensive but it is readily available

Answer 2

Computed Tomography

Question 3

Has strong magnetic waves (cant use with metal) with multiplanar images. Slower results and very pricey

Answer 3

MRI

Question 4

What contrast is used in MRI?

Answer 4

Gadolinium

Question 5

Best for brain, bone, soft tissue and lung. Views images in different ‘windows’ and only scan once

Answer 5

Computed Topography

Question 6

Scan several times and get multiple planes with seen with different pulse sequences but view each image set with only one window

Answer 6

MRI

Question 7

Best for soft tissue adn marrow with contrast enhancement

Answer 7

MRI

Question 8

Best for assesing bone and to see acute hemorrhage, trauma and fluid

Answer 8

CT

Question 9

Bone and hemorrhage are WHITE in______

Fat and Brain is WHITE in _____

Answer 9

Bone and hemorrhage are bright in CT

Fat and brain are bright in MRI

Question 10

What is dark in MRI T1?

what is dark in CT?

Answer 10

Bone/CSF/Air are dark in MRI

Fat/CSF/ dark in CT

Question 11

Difference between T1 and T2 MRI

Answer 11

In T1 CSF is Dark, in T2, CSF is bright

In T1 white matter is brighter

In T2, grey matter is brighter

Question 12

Become familiar with anatomy

Answer 12

Note location of central sulcus

Question 13

Become familiar with the neuro anatomy

Answer 13

Question 14

What are the benefits of CTA real time

Answer 14

non invasive and low risk

mainstay for dx of vascular pathology

Question 15

What do we use MRA to see?

Answer 15

to visualize vasculature

Question 16

What pathologies occur in the Brain?

Answer 16

Stroke, MS, HTN, Aneurysm, Tumor, Trauma

Question 17

Common CNS Pathologies in the Spine

Answer 17

Trauma, Degenerative disease, Infection, Metestatic Disease

Question 18

Common Pathologies in the Head and Neck

Question 19

When do we perform CT with contrast?

Answer 19

of head and neck soft tissues looking for infection or malignancy

CT angiograms of head and neck

CT venograms of head and neck

Question 20

When would you use Gadolinium contrast in MR imaging

Answer 20

Infection, Primary tumors or metestatic disease

Demyelinating disease (MS)

Question 21

Contrast not usually necessary when evaluating stroke, trauma, or degenerative spine disease:

MRA head is done ____ contrast

MRA neck and MRV best when done ______ contrast

Answer 21

without

with

Question 22

Key resource to select appropriate imaging modality

Answer 22

ACR appropriateness criteria from the American College of Radiology

Question 23

This is cheaper, uses ionizing radiation, takes minutes but has more tendency for allergic reactions

Answer 23

CT

Question 24

More expensive, no radiation, takes about a half hour to acquire, is usually well tolerated

Answer 24

MRI

Question 25

What is the best imaging modality to use to eval for a bleeding source?

Answer 25

CT angiography of the head

***need contrast !!

Question 26

Acute hemorrhage is _____ while chrnoic hemorrhage is _____ on CT

Answer 26

acute = hyperdense or BRIGHT

chronic = hypodense or DARK

Question 27

Most common causes of subarachnoid hemorrhage

Answer 27

from trauma or ruptured aneurysm

Question 28

Pt has acute onset right side weakness and aphasia for one day

Hx of fibrillation, HTN and COPD with previous stroke and residual Left side weakness. Been on antiocags in past but stopped d/t frequent falls

DDX?

Answer 28

Cerebrovascular accident, transient ischemic attack, seizure, encephalopathy.

Question 29

You suspect a pt is suffering from acute infarct and order a CT. The results come back negative. What is the next step?

Question 30

Your pt presents with all sypmtoms pointing to acute infarct. The CT comes back negative, what do you order next (be specific and why)

Answer 30

order MRI with DWI (diffusion weighted imaging)

pay attention to functional anatomy

Question 31

What benefits does a CT vs MRI provide for spinal cord injuries?

Answer 31

CT good for bone and fractures

MRI is better at seeing ligament and disk problems

Question 32

What is the first screening exam done for spine trauma?

Answer 32

CT is initial screen for trauma pts not cleared with sensitivity increased from 50-75% with plain film to 90-100% in CT