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6. Neurology (Med) > Neuroradiology > Flashcards

Neuroradiology Flashcards

1
Q

What are common indications for head CT scan?

A
  • Head trauma
    • NICE guidelines
  • Acute stroke
    • NICE guidelines
  • Headache
    • SIGN guidelines, red flags for suspected tumour or subarachnoid haemorrhage
  • Cancer
    • Looking for metastatic brain tumours in patients with symptoms
  • Post-surgical
    • Hydrocephalus, haemorrhage
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2
Q

What are contraindications for head CT scan?

A

For head trauma follow NICE and SIGN guidelines:

  • Such as GCS score of 15, no suspected open or depressed skull fracture, no CSF leakage from ears or nose, no post-traumatic seizure etc

NICE guidelines for seizure usually suggest MRI:

  • Primary idiopathic generalised epilepsy
    • No imaging
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3
Q

What are indications to perform MRI scan?

A
  • Neurologists
    • Demyelination
      • Such as to help diagnose MS
    • Epilepsy
      • NICE and SIGN guidelines (and if surgery is contemplated)
    • Paediatric neurology
      • Disorders of development, head circumference, congenital malformation
    • Headache
      • Benign intracranial hypertension
  • Surgeons
    • Spine
      • Intervertebral disc degeneration causing neural compression
    • Cancer
      • Clarifying the number, location and aggressiveness of brain tumours
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4
Q

What are contraindications to performing MRI scan?

A

Implanted electronics (check with manufacturer):

  • Cardiac pacemakers, implantable defibrillators, cochlear implants
  • Relative contraindication for programmable shunts, insulin pumps

Moveable metallic implants (check make and model):

  • Aneurysm clips, heart valves, recent intra-abdominal clips

Relative contraindications:

  • Claustrophobia, pregnancy, tattoos
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5
Q

When is angiography used in neurology?

A

Large vascular (arterial and venous) abnormalities

Diagnosis and treatment of:

  • Aneurysm
  • Arteriovenous malformation
  • Carotidocavernous fistula
  • Unstoppable epistaxis
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6
Q

What is perfusion?

A

Volume of blood passing through a defined volume of tissue per unit of time

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7
Q

What are the units of perfusion?

A

Units are ml blood, 100g tissue or per minute

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8
Q

Is perfusion measured using CT or MRI?

A

Either, you get CT perfusion or MRI perfusion

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9
Q

What are some disorders of abnormal perfusion?

A
  • Stroke
    • Decreased perfusion
  • Tumour
    • Increased perfusion indicates angiogenesis and a more aggressive tumour
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10
Q

Is the perfusion in a stroke increased or decreased?

A

Decreased

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11
Q

Is the perfusion in a tumour increased or decreased?

A

Increased perfusion (indicates angiogenesis and a more aggressive tumour)

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12
Q

What are PET scans used for?

A

Usually used to map out glucose usage

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13
Q

Increased metabolism of glucose is seen in what?

A
  • Tumour
  • Inflammation
  • Infection
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14
Q

Why are PET scans useful after brain tumour resection?

A

Differentiating granulation tissue (low energy use) from leftover tumour (high energy use)

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15
Q

What are clues for identifying that an image is a plain radiograph?

A
  • Multiple superimposed bones, bones are white
  • Immediately recognisable body parts
  • Soft tissue is grey
  • Air is black
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16
Q

What colour is air in a x-ray?

A

Black

17
Q

What colour is soft tissue in a x-ray?

A

Grey

18
Q

What are clues for indentifying an image is a CT scan?

A
  • White circle of skull
  • Black CSF in sulci and ventricles, air is black
  • Grey brain with subtle grey white matter difference
  • Image quality
    • Reconstructed by back projection from a rotating fan beam of x-rays
    • Beam hardening from radiodense objects
      • Metal produces white starbust artefacts
    • Slightly grainy
19
Q

What colour is the skull in a CT scan?

A

White

20
Q

What colour is CSF in a CT scan?

A

Black

21
Q

What colour is air in a CT scan?

A

Black

22
Q

What colour is the brain in a CT scan?

A

Grey with subtle grey white matter differences

23
Q

What are clues an image is a MRI scan?

A
  • White CSF is the best clue (but only true for T2 weighted MRI)
    • Same anatomy with different sequencing often shown
  • Better grey-white matter differentiation than CT
  • Image quality
    • Reconstructed from Fourier transforms of radio signals
    • Has a JPEG like quality, usually not grainy
24
Q

What colour is CSF in a MRI scan?

A

White

25
Q

What are clues an image is a radionuclide radiology/nuclear medicine/PET image?

A
  • Images often have bright and varied colours
  • The image is fuzzy
26
Q

What are clues an image is an ultrasound?

A
  • Wedge shaped image with the edges of the image diverging away from top to bottom
  • Often has a curve at the top matching the ultrasound probe (exception is flat probes)
  • Very noisy image (like an old un-tuned TV)
  • Objects which block the ultrasound beam (air, bone, stones) cast shadows downwards
27
Q

What are some examples of important neurological emergencies?

A
  • Trauma
  • Acute stroke
  • Cauda equine compression
  • Subarachnoid haemorrhage
28
Q

What is helpful when discussing neuroradiology referrals?

A
  • For stroke
    • Know about carotid arteries, cardiovascular risk and atrial fibrillation as well as functionally important areas of the brain
  • Be able to differentiate upper motor neuron from lower motor neurone
  • For cauda equine syndrome or intervertebral disk herniations you should be able to link reflexes and dermatomes to approximate spinal levels and be able to number vertebrae
29
Q

What are advantages and disadvantages of US?

A
  • Advantages
    • No radiation
    • Less expensive equipment
    • Can be performed in the neonatal unit
    • Movement tolerant
  • Disadvantages
    • Requires a wide enough fontanelle (ie about up to 1 year of age)
    • Image quality and interpretation based on operator skill
30
Q

What are advantages and disadvantages of plain radiographs?

A
  • Advantages
    • Almost universally available
    • Fast
    • Sequential images in subtraction angiography
  • Disadvantages
    • Lacks soft tissue detail
31
Q

What are advantages and disadvantages of CT?

A
  • Advantages
    • Rapid
    • Metal and pacemaker tolerance
    • Good for demonstrating acute haemorrhage
  • Disadvantages
    • Radiation 2mSv
    • More expensive cumbersome equipment
32
Q

What are advantages and disadvantages of radionuclide radiology?

A
  • Advantages
    • Physiological information
      • Glucose metabolism
      • Perfusion
      • Dopamine reuptake receptors
  • Disadvantages
    • Unclear anatomical information
    • Medium cost of equipment
    • Radiotracers can be expensive
33
Q

What are advantages and disadvantages of MRI?

A
  • Advantages
    • No radiation
    • Soft tissue differentiation
    • Physiological information
      • Blood flow
      • Diffusion restriction
      • Metabolite concentrations
  • Disadvantages
    • Poor tolerance of metalwork
    • Magnetic sensitive electronics may fail ore are contraindicated
      • Pacemakers
      • Cochlear implants absolutely contraindicated
    • Least movement tolerance
    • Slow, must limit sequence
    • Most expensive equipment

Danger of metallic objects becoming projectiles

6. Neurology (Med) (47 decks)

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