Neuroradiology

Question 1

X ray:

is air white or black
what colour is soft tissue

Answer 1

Black

grey

Question 2

CT:

what colour is bone
what colour is CSF
what colour is air
what colour is soft tissue
what colour is metal

Answer 2

White (white circle of skull bone)
Black
Black
Grey
White starburst effect

Question 3

MRI:

what colour is CSF
what colour is skull bone

Answer 3

White

Thin black circle surrounded by white circle of fat

Question 4

Indications of a CT (5)

Answer 4

Head trauma
Acute stroke
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

Question 5

Contraindications of CT

Answer 5

Minor head trauma exclusion criteria - NICE/SIGN guidelines

Question 6

Indications of MRI (7)

Answer 6

Demyelination – e.g. MS
CNS tumours 
Spine – for intervertebral disc prolapse
Transient ischaemic attacks 
Epilepsy
Paediatric neurology – developmental disorders, congenital malformations
Headache

Question 7

Contraindications of MRI (4)

Answer 7

Implanted electronics - pacemaker, cochlear implant

Moveable metallic implants - aneurysm clips, heart valves

Claustrophobia

Pregnancy

Question 8

What can angiography be used to diagnose in neuro pathology

Answer 8

Aneurysm
Arteriovenous malformation (AVM)
Carotidocavernous fistula
Unstoppable epistaxis

Question 9

What are CT perfusion scans used for (2)

Answer 9

Stroke

Tumours

Question 10

Is there increased or decreased perfusion in…

• someone with a stroke
• someone with a tumour

Answer 10

Decreased

Increased - indicating angiogenesis

Question 11

What is a PET scan essentially done to see

Answer 11

To map out glucose usage

Question 12

When are PET scans used (3)

Answer 12

Tumours
Inflammation
Infection

Question 13

Plain x rays

• advantages (3)
• disadvantages (1)

Answer 13

Universal availability
Fast
Sequential image

Lacks soft tissue detail

Question 14

Ultrasound

• advantages (2)
• disadvantages (2)

Answer 14

No ionising radiation
Less expensive equipment
Can be performed bedside

Requires wide enough open fontanelle
Image quality and interpretation requires skilful experience

Question 15

CT

• advantages (3)
• disadvantages (3)

Answer 15

Rapid
Metal and pacemaker tolerant
Good for acute haemorrhage/ skull fractures

Uses radiation
More expensive
Not mobile/portable

Question 16

Radionuclide radiology radioactive substances attached to other molecules) – e.g. PET, SPECT

• advantages (3)
• disadvantages (3)

Answer 16

To see glucose metabolism
To see perfusion
To see dopamine reuptake receptors

Unclear anatomy
Medium cost
Radiotracers can be expensive

Question 17

MRI

• advantages (3)
• disadvantages (4)

Answer 17

No ionising radiation
Good at differentiating soft tissue
Good at viewing physiological info, e.g. blood flow

Poor metalwork tolerance – danger of metal becoming projectiles
Sensitive to magnet
No pacemakers or cochlear implants allowed
Least movement tolerance
Most expensive