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NEUROLOGY > NeuroRadiology > Flashcards

NeuroRadiology Flashcards

1
Q

What would indicate the need for brain imaging?

A
  • headache/ raised ICP
  • seizure
  • weakness
  • stroke
  • trauma
  • loss of conciousness/ neurological deficit
  • Post Op monitoring
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2
Q

What are the advantages of CT scans?

A

Excellent bony details/spatial resolution
Fast
Compatible with emergency/ICU equipment

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3
Q

What are the disadvantages of CT scans?

A
  • Only sensitive to blood EARLY in acute injury
  • Poor soft tissue detail
  • Grey and white matter show little difference in density
  • High radiation dose
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4
Q

What shows up bright and what shows up dark on CT imaging?

A

Bright = More dense => bone, any metal implants

Dark = Less dense => air

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5
Q

What are the advantages of MRI scanning?

A
  • Excellent contrast/soft tissue resolution
  • Excellent depiction of anatomy
  • Good for visualising marrow and cord pathologies
  • Multiplanar
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6
Q

What are the disadvantages of MRI scanning?

A
  • Less bony detail/spatial resolution
  • Not compatible with pacemakers and many implants (due to magnet)
  • Not compatible with ICU/emergency equipments
  • Not as quick as CT
  • Patient cooperation required
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7
Q

Why are different MRI sequences used and give some examples of commonly used sequences.

A

Multiple sets of MRI images are taken at the one time
(e.g. T1, T2 etc)

=> Different sequences use different combinations of technical parameters
=> Each sequence is unique and gives different information.

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8
Q

What components of the brain enhance as “hyperintense” on T1-weighted MRI imaging?

A 
3 Fs and 4Ms 
F: fat
F: slow flow (e.g. partially blocked vessel)
F: fluid (containing protein)
M: melanin
M: methaemoglobin (blood)
M: mineralisation (Ca/Mg etc)
M: Magnevist (gadolinium contrast)
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9
Q

What components of the brain appear as “hypointense” on T1-weighted imaging?

A 
Water
High Flow (e.g. arteries)
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10
Q

What shows up as hyperintense on T2-weighted MRI imaging?

A

Water or any fluid collections
- oedema, demyelination, gliosis, some tumors

Fat (this can be suppressed by design)

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11
Q

What shows up as hypointense on T2-weighted imaging?

A
  • Some blood products (subacute hematoma)
  • Mineral deposition
  • High flow (e.g. arteries)
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12
Q

What are some of the basic sequences used in MRI and why are they used?

A

T1, T2,
FLAIR (Type of T2 where free water = suppressed e.g. ventricles)

T2* (gradient echo) = highlights blood

T1 (3D): Volumetric

Contrast enhancement = increases density of objects needing to be visualised

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13
Q

Any structure within the blood-brain barrier resists contrast. TRUE/FALSE?

A

TRUE

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14
Q

Why is gadolinium used as MRI contrast?

A
  • Patients are not allergic to it like iodine CT contrast

- Has many unpaired electrons which cause an MRI signal to be picked up

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15
Q

What vascular pathologies would you expect to see on brain imaging?

A
  • Infarcts
  • Haemorrhage
  • Vascular anomalies
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16
Q

Describe how a thrombus in a blood vessel of the brain will appear on CT?

A

Bright

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17
Q

Why is MRI more sensitive to diagnosing stroke?

A

Grey and white matter differentiation on CT not good enough to outline small infarcts

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18
Q

Why is CT completed first over MRI on presentation of stroke?

A

Faster

Gives indication of infarct vs haemorrhage and whether pt should receive thrombolysis

19
Q

An intreparenchymal bleed can break through to the ventricles. TRUE/FALSE?

A

TRUE

20
Q

What is a Susceptibility weighted imaging (SWI) MRI sequence used to look for?

A
  • sensitive to venous blood
  • especially old venous blood that cannot be picked up on CT
    => looking for haemorrhage and iron storage
21
Q

what usually causes a subarachnoid haemorrage?

A

Usually due to aneurysm

22
Q

How long after an IV injection of CT contrast does it show up in arteries?

A

8-10s

23
Q

In what type of imaging is CT contrast used?

A

CT angiogram

24
Q

Why are arteries and veins easy to distinguish in the brain?

A

separated anatomically

=> distinct from each other in imaging

25
Q

What imaging modality is used for aneurysm follow up?

A

MRI

26
Q

Describe how a “cavernoma” (type of vascular anomaly) appears on imaging?

A

Popcorn appearance

Ca2+ present

27
Q

MRI is more sensitive than CT for small aneurysms. TRUE/FALSE?

A

FALSE - CT more sensitive due to use of contrast, MRI angiography often doesnt use contrast

28
Q

X-Rays are still routinely completed in trauma cases. TRUE/FALSE?

A

FALSE

29
Q

What modality of imaging is sensitive for bone injury and ACUTE bleeding in trauma?

A

CT

30
Q

What structures in the brain are rather immobile if a bleed occurs and compresses them?

A

Falx Cerebri - quite stiff and wont initially move much with internal bleed

31
Q

What is brain contusion, and where does it usually occur?

A
  • Part of many traumatic brain injuries
  • Bruise of the brain tissue
  • associated with multiple microhemorrhages
  • usually occurs on underside of frontal lobe
32
Q

Describe the difference between the appearance of an extradural and subdural haematoma on imaging

A

Extradural - biconvex, lemon-shaped and do not cross sutures

Subdural - concave, banana-shaped, crescentic, can cross sutures

33
Q

What is the difference in location between intra and extra-axial neoplastic processes?

A

Extra-axial - outwith brain parencyhma

Intra-axial - within brain parenchyma

34
Q

Intra-axial neoplastic processes are more likely to be benign. TRUE/FALSE?

A

FALSE
extra-axial = more often benign
nitra-axial = mostly malignant

35
Q

Give examples of benign extra-axial tumours

A

meningioma
pituitary adenoma
dermoid/epidermoid
acoustic schwannoma

36
Q

Give examples of intra-axial tumours

A

Glioma
Glioblastoma
Metastases

37
Q

What is a chiari malformation?

A
  • Congenital problem
  • lowest part of the back of the brain extends into the spinal canal
  • Can put pressure on the brainstem, spinal cord, and obstruct the flow of fluid.
38
Q

What is cortical dysplasia?

A

Migration of sensory and motor information to the outer cortex during development is impaired
- grey and white matter seem “blurred” in the dysplastic areas

39
Q

What is polymicrogyria?

A
  • the brain develops too many folds (gyri and sulci)

- the folds are unusually small.

40
Q

What is schizencephaly? How does it look on radiology and what can this cause?

A
  • slits across grey and white matter from outer cerebral cortex
  • clefts in both hemispheres commonly have developmental delays, delays in speech and language skills, seizures, and problems with brain-spinal cord communication
41
Q

How does demyelination usually affect the brain?

A

Occurs in white matter surrounding small veins

- demyelination occurs perpendicular to corpus callosum

42
Q

What type of MRI imaging would you use to visualise demylination of the white matter?

A

T2 and FLAIR

43
Q

Where in the brain does Herpes Encephalitis normally occur, and what does it cause in these areas?

A
  • Temporal lobe and limbic system

- swollen neurones seen

44
Q

What is CJD?

A
  • spongiform encephalopathy of brain => degenerative

Early Symptoms:

  • memory problems
  • behavioural changes
  • poor coordination
  • visual disturbances

Later Symptoms:

  • dementia
  • involuntary movements
  • coma

NEUROLOGY (29 decks)

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