正常颅脑CT及MRI影像表课件

1、正常颅脑CT及MRI影像表正常颅脑CT及MRI影像表正常颅脑CT及MRI影像表NORMAL ANATOMY OF BRAINBrain is separated from calvarium by three meninges-dura mater,arachnoid membrane and pia mater. Divided into supra tentorial and infra tentorial compartments containing:- Supratentorium: Cerebral hemispheres diencephalonInfratentorium: B

2、rain stem structures cerebellum Each cerebral hemisphere is further divided in to Frontal,Parietal,Temporal and Occipital lobes by fissures 正常颅脑CT及MRI影像表正常颅脑CT及MRI影像表正常颅脑NORMAL ANATOMY OF BRAINBrain is separated from calvarium by three meninges-dura mater,arachnoid membrane and pia mater. Divided in

3、to supra tentorial and infra tentorial compartments containing:- Supratentorium: Cerebral hemispheres diencephalonInfratentorium: Brain stem structures cerebellum Each cerebral hemisphere is further divided in to Frontal,Parietal,Temporal and Occipital lobes by fissures NORMAL ANATOMY OF BRAINBrain

4、iBRAIN ANATOMYBRAIN ANATOMYSagittal surfaceLat vent GenuFornixPituitary gland Mid brainPonsMedullaCingulate gyrusQuadrigeminalcisternSpleniumColliculi4th ventCerebellumThalamusSagittal surfaceLat vent GenuFSagittal surfacePineal glandInf. ColliculiAqueduct of sylviusMidbrainCerebellum4th ventriclePo

5、nsOculomotor nInter thalamic commissure109Sagittal surfacePineal gland10Inferior surfaceInterhemispheric fissureTemporal lobe Mammillary bodies Frontal lobeOlfactory tractOptic tractPit. stalkponsMedulla oblongataCerebellumVermisInferior surfaceInterhemispherBrain stem structuresMid brain: divided i

6、nto Cerebral peduncles and colliculi. Sup colliculi attached to med.Geniculate & Inf to lateral Geniculate bodySurrounded by Peri-mesencephalic cistern.Pons: divided in to tectum and tegmentum Connects mid brain to medullaMedulla:continues as spinal cordContains ascending and descending Spinal tract

7、sBrain stem structuresMid brainCerebellumDivided into two hemispheres by falx cerebelliConnected in the midline by a worm like structure -VermisDivided into I. Anterior lobeii. Middle lobeIii. Flocculo-nodular lobeCerebellumDivided into two hemVentricles of brainLateral ventricle:-C shaped cavity wi

8、th body in the parietal lobe and extensions in the frontal temporal,occipital lobesConnected to third ventricle by foramen of monro.Third ventricle:-lies b/w two thalami.connected to fourth ventricle by cerebral aqueduct.Fourth ventricle:-lies in the cerebellumCSF Flow:-Lat.vent-foramen of monro-3rd

9、 vent-cerebral aqueduct-4th vent-foramen of magindie and luschka-sub arachnoid space finally absorbed by the arachnoid granulationsVentricles of brainLateral venVentricles of brainVentricles of brainBlood supply of the brainBlood supply of the brainBlood supply of the brain By Internal Carotid and V

10、ertebral A Internal carotid A: Middle cerebral A Ant cerebral A Post. communicating A Ant. Choroidal A Vertebral As:- two Vertebral as join to form Basilar A Branches: Ant inf cerebellar A Sup cerebellar A Pontine As & labyrinthine As Post cerebral ABlood supply of the brain By IContd.Divides into c

11、ortical and perforating APerforating As supply Basal ganglia,Thalami, internal capsuleThalamus:-Perforating br of PCAInternal cap:-Med& lat striate br of MCA,recurrent br of ACA ,Ant choroidal AMid brain:-Post.cerebral and Sup cerebellar APons:-Pontine br of Basilar ACerebellum:- cerebellar A,Post i

12、nf cerebellar AMedulla:-Ant &Post spinal A, PICAContd.Divides into cortical aBlood supply of the brainRed:- MCABlue:-ACAGreen: PCABlood supply of the brainRed:-Circle of willisCircle of willisVenous sinuses of brainStraight sinusTorculaherophiliOccipital sinusTransverse sinusSup. Sagittal sinusInf.

13、SagittalsinusVenous sinuses of brainStraighVenous sinuses.Transverse sinusStraightsinussigmoidsinusPitutiary glandICA3rd CN4th CN6th CNSphenoid boneVi Vii br Of 5th CNVenous sinuses.Transverse sinAxial sectionCingulategyrusCaudateheadPineal glandCorpus callosumLentiform nucleustrigoneSup.cerebellar

14、cisternThalamusAxial sectionCingulateCaudatehCoronal sectionCoronal sectionCT TechniquePatient is kept in supine position and head is placed in the gantry under the cursors.Axial sections are taken at an angle of 10-13 degree to the canthomeatal line.Slice thickness:- Posterior fossa:-5mmSupra tento

15、rial structures:-10mmPituitary gland and sellar region:-1- 3mm (coronal sections )CONTRAST STUDIES: done by injecting 100 ml of 60%iodinated contrast CT TechniquePatient is kept in contd.Normal enhancement : Arterial &venous structures Dural structures:-falx,tentorium Choroid plexus Pituitary glandI

16、ndications of CECT: I.Infections: ring enhancing lesions eg tuberculoma, neurocysticercosis,Meningitis,Encephalitis ii.Tumours:astrocytomas,meningiomas iii. Vascular lesions: aneurysms,AV malformationsContraindications of CECT: I.history of allergy,renal failure ii.acute haemorrage ; contd.Normal en

17、hancement :Axial sections-TopogramFor CT Axial sections are taken at an angle of10-13degree to the Canthomeatal lineFor MRI sections are parallel to the reference lineAxial sections-TopogramFor CT CT Brain contdNormal HU values in NCCT brainGray matter:- +36-42 HUWhite matter:- +26-34 HUCSF:- +4-11H

18、UBone:- +200 to +1000 HUCalcification:- +100 to +220 HUBlood:-+56-80CT Brain contdNormal HU valueMRI ImagingMultiplanar modlity so sections can be taken in axial ,coronal and sagittal planesSlice thickness is same as CT imaging. Routinely applied sequences are T1 Weigheted spin echo T2 Weigheted spi

19、n echo Proton density imagesAnatomy of brain is better explained on T1W seq while pathologies are better studied on T2W and Proton density sequences.MRI ImagingMultiplanar modlityTISSUE CHARACTERISTICSSeq Parameters CSF Gray M WhiteM FatT1W short TR Hypo iso hyper hyper short TE T2W short TR hyper i

20、so hypo iso / long TE hypoProton long TR iso Iso iso/hypo hyperdensity short TE blood vessels appear signal void in all the sequences calcification and fibrous tissue appear hypointense in all sequences TISSUE CHARACTERISTICSSeq PMRI Axial section above foramen magnumMaxillary sinusBasilar A.Medulla

21、Cerebellar hemisphereCisterna magnaTonsilsPetrous boneSphenoid sinusNasal cavityZygomatic archMRI Axial section above forameCT Axial section above foramen magnumFrontal sinusSphenoid sinusTemporal lobeBasilar A.Mastoid cellsCerebellar hemisphereCisterna magnaMedullaOptic nervePituitarySphenoid boneT

22、emporal boneCerebellar tonsilsCT Axial section above foramenMRI Axial Section at 4th VentricleLensOptic nervePituitaryTemporal lobeMiddle cerebellar peduncle4th VentricleMedial rectusLateral rectusPonsPetrous temporal boneCerebellar hemisphereMRI Axial Section at 4th VentrCT Axial section at 4th ven

23、tricleFrontal sinusFrontal boneMid.cerebral ABasilar A.Pons4th ventcerebellumMid cerebellarpedunclePetrous boneTemporal hornAnt.cerebral aSella turcicaVermisCT Axial section at 4th ventriMRI Axial Section above 4th ventricleSuperior oblique musclePituitary stalkUpper ponsSuperior cerebellar peduncle

24、Optic chiasmaAmbient cisternCerebellar foliaMRI Axial Section above 4th veCECT Axial section above 4th ventricle Frontal lobe Ant cerebral A.4TH ventCerebellum Pons Temporal hornInfundibulum Post.cerebral A.Sphenoid boneFrontal boneFrontal sinusMid.cerebral ACECT Axial section above 4th vMRI Axial s

25、ection at midbrainFrontal lobeInterpeduncularcisterninferiVermisInferior colliculiConfluence of sinusesAmbient cistern UncusOptic tractMid cerebralACerebral peduncleAnt cerebral AMRI Axial section at midbrainFMRI Axial section at 3rd ventricleGenu of corpuscallosum Caudate head Lentiform nuleusThala

26、musSplenium of corpus callosumFrontal hornsInsula3rd ventricleOccipital hornsOptic radiationMRI Axial section at 3rd ventrCT Axial section at 3rd ventricleGenu of corpus callosumCaudate nucleus3rd ventriclePineal glandvermisOccipital lobeChoroid plexusThalamusLentiform nucleusFrontal hornPericallosa

27、l ACT Axial section at 3rd ventriMRI Axial section at mid ventricleCingulate gyrusBody of lateralventricleCorpus callosumCentral sulcusCorpus callosumInter hemisphericfissureMRI Axial section at mid ventrCT Axial section at mid ventriclesCingulate gyrusBody of lateral ventricleCorpus callosumFalx ce

28、rebriOccipital hornsParietal lobeCorona radiataFrontal hornsConfluence of Sinuses (torcula)CT Axial section at mid ventriMRI Axial section at centrum semiovaleInter hemispheric fissureCentrum semiovaleOccipital lobeParietal lobeFrontal lobeMRI Axial section at centrum sCT Axial section at centrum se

29、miovaleFalx cerebriCentrum semiovaleOccipital lobeParietal lobeFrontal lobeCT Axial section at centrum seMRI Coronal section at 3rd ventricleFrontal hornsFornix3rd ventricleClivusInterpeduncularcisternInsulaSylvian fissureTemporal lobeParotid glandOdontoid (dens)MRI Coronal section at 3rd venMRI Cor

30、onal section at suprasellar levelInter hemispheric fissureLat ventricleLat.Pterygoid MsNasopharynxMed.Pterygoid Ms.Sylvian fissureSphenoid sinusPituitary glandOptic chiasmAnt cerebral aMid cerebral AMRI Coronal section at supraseMRI Coronal section at post. ventricleParietal lobeSplenium of corpus c

31、allosumSup.cerebellar cisternTentoriumChoroid plexusAtria of lateral ventricle 4th ventricleMRI Coronal section at post. vMRI Sagittal sectionLat ventGenu3rd ventSphenoid sinusNasopharynxBody of CCSpleniumQuadrigeminal cisternPons4th ventMedullaCerebellumTonsilCingulate gyrusPrepontine cisternMRI Sa

32、gittal sectionLat ventGeCT Coronal section for Pituitary glandPatient is kept in prone position in sub mento vertical position,in the head rest of CT tableTopogram is taken in this position and planning is done so that cut sections parallel to the line passing from frontal bone to mentis is takenFor

33、 pituitary 1-3mm thick sections are taken in the coronal plane starting from anterior to posterior.CT Coronal section for PituitaCT Coronal section for Pituitary glandLateral ventAnt.cerebral APituitary glandOptic chiasmSphenoid sinusLat.pterygoid plateNasopharynxLat. Pterygoid msMid.cranial fossaCT

34、 Coronal section for PituitaCT Coronal section for Pituitary glandLat pterygoid plateSphenoid sinusMid.cerebral aAnt.cerebral aFrontal sinusInternal carotid aNasopharynxPituitary glandCT Coronal section for PituitaCT Axial section (bone window)Petrous boneMastoid air cellsCarotid canalForamen ovaleSphenoid sinusBase sphenoidEustachian tubeExt.acoustic canalLambdoid sutureOccipital boneCT Axial section (bone window)CT Axial sections(bone window)Ear ossiclesMastoid air cellscochleaInt. acoustic meatusAditus to antrum boneFacial n can