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2/3/20232CommunicationforBetterPatientCareCommunicatingwithPatientsCommunicatingwithColleaguesCommunicatingwithStudentsCommunicatingwiththePublicRadiology2005;234:13–142/3/20233TechniquesplainfilmofskullcerebralangiographyCTnon-enhancedCTenhancedCT脑池造影CT(CTcisternography)CTA2/3/20234TechniquesMRInon-enhancedMRIDWI,DTI,SWIenhancedMRIPWI(perfusion)MRAMRSfMRI2/3/20235NormalImagingAnatomyskullandbrain2/3/20236Normalheadplainfilm;A-Pandlateralview2/3/20237PlainFilmofSkull颅板颅缝与囟门颅板压迹脑回压迹脑膜中动脉压迹板障静脉压迹蛛网膜颗粒压迹蝶鞍内耳道颅内生理性钙斑松果体钙化大脑镰钙化床突间韧带钙化脉络丛钙化2/3/20238松果体钙化Calcificationofpinealgland2/3/20239床突间韧带钙化2/3/202310Normalchildheadplainfilm;A-Pandlateralview2/3/202311CerebralAngiography颈内动脉internalcarotidartery颈外动脉externalcarotidartery椎动脉vertebralartery2/3/202312internalcarotidarterymiddlecerebralAanteriorcerebralA

2/3/202313

anteriorcerebralAmiddlecerebralAinternalcarotidartery2/3/202314ComputedTomographyoftheHead(HCT)OftenthefirstimagingexamofthebrainFirstlineimagingoftraumapatientsEasytoobtainQuickstudyIntravenouscontrastadministrationUsuallynotindicatedintraumapatients,whereitcanobscurehemorrhageAllowsforfurtherlesioncharacterizationinotherclinicalsettings2/3/202315CT切面的角度Canthomeatalline眼角-外耳道连线(150)(redline)2/3/202316NormalaxialCT颅底层面（levelofthebaseoftheskull）第四脑室层面（thefourthventricularlevel）鞍上池层面（suprasellarcisternlevel）第三脑室前部层面（anteriorthethirdv.)第三脑室后部层面(posteriorthethirdv.)侧脑室体部层面(midventricularlevel)侧脑室顶部层面(highventricularlevel)侧脑室上层面(abovetheventricularlevel)2/3/202317AxialbrainCTscan2/3/202318正常垂体冠状位增强Normalcoronalpituitaryglandenhancement2/3/202319CerebralparenchymaCortex,medulla,brainstem,cerebellumCSF(cerebrospinalfluid)ventricle池(cistern)、裂(fissure)、沟(sulcus)中线结构(interhemisphericstructure)生理性钙化(pinealglandcalcification)ContrastEnhancement,CE2/3/202320CT

“TheWorkhorse”TraumaAcutesubarachnoidhemorrhageCVADetectionofcalcificationsSinusdiseaseTemporalbonedisease2/3/202321DensFracture2/3/202322EpiduralHematomafracture2/3/202323SubarachnoidHemorrhage2/3/202324TuberousSclerosiscalcification2/3/202325MRIoftheBrainAmorecomprehensiveexamthanCTforvirtuallyallclinicalindicationsBetterresolution&contrastNoradiationCanimageinmultipleplanes2/3/202326MRICerebralParenchymacortex,medullaCSFFatCortexofbone,calcification,meningesCerebralvesselsCranialnerve2/3/202327T1WI,T2WIMRI2/3/202328冠状位、矢状位T1WIMRI2/3/202329High-ResolutionMRAat3T2/3/2023302/3/202331异常MRI影像水肿呈长T1长T2；出血因血肿期龄而异，梗塞急性期呈长T1长T2；梗塞纤维修复期呈长T1

短T2或长T2；肿块呈略长T1略长T2；脂类呈短T1长T2；骨化钙化呈长T1短T2；黑色素瘤（顺磁物多）呈短T1短T22/3/202332病理组织信号强度组织CT密度T1WIT2WI水肿低低高含水囊肿低低高瘤结节等、高低高亚急性出血高高高钙化高低低脂肪低高高胆固醇低中、高高三酸甘油脂黑色素瘤低高高高低低2/3/202333glioblastoma2/3/2023342/3/2023352/3/2023362/3/202337DiffusionTensorImagingTractographyFunctionalBoldMRIPerfusionMRImagingMRSpectroscopyMRAngiographyAdvancedNeuroImagingMagneticResonanceImaging1.5to8Tesla2/3/202338PERFUSIONRapidimagingisperformedduringabolusinjectionofaparamagneticcontrastagentAstheagentpassesthecerebralvasculature,thereisadropinthemeasuredsignalduetotheT2*effectsoftheagentIdentifysalvageabletissueinCVAorperfusionchangesintumorsGadolinium-DTPA2/3/202339ConventionalMRimagesandrCBVmapin37-year-oldmanwithbiopsy-provedWorldHealthOrganizationgradeIIIastrocytoma.(a)Transversecontrast-enhancedT1WIshowsinhomogeneousmassinrightfrontallobe.Anteriorportionofthemass(arrowhead)showscontrastenhancement;posteriorhalfofthemassdoesnot.(b)BaselinetransverseEPIT2*WIefromDSCsequence(precontrast)showshomogeneoushyperintensesignalthroughoutthemass.(c)

rCBVmapshowsthatanteriorportionofthemass(correspondingtocontrast-enhancedportionina)hashighrCBV(redandyellow),andposteriorportionhaslowrCBV(blue).Radiology:Volume2392/3/202340DIFFUSIONSensitivetothemicroscopicmotionofH2OmoleculesIsdirectiondependentT2shine-throughMostsensitiveindicatorofischemiaAcuteCVAlooklikeLIGHTBULBS2/3/202341CVA2/3/202342DiffusionImagingBeyondStrokeNeoplasmsDemyelinatingdiseasesInfectionHemorrhageDiffuseaxonalinjury(DAI)2/3/202343Abscess2/3/202344Epidermoid2/3/202345MRSpectroscopy1H(proton),23Na,31PProvidesspectralandmetaboliteinformationbydeterminingthelevelsofselectneurochemicalsIdentifyareasofneuronallossand/ormetabolicabnormalityComplimentarywithMRIfordiagnosis2/3/202346LongTEProtonBrainSpectrumHealthyvolunteer

NAA 2.02ppm

Cr 3.02ppm

3.90ppm

Cho 3.20ppm

lipids* 1.3ppm

whenpresentlactate* 1.3ppm

whenpresent*notseeninnormalbrainspectraMetabolitesNormalvsTumorAngleRev