بسم الله الرحمن بسم الله الرحمن الرحيمالرحيم

DR HAMDY HASSAN , FRCRDR HAMDY HASSAN , FRCRASSISTANT PROFESSORASSISTANT PROFESSOR

CONSULTANT RADIOLOGISTCONSULTANT RADIOLOGIST

KING KHALID UNIVERSITY HOSPITALKING KHALID UNIVERSITY HOSPITAL

INVESTIGATION OF CNSINVESTIGATION OF CNSPart IIPart II

Left parietal fracture

Fracture left inferior orbital wall

Hyperparathyroidism(Salt and pepper)

Hyperparathyroidism

Brown tumour

Multiple myeloma

Multiple myeloma

Depressed skull fracture

Bone windowBrain window

fracture

Bone window

Acute extradural hemorrhage

Bone window Brain window

fracture

Acute subarachnoid hemorrhage

Acute intraventricularhemorrhage

Acute intracerebralhemorrhage

Acute ischemic infarction

CT MRI-T2WI

MRI-DiffusionMRI-FLAIR

Acute infarction

LEFT MCA INFARCTION

Thrombosis in MCA

Hyperdense basilar artery

Acute infarction due to basilar artery thrombosis

Acute infarction due to basilar artery thrombosis

Diffusion sequence

Old infarction

Acute and old infarction

Old infarction

Acute infarction

Follow up

Role of Recent Advanced Techniques in Diagnosis of Stroke

Ischemic tissue can be divided into two compartments:

1) The infarct core representing the dead or dying tissue is at the center of the infarction.

2) The zone around the central core may have lost electrical activity, but it has more moderate reductions in blood flow and is defined as the penumbra. With reperfusion this tissue may be salvageable, but without reperfusion it may go on to infarction.

cerebral blood volume cerebral blood flow

CT PERFUSION

Acute stroke in a 65-year-old man with left hemiparesis. mismatched abnormalities (arrows) that implythe presence of a penumbra. The area with decreased blood volume represents the ischemic core, and that withnormal blood volume but decreased blood flow and increased mean transit time is the penumbra.

cerebral blood volume cerebral blood flow mean transit time

CT PERFUSION

On the left we first have a diffusion image indicating the area with irreversible changes (dead issue).In the middle there is a large area with hypoperfusion.On the right the diffusion-perfusion mismatch is indicated in blue.This is the tissue at risk.This is the brain tissue that maybe can be saved with therapy.

MR DIFFUSION PERFUSION

On the DWI there is a large area with restricted diffusion in the territory of the right MCA.

There is a perfect match with the perfusion images, so this patient should not undergo any form of thrombolytic therapy.

2

MR DIFFUSION PERFUSION

Evolution of cerebral infarction with time

Meningioma

Meningioma

Post contrast

Glioblastoma

Glioblastoma

Post contrast

Brainstem glioma

PITUITARY MACROADENOMANormal Pituitary

CRANIOPHARYNGIOMA

Multiple sclerosis