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Klaus Sartor
MRImaging of the Skull and Brain A Correlative Text-Atlas
With Contributions by H. Gries, W. Loeffler, S. A. Mirowitz, U. Speck, H.-J.Weinmann
With a Foreword by Mokhtar Gado
With 690 Figures Containing 2455 Separate Illustrations
Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest
Klaus Sartor, M. D. Professor of Neuroradiology Director, Dept. of Neuroradiology; Center for Neurological Diseases and Diseases of the Head and Neck (Kopfklinik) University of Heidelberg Heidelberg, Germany
formerly Associate Professor of Radiology Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis, Missouri, USA
ISBN-13: 978-3-642-75527-9 DOl: 10.1007/978-3-642-75525-5
e-ISBN-13: 978-3-642-75525-5
Library of Congress Cataloging-in-Publication Data Sartor, Klaus. MR imaging of the skull and brain: a correlative text-atlas / Klaus Sartor; with contributions by Gries H .... ret al.l. p. cm. Includes bibliographical references and index.
1. Brain - Magnetic resonance imaging. 2. Skull - Magnetic resonance imaging. 3. Brain - Magnetic resonance imaging - Atlases. 4. Skull- Magnetic resonance imaging - Atlases 1. Gries, H. (Heinz) II. Title. [DNLM: 1. Brain - pathology - atlases. 2. Brain Diseases - diagnosis - atlases. 3. Brain Injuries -diagnosis - atlases. 4. Magnetic Resonance Imaging - methods - atlases. 5. Skull- pathology -atlases. WL 17 S25ml RC386.6.M34S26 1992 616.8'047548 - dc20 DNLMIDLC for Library of Congress
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© Springer-Verlag Berlin Heidelberg 1992 Softcover reprint of the hardcover I st edition 1992
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23/3145-543210 - Printed on acid-free paper
For Helga and Julia - with a promise
Gyroscope
This admirable gadget, when it is Wound on a string and spun with steady force, Maintains its balance on most any smooth Surface, pleasantly humming as it goes. It is whirled not on a constant course, but still Stands in unshivering integrity For quite some time, meaning nothing perhaps But being something agreeable to watch, A silver nearly silence gleaning a still-ness out of speed, composing unity From spin, so that its hollow spaces seem Solids of light, until it wobbles and Begins to whine, and then with an odd lunge Eccentric and reckless, it skids away And drops dead into its own skeleton.
Howard Nemerov Reprinted with kind permission of the author from "The Collected Poems of Howard Nemerov", The University of Chicago Press, 1977
Foreword
Several excellent reference and textbooks on magnetic resonance (MR) imaging are available to readers interested in this field. They vary markedly in scope, however, ranging from mere collections of case presentations to detailed coverage of the physical principles and clinical applications. Dr. Sartor has taken a unique approach, and his work is a welcome addition to the desktop library of practitioners of the clinical neurosciences. The features which make this book special are also those which make it appealing to an even wider audience. For the seasoned neuroradiologist it is a quick, attractive, up-to-date reference on craniocerebral MR imaging, while for the newcomer who is more familiar with "traditional" radiology in the diagnosis of diseases of the central nervous system it is an advanced introduction to clinical MR, also providing information about the relative merits of the various diagnostic modalities. By addressing correlative analysis and choice of modality the book provides the necessary link between the two technologic fields, that is , "traditional" and "modem" neuroradiology. For neurologists and neurosurgeons, and for ophthalmologists, otolaryngologists, and other specialists of diseases of the head and neck as well, this book contains a wealth of information on state-of-the-art craniocerebral radiology presented in the context of pathology and the clinical problem.
Perhaps the most striking feature of the book, considering today's practice of multiauthorship with much smaller undertakings, is that it was essentially written by one person, with contributions from only a few collaborators. The text thus flows smoothly, is uniform in style, and is never marred by fragmentation or duplication. Another unusual feature - and one of the key elements of the book's straightforward organization - is that conditions which according to their MR appearance enter into the differential diagnosis of a disease entity are listed at the end of the discussion of the entity and are further cross-referenced by page number. Although the book is entitled MR Imaging of the Skull and Brain, it is more than just another monograph on this fascinating new diagnostic method; it is a handy reference of modem neuroradiology emphasizing cranial MR imaging. As an experienced neuroradiologist, the author addresses the subject from the angle of the clinical practitioner solving a diagnostic problem. He therefore consistently takes a thematic approach, covering each disease entity at three levels. This starts with a summary of the relevant pathologic and clinical aspects, thus placing the radiologic discussion in proper perspective. Then a brief but comprehensive review of current knowledge of "traditional" radiologic methods such as radiography, computed tomography, and angiography follows as a prelude to the extensive discussion of the MR aspects of the condition. The main emphasis in MR imaging is placed on clinical applications rather than physical principles.
I have known the author for many years. He held the position of Associate Professor of Radiology (Neuroradiology) at the Mallinckrodt Institute of Radi-
VIII Foreword
ology (MIR) at Washington University in St. Louis, Missouri, where the idea of writing this book was conceived and where much of the material and text was compiled. Klaus Sartor and I worked closely during the time he spent at MIR and I know that he is a scholar with an exquisitely analytical mind and a tireless drive towards perfection. The reader can be assured of the quality of this work, which is the product of long labor. I wish my former associate Klaus Sartor good luck and all the success that he rightfully deserves with this impressive book.
St. Louis MOKHTAR GADO, M. D. Professor of Radiology and Neurological Surgery
Preface
Less than a decade after the advent of computed tomography (CT) another imaging method thought to open a new window into the body was introduced in medicine. Again it was the brain where nuclear magnetic resonance (NMR) imaging, later called magnetic resonance (MR) imaging or simply MR(I), first demonstrated its potential. Preliminary studies on both normal volunteers and patients with known intracranial disease resulted in an image quality comparable to or better than that of early CT. Meanwhile, barely another decade later and after the introduction of paramagnetic contrast agents, the new diagnostic tool has evolved to an astonishing level. No longer a slow procedure and still becoming faster, MR now produces images of the head (or spine) that in most neurodiagnostic situations greatly surpass those of CT. Advanced three-dimensional MR already assists in the structural analysis of complex cerebral anatomy, paving the way for in vivo morphometry, while various other MR-based techniques are being tested for their potential as functional studies. Considering the rapid transformation of MR from a rather crude method into a sophisticated one, it is not too difficult to understand why, when properly used, this extremely safe imaging modality became accepted in the clinical neurosciences before there was sound scientific proof of its diagnostic superiority.
Today MR is becoming increasingly available for diagnosis of neurologic diseases, though faster in the USA, Europe, and Japan than in less privileged parts of the world. Correspondingly, the interest in practical aspects of the method is also growing. Common questions posed by radiologists, neurologists, neurosurgeons, maxillofacial surgeons, ophthalmologists, ENT specialists, and other physicians caring for patients with disorders of the brain and the head and neck are: When should MR be used? How should it be performed? What information can be expected and what cannot? In view ofMR's most obvious strength - detailed depiction of morphology - interest is presently focused on structural abnormality; people want to learn primarily about morphologic alterations that define a certain disease, possibly distinguishing it from another. Regarding these issues, an impressive amount of knowledge has already been accumulated, but rigidly controlled efficacy studies are still lacking. Until such studies are done, communicating the existing, largely empirical knowledge by critically comparing the performance of MR with that of CT and other radiologic tests may be the second-best thing. Therefore, after more than 8 years of involvement in clinical MR neuroimaging at two major universities in the USA and Germany, and after altogether about 20 years of neuroradiologic practice, I'd like to share my experience. This I intend to do by presenting a comprehensive treatise on MR imaging of the skull and brain that combines a concise but, I hope, palatable text with a large number of carefully illustrated case presentations.
Why the term skull in the title of a book that deals almost exclusively with cranial neuroimaging? Well, because MR's ability to show bony abnormalities
X Preface
related to, or potentially causing, intracranial disease can no longer be ignored. Then why a book on MR neuroimaging essentially confined to diseases of the brain and its immediate surroundings? Well, simply because there is enough information to convey, and the diseases of the spine and spinal cord have already been covered in several excellent monographs. Instead of discussing the various diseases largely on the basis of MR findings I have elected to inform the reader first about pathology (pertinent findings, both gross and microscopic), neurology (common symptoms and signs, accepted treatment, course of disease), and traditional radiology (utility and results of previously available but not necessarily conventional methods). Thus prepared, even readers without any MR experience will be able to make the necessary conceptual transition fairly easily; drawing analogies between CT and MR is particularly encouraged. Differential diagnoses, which are occasionally mentioned in the text but consistently summarized after the discussion of individual diseases or groups of diseases, are solely MR related; they refer to similarities of MR appearance, not clinical similarities. As to fundamentals (including MR anatomy), I did not intend to compete with existing texts; I merely wanted the reader to have direct access to as much information as would be necessary for an understanding of the clinical chapters, which form the bulk of the book. What has come out of my work is, strictly speaking, not a pure MR book on craniocerebral diseases but a heavily MR-weighted book on cranial neuroradiology.
The book is based on more than 20000 MR imaging studies performed during my 6-year tenure at the Mallinckrodt Institute of Radiology, Washington University, St. Louis, USA, and my now over 2-year tenure at the Department of Neuroradiology, University of Heidelberg, Germany; important additional case material has come from numerous colleagues from all over the world. Unless clearly stated by the term presumed, all diagnoses are verified, either histologically, where appropriate, or by strong clinical evidence. While I tried hard to include only studies of high quality, preferably done on state-of-the-art MR equipment, a few compromises were unavoidable. The reader will immediately notice that as far as MR technique is concerned the emphasis is on spin echo (SE) imaging. In fact, whenever questions arise as to what type of sequence the text is referring to, standard SE may be assumed. That such terms as Tl-weighted, T2-weighted, and proton density (PD )-weighted are imprecise is known to all with more advanced knowledge of MR. For want of something better I have used them nonetheless in the general text, as is still common practice in scientific journals. In the figure captions, however, I was able to avoid them almost entirely; instead, I mentioned the imaging parameters by following the ACR recommendations as far as possible. I am also aware of the weaknesses of such terms as dense, density, hypo density, and the like when used to describe differences in X-ray attenuation on CT images. I deliberately left these potentially misleading terms in because I wanted readers to see certain CTIMR analogies (density/intensity) more readily. Terms like specific/specificity and sensitive/sensitivity were nearly always used in a nonstatistical sense. Most scientific references cited were found in major, prevailingly radiologic, journals published in English; some were taken from German-language journals. The clinicopathologic discussion regarding the various disorders was influenced particularly by my reading of such great sources of knowledge as Merritt's Textbook of Neurology, Greenfield's Neuropathology, Principles of Neurology by Adams and Victor, Child Neurology. A Clinical Manual by Berg, and Brain Tumors by Zulch.
Preface XI
Many people helped me in many ways to succeed in completing this book; without their assistance, which I gratefully acknowledge, I would have failed. I want to especially thank Heinz Gries, Wilfried Loeffler, Scott Mirowitz, Ulrich Speck, and Hanns-Joachim Weinmann for their contributions to some of the chapters. I am also greatly indebted to the Siemens Corporation, Erlangen, Germany, for providing some of the MR images used in Chap. 3. Much of my motivation to start this work at all lowe Ronald Evens, chairman, and his staff at the Mallinckrodt Institute of Radiology (MIR), whose combined efforts have created a scientifically unique environment with a great professional relationship among the people working there. Important suggestions regarding the concept or contents of my book, often after having read large parts of the manuscript, were provided by Fritz Albert, Karsten Boker, Georg Fahrendorf, Michael Forsting, Mokhtar Gado, Charles Garvin, Suzanne Gronemeyer, Werner Hacke, Fred Hodges, Rudiger von Kummer, Walter Lemann, Allan Romano, Elliot Shoemaker, and James Winthrop. Most of the word processing was done by Nancy North, whose patience with my idiosyncrasies I shall never forget; Beverly McDonald assisted in the preparation of some of the manuscript. After my move back to Germany I was less fortunate than in St. Louis: I had to do the typing myself. While much of the photographic and art work is my own, a considerable proportion of photographing was done by Eva and Hubert Bontzol from Medical Photography, Department of Radiology, University of Heidelberg. Photographic prints were all made by the Bontzols, by Thomas Murry and Norman Hente, Medical Photography, MIR, or by the staff of Medical Illustrations, Washington University School of Medicine. The quality of the case illustrations in the book is also closely related to the high degree of professional dedication of the radiologic-technologic staff at both MIR and my new department in Heidelberg. Several young colleagues I am working with now, notably, Uta Meyding-Lamade, Gunter Muller, and Helmut Wollanka, helped me in various ways, in particular, by obtaining clinical information for case presentations. I should like to also thank those clinicians in St. Louis and Heidelberg who generously provided me with follow-up information or final diagnoses regarding their patients.
This book was originally (in the early 1980s, that is) conceived as an introductory text, meant to have something like 300 pages, with a reasonable number of "pictures." That it became a bit more voluminous and a bit less introductory than planned is as much related to my constant striving to remain up-to-date as it is to the benevolent understanding of my publisher, Dietrich Gotze. The other important persons at Springer-Verlag who had to put up with me in one way or another were Sherryl Hirsch, Barbara Montenbruck, and Jaroslaw Sydor; they did this empathetically more than stoically and thus encouraged me, sometimes unwittingly so, to keep on going.
Now that the job is done, I am convinced more than ever of MR's enormous diagnostic importance and fear little about its future. One does not need a crystal ball to foresee that this imaging method is unlikely to stop at showing normal or abnormal craniocerebral structures more beautifully and in greater detail than before but is also going to be used increasingly to reveal abnormalities of function.
Heidelberg/St. Louis KLAUS SARTOR
Contents
CHAPTER 1 Fundamental Physics and Chemistry Wilfried Loeffler; Hanns-Joachim Weinmann, Heinz Gries, Ulrich Speck
Introduction 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (Wo Loeffler) 1 Nuclear Magnetic Resonance 00000000000000000000000000000000000 1 Relaxation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 Image Formation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 Pulse Sequences and Image Contrast 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9
Gradient Echo Sequences 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 Steady State Sequences 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 Spin Echo Sequences 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 Inversion Recovery Sequences 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12
Instrumentation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 Magnet System 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 Gradient System 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 RF Electronics 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 RF Coils 00000000000000000000000000000000000000000000000000 14 Computer System, Display System, and Software 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 Potential Hazards 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15
Image Artifacts 0000000000000000000000000000000000000000000000 16 Chemical Shift Misregistration 00000000000000000000000000000000 16 Edge Ringing (Truncation Artifact) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17 Aliasing (Wrap-Around Artifact) 00000000000000000000000000000 17 Metal Artifacts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17 Magnetic Susceptibility 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19 Gradient Nonlinearity and Magnet Inhomogeneity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19 Motion and Flow Artifacts 00000000000000000000000000000000000 19
Flow Imaging and MR Angiography 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 Phase-Sensitive Methods 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 Inflow-Enhancement Methods 00000000000000000000000000000000 21
Contrast Agents 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (H.-J. Weinmann, H. Gries, U. Speck) 23 Mechanism of Contrast Enhancement 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 23 Types of Contrast Agents 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26 Gd-DTP AlDimeglumine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28
References 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30
XIV Contents
CHAPTER 2 Principles of Examination and Interpretation Scott Mirowitz, Klaus Sartor
Introduction ................................................. 33 Safety Considerations ......................................... 33 Patient Preparation and Monitoring ............................. 34 Examination Techniques ...................................... 35
General Objectives ......................................... 36 Standard (Spin Echo) Pulse Sequences ......................... 38 Special Pulse Sequences ..................................... 40 Imaging Protocols .......................................... 42
Imaging Strategies ............................................ 46 Image Analysis and Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 References .................................................. 50
CHAPTER 3 Nonnal Anatomy Klaus Sartor
Introduction ................................................ . Brain and Skull Maturation ................................. . General Features of the Adult Brain .......................... . Normal Aging of the Brain ............ (with assistance of S.A.Mirowitz)
Cerebral Hemispheres ........................................ . Deep and Midline Cerebral Structures .......................... . Brainstem and Cerebellum .................................... . Cranial Nerves and Sellar Region .............................. . Cerebral Blood Vessels and Meninges .......................... . Orbit and Cranium .......................................... . References
CHAPTER 4 Developmental Anomalies Klaus Sartor
53 53 55 56 57 66 74 83 94
102 112
Introduction ................................................. 117 Gross Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 118 Differentiation of Gray and White Matter and Myelination ........ 118 Neoplastic Degeneration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 119 Other Structural Abnormalities ............................... 119 Functional Anatomy ........................................ 120 Associated Extracranial Anomalies ............................ 120
Disorders of Dorsal Induction .................................. 120 Encephaloceles ............................................ 120 Chiari I and II Malformations ................................ 123 Syringohydromyelia and Syringobulbia ......................... 130
Disorders of Ventral Induction ................................. 134 Holoprosencephaly ......................................... 134 Neuroepithelial Cysts ....................................... 137 Dandy-Walker Malformation. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. 141
Contents
Disorders of Gray and White Matter Formation .................. . Anomalies of Neuronal Proliferation and Migration ............. . Dysgenesis of the Corpus Callosum ........................... . Anomalous Myelination .................................... .
Neurocutaneous Syndromes ................................... . Neurofibromatosis ......................................... . Tuberous Sclerosis ......................................... . Von Hippel-Lindau Disease ................................. . Sturge-Weber Disease ...................................... . Ataxia-Telangiectasia Syndrome ............................. .
Hydrocephalus .............................................. . Noncommunicating Hydrocephalus ........................... . Communicating Hydrocephalus .............................. . Normal Pressure Hydrocephalus ............................. .
Other Developmental Disorders ............................... . Porencephalic and Arachnoid Cysts .......................... . Ectopia of Posterior Pituitary Lobe ........................... . Ocular Anomalies ......................................... . Malformations of the Skull and Craniovertebral Junction ......... .
References
CHAPTER 5 Mechanical Trauma Klaus Sartor
Introduction ................................................ . Hemorrhage .............................................. . Edema .................................................. . Other Structural Abnormalities .............................. . Functional Anatomy ....................................... .
Craniocerebral Trauma ....................................... . Epidural Hematoma ....................................... . Subdural Hematoma ....................................... . Cerebral Injuries .......................................... . Skull Injuries ............................................. .
Facial Trauma .............................................. . References
CHAPTER 6 Tumors and Related Conditions Klaus Sartor
XV
145 145 154 158 161 161 166 171 172 175 175 177 183 185 187 187 195 196 199 201
207 208 209 210 211 212 212 215 224 236 242 245
Introduction ................................................. 249 Edema ................................................... 251 Cyst Formation ............................................ 251 Calcification and Bone Involvement ........................... 252 Hemorrhage .................................... . . . . . . . . . .. 253 Other Structural Changes .................................... 254 Blood-Brain Barrier Abnormalities ............................ 255 Prediction of Tumor Type ................................... 256
XVI Contents
Stereotaxy and Radiation Therapy ............................ 256 Postoperative Changes and Tumor Recurrence .................. 257
Supratentorial Tumors ........................................ 258 Glial and Neuronal Tumors .................................. 258 Ependymal and Choroid Plexus Tumors . . . . . . . . . . . . . . . . . . . . . . .. 281 Lymphoma and Sarcoma .................................... 284 Pineal Gland Tumors ....................................... 289 Meningioma ............................................... 295 Malformative Tumors ....................................... 309 Metastases ................................................ 317 Other Supratentorial Tumors ................................. 326
Infratentorial Tumors ......................................... 330 Brainstem Glioma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 331 Astrocytoma of the Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 338 Medulloblastoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 341 Ependymal and Choroid Plexus Tumors . . . . . . . . . . . . . . . . . . . . . . .. 345 Hemangioblastoma ......................................... 349 Neurinoma ................................................ 354 Meningioma ............................................... 366 Malformative Tumors ....................................... 369 Metastases ................................................ 372 Other Infratentorial Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 377
Tumors of the Sellar Region and Base of Skull .................... 379 Pituitary Adenoma ......................................... 381 Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 397 Meningioma ............................................... 403 Optic and Hypothalamic Glioma .............................. 415 Germinoma ............................................... 421 Malformative Tumors ....................................... 422 Chordoma and Chondroma .................................. 429 Paraganglioma ............................................. 435 Metastases and Miscellaneous Tumors of the Sellar Region and Base of Skull . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 439
Orbital Tumors ......................... .. . . . . . . . . . . . . . . . . . . .. 452 Tumors of the Globe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 454 Tumors of the Optic Nerve and Sheath . . . . . . . . . . . . . . . . . . . . . . . .. 457 Vasculogenic Tumors ....................................... 462 Lymphoma and Metastases .................................. 467 Other Orbital Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 471 Tumor-Simulating Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 476
References .................................................. 480
CHAPTER 7 Vascular Diseases Klaus Sartor
Introduction ................................................. 495 Edema ................................................... 495 Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 496 Other Structural Changes .................................... 497 Blood-Brain Barrier Abnormalities. . . . . . . . . . . . . . . . . . . . . . . . . . .. 497
Contents XVII
Blood Flow Phenomena ..................................... 498 Functional Anatomy ........................................ 499
Ischemic Insults .............................................. 499 Cerebral Infarction ......................................... 499 Subcortical Arteriosclerotic Encephalopathy .................... 532 Periventricular Leukoencephalopathy .......................... 535
Hemorrhagic Insults .......................................... 539 Hypertensive Intracerebral Hemorrhage . . . . . . . . . . . . . . . . . . . . . . .. 539 Hemorrhagic Cerebral Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 547 Other Intracerebral Hemorrhages ............................. 551
Angiodysplasias .............................................. 558 Aneurysm and Subarachnoid Hemorrhage . . . . . . . . . . . . . . . . . . . . .. 558 Vascular Malformations ..................................... 571
Other Vascular Disorders ...................................... 593 Vasculitis ................................................. 593 Moyamoya Phenomenon .................................... 598 Spontaneous Arterial Dissection .............................. 600 Arteriovenous Fistula ....................................... 603 Sinovenous Thrombosis ..................................... 603
References .................................................. 609
CHAPTER 8 Infections and Inflammations Klaus Sartor
Introduction ................................................. 617 Edema ................................................... 618 Blood-Brain Barrier Abnormalities and Other Vascular Alterations ................................................ 618 Necrosis .................................................. 618 Other Structural Changes .................................... 619 Functional Anatomy ........................................ 620
Pyogenic Bacterial Infections ................................... 620 Epidural Abscess ........................................... 620 Subdural Empyema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 623 Brain Abscess ............................................. 626 Acute Bacterial Meningitis and Ependymitis .................... 630
Nonpyogenic Bacterial Infections ............................... 633 Tuberculosis ............................................... 634 Sarcoidosis ................................................ 638 Other Nonpyogenic Infections ................................ 641
Viral Infections .............................................. 644 Herpes Simplex Encephalitis ................................. 645 Other Acute Viral Infections ................................. 648 Progressive Multifocal Leukoencephalopathy . . . . . . . . . . . . . . . . . . .. 651 Other Subacute Encephalitides ............................... 653
Fungal Infections ............................................. 655 Parasitic Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 658
Cysticercosis ............................................... 658 Other Parasitic Infections .................................... 663
XVIII Contents
Acquired Immunodeficiency Syndrome .......................... 664 AIDS Dementia Complex ................................... 664 Opportunistic Infections and Other Complications ............... 667
Infections and Inflammations of the Head and Neck . . . . . . . . . . . . . . .. 669 Paranasal Sinus Disease ..................................... 670 Cholesterol Granulomas of the Temporal Bone . . . . . . . . . . . . . . . . .. 676 Inflammatory Cranial Nerve Syndromes. . . . . . . . . . . . . . . . . . . . . . .. 681 Rheumatoid Arthritis of the Craniovertebral Junction ............ 686
References .................................................. 687
CHAPTER 9 Demyelinating and Degenerative Diseases Scott Mirowitz, Klaus Sartor
Introduction ................................................. 693 Demyelination and Dysmyelination . . . . . . . . . . . . . . . . . . . . . . . . . . .. 693 Iron Deposition ............................................ 694 Atrophy .................................................. 694 Other Structural Changes .................................... 695 Functional Anatomy ........................................ 696
Demyelinating Diseases ....................................... 696 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 697 Immune-Mediated Encephalomyelitis. . . . . . . . . . . . . . . . . . . . . . . . .. 709 Marchiafava-Bignami Disease ................................ 713 Central Pontine Myelinolysis ................................. 714
Leukodystrophies ............................................ 716 Adrenoleukodystrophy ...................................... 717 Metachromatic Leukodystrophy .............................. 720 Pelizaeus-Merzbacher Disease ................................ 721 Canavan-van Bogaert Disease ................................ 722 Alexander Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 724 Krabbe Disease ............................................ 726 Mucopolysaccharidoses ...................................... 727
Degenerative Disorders with Deep Gray Matter Involvement ........ 728 Huntington Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 728 Wilson Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 729 Parkinson Disease .......................................... 731 Heterogeneous Systems Degenerations . . . . . . . . . . . . . . . . . . . . . . . .. 733 Hallervorden-Spatz Disease .................................. 736 Leigh Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 737 Aminoacidopathies ......................................... 740 Idiopathic Movement Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 744 Basal Ganglia Necrosis and Calcification ....................... 745
Cerebral, Cerebellar, and Brainstem Atrophies. . . . . . . . . . . . . . . . . . .. 748 Alzheimer Disease or Senile Dementia of the Alzheimer Type. . . .. 749 Pick Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 752 Amyotrophic Lateral Sclerosis ................................ 753 Menkes Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 755 Cushing Disease and Steroids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 755
Contents XIX
Spinocerebellar Degeneration ................................ 756 Other Causes of Cerebellar Degeneration ...................... 759
References .................................................. 761
CHAPTER 10 Miscellaneous Conditions Klaus Sartor
Introduction Seizure Disorders ............................................ . Neurobehavioral Disorders .................................... . Idiopathic Intracranial Hypertension ............................ . Effects of Radiation and Chemotherapy ......................... . Bone Diseases of the Skull .................................... . References .................................... ' ............. .
769 769 774 776 777 782 788
Subject Index ..................... . . . . . . . . . . . . . . . . . . . . . . . . .. 791
Contributors
Heinz Gries, Ph. D., Institute of Contrast Media Research, Schering AG, Miillerstrasse 170--178, W-lOOO Berlin 65, Federal Republic of Germany
Wilfried Loeffier, Ph. D., Medical Engineering Group, Siemens AG, Henkestrasse 127, W-8520 Erlangen, Federal Republic of Germany
Scott A. Mirowitz, M. D., Department of Radiology, Jewish Hospital at Washington University Medical Center, 216 South Kingshighway, St. Louis, Missouri 63178, USA
Ulrich Speck, Ph. D., Institute of Contrast Media Research, Schering AG, Miillerstrasse 170--178, W-lOOO Berlin 65, Federal Republic of Germany
Hanns-Joachim Weinmann, Ph. D., Institute of Contrast Media Research, Schering AG, Miillerstr. 170--178, W-lOOO Berlin 65, Federal Republic of Germany
