NEURORADIOLOGYNEURORADIOLOGY

By Thamrin Syamsudin, dr., Sp.S(K)

Definition :

Radiological examination that used to support or confirm the diagnosis of neurological disorder

Two types of examination :

Non-invasive :

Skull X-Ray,

Vertebrae X-Ray

Invasive (use contrast agent) :

Angiography

Myelography

Skull X-Ray

Projection :

•Postero-Anterior (PA) in varies angle

•Antero-Posterior (AP)

•Right or Left Lateral

•Basis Cranium

•Other special photos :

Paranasal Sinus,

Sellar photo

Skull X-Ray

Assess

1. Skull bone

•external tabulae

•intenal tabulae

•diploe

•digital markings

In meningioma : endostosis or protrusion into internal tabulae

2. Sutures : sagital, coronary, lambdoid

Children : have not closed completely

Synostosis : sutures close in earlier time

Space Occupying Process : widening sutures

3. Sella tursica :

•Sellar tubercle

•Dorsum of sellae

•Anterior and posterior clinoid process

In chronic increased ICP destruction of sellae : thinning of the dorsum first

Hypophyseal tumour : ballooning sellae

4. Temporal bone :

•Often fractures in head injury

•Dangerous : rupture of middle meningeal artery subarachnoid bleeding (dead if massive)

•Vascular markings

5. Paranasal sinus :

Infection/inflammation opacities

Abnormalities in Skull X-Ray :

•Congenital : microcephaly, macrocephaly, cranio-synostosis

•Fracture : in head injury

•Bone disease : osteoporosis, osteoblastic

•Calcification :

Normal – in pineal gland, choroid plexus, duramatter

Abnormal – AVM, brain tumour, tuberculoma, advanced hemorrhagic lesion

Signs of increased Intra Cranial Pressure (ICP)

Sellae destruction

Impressiones digitatae

Widening sutures (in children)

Increased vascular markings

Vertebra X-Ray

Projection :

AP, PA

Lateral, and

Obligue

Consist of : 7 cervical segments

12 thoracal segments

5 lumbal segments

5 sacrals segments

Vertebral X-Ray

Assess :

Shape –

Lordosis (normal in cervical and lumbal)

Scoliosis : HNP

Kyphosis : Tuberculous spondylitis

Vertebral body –

Destructive lesion in metastatic tumour, inflammation

Compressive lesion in trauma

Intervertebral space –

disc protrusion in HNP

Vertebra X-Ray

Pedicles –

Attach to vertebra body : eroded and destroyed by tumour

Articular process : luxation

Intervertebral foramina : widened in neurinoma

Spinal process

Laminae : erosion narrowed intervertebral space

Spinal canal : stenosis if narrowed

Disorder of vertebral collumn

Congenital anomaly

Fracture/Dislocation

Inflammation

Tumour, etc

Patient preparation especially for lumbosacral photo : laxantia in previous night.

Myelography

Definition :

Introducing the contrast media into subarachnoid space in order to

investigate CSF pathway

Procedure :

Point of insertion via

lumbal puncture in ascending myelography

cisternal puncture in descending myelography

Take out CSF in same as contrast agent volume (about 10-20 mL)

Inject the contrast agent slowly

Take X-ray photo in various projections needed (AP, Lateral, Obligue)