1. NEURORADIOLOGY
Prof. Dr. Mahmoud El Sheikh
Professor of Radiology
Faculty of Medicine . University of Alexandria

2. Imaging Modalities
•
•
•
•
•
•
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Conventional Radiography: Plain, Contrast, Fluoro
Computed Tomography: MDCT
Magnetic Resonance Imaging: fMR, MRS
Ultrasonography: Color Doppler
Angiography: DSA, MRA, CTA
Scintigraphy, SPECT
Positron Emission Tomography, PET/CT

3. Computed Tomography (CT)

5. Digital Image

6. CT Tissue Characterization
Tissue Contrast depends on Attenuation Number (Hounsfield Unit)
Air = -1000 HU
Fat = -50 HU
Water = 0 HU
Soft Tissue = 25-35 HU
Acute Hemorrhage = 70-100 HU
Calcification = 200-300 HU
Cortical Bone >= 1000 HU

7. IV Contrast Enhancement
► Improves the soft tissue contrast.
► Enhancement depends on:
 Extra-axial tissue: vascularity
 Intra-axial tissue: BBB Breakdown

9. Magnetic Resonance (MR)
Closed Magnet
Open Magnet

10. Advantages of MR
► No ionizing radiation
► High contrast resolution
► Good spatial resolution
► Multiplanar capabilities
► Multi weighted sequences:





Fluid attenuation (FLAIR)
Fat suppression (STIR)
Diffusion weighted (DWI)
Functional MR (fMR: BOLD)
Spectroscopy (MRS)

11. Protons (nuclei of hydrogen atoms) placed
in a strong magnetic field are excited by a
radio-frequency pulse, then allowed to loose
energy.
• The loss of gained energy occurs either to
the surrounding matrix (T1) or through
interaction between each other (T2).
• The loss of energy is measured and used to
produce images.
•

12. Normal MR Brain
T1 Weighted Image
T2 Weighted Image

13. Other Pulse Sequences
Fluid Attenuation (FLAIR)
Fat Suppression (STIR)

14. T1 or T2 Weighted Images
► When
reviewing an MR image, the easiest way to
determine the type of image, is to look at the
cerebrospinal fluid (CSF).
►
If the CSF is dark it is a T1-weighted imaged.
► If
the CSF is bright, it is a T2-weighted image.

15. Sagittal MR Brain
T1 WI

16. MR Tissues Signal Characteristics
T1
T2
Fluid
Dark
Bright
Fat
Bright
Dark
Solid
Grey
Bright
Subacute Blood
Bright
Bright
Dark
Dark
Grey
Dark
Calcifications
Flowing Blood
Acute, Ch Blood

17. IV Contrast Enhancement
Gadolinium
► Gadolinium
increases signal intensity on
T1-weighted images through shortening
the T1 relaxation time of the tissue.
► Enhancement depends on:
 Extra-axial tissue: vascularity
 Intra-axial tissue: BBB Breakdown

18. BRAIN

19. TRAUMA

20. Plain X-Ray
Fracture
Line
SKULL FRACTURE

21. Digital Image
Soft Tissue Window
Bone Window

22. Traumatic Cranio-Cerebral Lesions

23. Brain Contusions
Hemorrhagic Contusions

24. Brain Lacerations
R
Gunshot Injury

25. Extradural Hematoma

26. Subdural Hematoma

27. Subacute Subdural Hematoma

28. Subarachnoid Hemorrhage

29. Diffuse Axonal Injury (DAI)

30. Generalized Brain Edema

31. Mass Effect
Brain Herniation
Mass
Brain
Stem

32. Decompressive Craniectomy

33. Non-Traumatic Hemorrhage

34. Non-Traumatic Intracranial Hemorrhage
► Very



►
Hypertension
Aneurysm
Vascular Malformation AVM
Common






►
Common
Embolic stroke with reperfusion
Amyloid angiopathy
Prematurity (Germinal Matrix Hemorrhage)
Coagulopathies
Drug abuse
Tumor
Uncommon
 Venous infarct
 Vasculitis

35. Hypertensive Hemorrhage

36. Massive Hypertensive Hemorrhage

37. Hemorrhage in Arterio-Venous
Malformation (AVM)

38. Subarachnoid Hemorrhage

39. Anterior Communicating Aneurysm

40. Posterior Communicating Aneurysm

41. Cerebral Angiography

42. Cerebral Angiography
► Direct
Angiography
► Catheter Angiography:
 Conventional
 Digital Subtraction
► Magnetic Resonance
Angiography (MRA)
► Computed Tomography Angiography (CTA)

43. Anterior Communicating Artery
Aneurysm
MR Angiography

44. Middle Cerebral Artery Aneurysm
CT Angiography

45. Infarct

46. Cerebral Arteries Territories
Anterior CA
Middle CA
Posterior CA

47. Anterior Cerebral Infarct

48. Acute Middle Cerebral Infarct

49. Posterior Cerebral Infarct

50. Focal Thalamic Infarct
T1 WI
T2 WI
Magnetic Resonance

51. Brain Stem Infarct
T2 WI

52. Early Infarct
CT

53. Early Infarct
CT Perfusion
MR Diffusion

54. Perfusion/Diffusion Mismatch
Penumbra

55. Old Infarct

56. Neuro-Intervention

57. Embolization of AVM
Before
After

58. Occluding Aneurysm with Coils
Before
After

59. Balloon Angioplasty
Before
After

60. Brain Lesions

61. Parameters Used In Lesions Diagnosis
 Age
 Clinical
presentation
 Location
 Characteristic imaging features
Similar lesions have Similar imaging features

62. Brain Aging
Involutional Changes

63. Hydrocephalus
Aqueduct Stenosis

64. Herpes Virus Encephalitis
T1 WI
T2 WI

65. Pyogenic Brain Abscess

66. Multiple Sclerosis

67. Brain Tumors

68. Glioma
T1 WI
T2 WI
T1 WI Post-Contrast

69. Glioblastoma Multiforme

70. Oligodendroglioma

71. Sellar & Suprasellar Tumors

72. Pituitary Adenoma

73. Brain stem Glioma

74. Cerebello-Pontine Angle Tumors

75. Acoustic Neurinoma
Post Contrast CT
Bone Window CT

76. Acoustic Neurinoma
T1 WI
T1 WI Post Contrast
MR

77. Meningioma
T1 WI
T1 WI Post Contrast
MR

78. Metastases

79. Metastases

80. SPINE

81. Anatomy

82. Plain X-Ray
A-P view
Lateral view
Oblique view

83. MYELOGRAPHY

84. CT

85. MR
T1 WI
T2 WI

86. Sagittal View
T1 WI
T2 WI
MR

87. Parasagittal View
T2 WI
T1 WI
MR

88. Spinal Trauma
CT
Plain x-ray
T1 WI

89. Traumatic Cord Contusion
T2 WI

90. Normal Intervertebral Disc
Epidural Fat
Nerve Root
Thecal Sac
Epidural Fat
Disc

91. Disc Herniation
CT
Normal
Disc
Rt Postero-lateral
Herniation
Lt Foraminal
Herniation

92. Disc Herniation
MR
T1 WI
T2 WI

93. Disc Herniation
T1 WI
T2 WI

94. Caudal Migration

95. Sequestrated Disc

96. Post-Operative Spine
Recurrent Disc/Scar tissue
Enhancing
Scar
Nerve Root
T1 WI PreContrast
T1 WI PostContrast

97. Degenerative Changes
Lateral Recess
Disc bulge with vacuum
Apophyseal Arthrosis

98. Spinal Canal Stenosis
Developmental
Degenerative

99. Central Spinal Canal Stenosis
MR
Thickened Ligamenta Flava
CT
Calcified Ligamenta Flava

100. Foraminal Stenosis

101. Compression Myelomalacia

102. Spondylolisthesis
Spondylolisthesis is forward sliding of
a vertebra over the vertebra below.
Types:
► Lytic
► Degenerative

103. Lytic Spondylolisthesis
Defect in Pars Inter-articularis

104. Pars Interarticularis

105. Degenerative Spondylolisthesis

106. Infective Spondylitis
T1WI
T1WI Post Contrast

107. Transverse Myelitis
T2 WI

108. Syringomyelia
T1 WI

109. Glioma
T1 WI POST CONTRAST

110. Meningioma
T1 WI POST CONTRAST

111. Metastases
CT
Soft tissue Window
Bone Window
MR T1 WI

112. Isotope Bone Scan
Normal
Deposits

113. THANK YOU
Prof Dr Mahmoud El Sheikh