Brain (CT, MRI & Angiography) - PowerPoint Presentation

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Brain (CT, MRI & Angiography)

時間：

102.9.18

授課教師

:

薛俊仁 醫師

三軍總醫院 放射診斷部

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1.Frontal bone

2.Parietal bone

3.Dura mater

4.Arachnoid mater

5.Pia mater6.Superior sagittal sinus7.Superior cerebral vein8.Arachnoid granulation

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1.Frontal bone

2.Parietal bone

3.Sagittal suture

4.Dura mater

5.Arachnoid mater6.Superior sagittal sinus7.Falx cerebri8.Subarachnoid space

9.Pia mater

Central

sulcus

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1.Frontal bone

2.Parietal bone

3.Skin and dense

subcutaneous tissue

4.Epicranial aponeurosis (galea aponeurotica)5.Pericranium6.Branches of superficial

temporal artery

7.Sagittal suture

8.Dura mater

9.Arachnoid mater

10.Superior sagittal sinus

11.Falx cerebri

12.Grey matter

13.White matter

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1.Frontal bone

2.Parietal bone

3.Skin and dense

subcutaneous tissue

4.Epicranial aponeurosis (galea aponeurotica)5.Temporalis6.Pericranium

7.Branches of superficial temporal artery

8.Sagittal suture

9.Dura mater

10.Arachnoid mater

11.Superior sagittal sinus

12.Falx cerebri

13.Cingulate gyrus

14.Parieto-occipital sulcus

15.Corona radiata

16.Anterior cerebral artery

(branches)

17.Postcentral gyrus

18.Central sulcus

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1.Frontal bone

2.Parietal bone

3.Skin and dense

subcutaneous tissue

4.Epicranial aponeurosis (galea aponeurotica)5.Temporalis6.Pericranium

7.Branches of superficial temporal artery

8.Diploic vein

9.Dura mater

10.Arachnoid mater

11.Sagittal suture

12.Superior sagittal sinus

13.Lunate sulcus

14.Falx cerebri

15.Cingulate gyrus

16.Postcentral sulcus

17.Central sulcus

18.Roof of body of lateral

ventricle

19.Corona radiata

20.Corpus callosum

21.Longitudinal fasciculus

(cortico cortical fibres)

22.Anterior cerebral artery

(branches)

23.Forceps minor

24.Cingulate sulcus

25.Inferior sagittal sinus

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1.Frontal bone

2.Parietal bone

3.Sutural bone

4.Skin and dense

subcutaneous tissue5.Epicranial aponeurosis (galea aponeurotica)6.Temporalis

7.Pericranium8.Branches of superficial

temporal artery9.Occipital vein

10.Superior sagittal sinus

11.Falx cerebri

12.Straight sinus

13.Parieto-occipital sulcus

14.Optic radiation

15.Chorlid plexus

16.Posterior horn lateral ventricle

17.Splenium of corpus callosum

18.Lateral sulcus (Sylvian fissure)

19.Third ventricle

20.Middle cerebral artery (branches)

21.Postcentral sulcus

22.Central sulcus

23.Arachnoid mater

24.Dura matter

25.Thalamostriate vein

26.Body of lateral ventricle

27.Body of caudate nucleus

28.Frontal horn of lateral ventricle

29.Septum pellucidum

30.Insula

31.Claustrum

32.Putamen

33.Internal capsule

34.Circular sulcus

35.Genu of corpus callosum

36.Anterior cerebral artery (branches)

37.Forceps minor

38.Cingulate sulcus

39.Supra-orbital artery

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1.Supra orbital artery

2.Frontal belly of occipitofrontalis

3.Frontal sinus

4.Frontal bone

5.Parietal bone6.Middle meningeal artery and vein7.Branch of temporal artery8.Sliver of squamous part of

temporal bone9.Skin and dense

subcutaneous tissue10.Epicranial aponeurosis

(galea aponeurotica)

11.Temporalis

12.Pericranium

13.Dura matter

14.Arachnoid mater

15.Occipital artery

16.Squamous part of occipital bone

17.Superior sagittal sinus

18.Occipital lobe

19.Falx cerebri

20.Calcarine sulcus

21.Straight sinus

22.Great cerebral vein

23.Fornix

24.Internal cerebral vein (branches)

25.Pulvinar of thalamus

26.Optic radiation

27.Medial nucleus of thalamus

28.Third ventricle

29.Ventroposterior thalamic nucleus

30.Circular sulcus

31.Globus pallidus-internal segment

32.Globus pallidus-enternal segment

33.Choroid piexus in interventricular

foramen (Monro)

34.Claustrum

36.Insula

36.Putamen

37.Middle cerebral artery (branches)

38.Anterior limb of internal capsule

39.Caudate nucleus-head

40.Corpus callosum

41.Anterior cerebral artery

42.Frontal horn of lateral ventricle

43.Frontal lobe

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Frontal lobe: precentral gyrus

Central sulcus:

Parietal lobe: post central gyrus

F

P

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Brain

Cerebrum (frontal, parietal, temporal, occipital lobe)

Cerebellum (hemispheres, vermis)

Midbrain

PonsMedulla oblongataCervical cord

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Midbrain (9)

Pons (6)

Medulla oblongata (5)

Cervical cord (4)

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Cingulate sulcus

Central sulcus

Parieto-occipital sulcus

Cerebellum tentorium

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Cranial nerves

CN2

CN3

CN5

CN7&8

CN12

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MCA

ACA

PCA

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CT

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CT angiography

Common carotid artery

Internal carotid artery

Vertebral artery

Basilar arteryAnterior cerebral arteryMiddle cerebral arteryPosterior cerebral artery

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Intracranial Hemorrhage

Epidural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Parenchymal hematomaIntraventricular hemorrhage

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F21, Sudden onset intractable headache nausea &

vomiting –

an AVM supplied by right MCA

Intraventricular hemorrhage

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Brain tumor:

meningioma

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F54 sudden onset right limb weakness

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TAE

MMA

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Navigator MR , 7 days after TAE

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Follow up

4 month later

One and half years later

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F68 right upper and lower limb

weakness –

left MCA

territory infarct

Hyperdense MCA sign

Follow up 2 days later

Ischemic infarction

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Acute left MCA infarct

ACA

MCA

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For comparison

Acute infarct involving posterior circulation

Posterior circulation

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MRI-

磁振造影基礎序列

(sequence):

提供不同軟組織對比

T1-weighted image T2-weighted image FLAIR DWI

T1

權重影像

T2

權重影象 液體衰減影象 水分子擴散影象

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ICA

AP view Lateral view

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Posterior circulation:

-Vertebral artery (VA); 1,2

-Basilar artery (BA); 5

-Posterior inferior

cerebellar artery (PICA); 4

-Anterior inferior cerebellar artery (AICA); 6-Superior

cerebellar artery (SCA); 8-Posterior cerebral artery (PCA); 9

-Posterior communicating artery (

Pcom

A); 10

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External carotid artery

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Pial

arteriovenous

fistula with ICH

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Digital-Subtraction cerebral Angiography (DSA)

Invasive study; CTA

普遍運用後，角色轉為

TAE procedure 的一部分或CTA

所給資訊不足時的輔助工具。Bi-planes angiographic machine 亦可提供 3D 立體影像，並作為Pre-procedure planning。

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CTA vs 3D DSA vs MRA

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Pituitary gland

Corpus

callosum

Midbrain

Pons

Medulla

Cervical cord

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Thanks for your attention