Central nervous system Guanghui Yu Radiology college

Central nervous system Brain Spinal cord

Radiographic technique brain Spinal cord Image acquisition time application Plain film invisible elimination CT visible fast Emergency radiology MRI low others DSA vessels vascular diseases

Grey and white matter Neural tissue white matter Fatty substance (white in color) Axon (surrounded by myelin) CT MR T1WI T2WI white matter hypodense high low Grey matter hyperdense low high Cell body (more H2O) Grey matter

hyperdense hypodense Grey matter white matter

hypointensity (Grey matter) hypointensity hyperintensity (white matter) hyperintensity T2WI T1WI

Fluid attenuated inverse recovery T1WI FLAIR T2WI

The brain consists of a、the brain stem b、the cerebellum c、the forebrain cerebellum midbrain pons medulla oblongata Spinal cord cerebellar tonil

the forebrain occipital lobe insular lobe parietal lobe frontal lobe temporal lobe occipital lobe insular lobe

Corona radiata

Lentiform nucleus Basal ganglia Head of caudate nucleus Genu of Corpus callosum External capsule Internal capsule Thalamus Splenium of Corpus callosum

A midline Post-contrast Sagittal T1 Weighted MRI 4 3 5 6 2 1 7 1. Scalp fat 2. Bone 3. Inferior sagittal sinus 4. Corpus callosum 5. Internal cerebral vein 6. Vein of Galen 7. Superior sagittal sinus 8. Parietal lobe 9. Occipital lobe 10. Straight sinus 11. Vermis 12. IV ventricle 13. Cerebellar tonsil 14. Cervical cord 15. Medulla 16. Pons 17. Midbrain 18. Mass intermedia of thalamus 19. Anterior III ventricle 20. Optic chiasm 21. Pituitary gland 22. Sphenoid sinus 23. Nasopharynx 24. Frontal lobe 8 9 24 10 18 19 17 20 21 16 22 11 12 15 23 13 14 A midline Post-contrast Sagittal T1 Weighted MRI

2. Cerebellar hemisphere 3. IV ventricle 4. Superior vermis 8 7 6 3 5 2 4 1 1. Cerebellar tonsil 2. Cerebellar hemisphere 3. IV ventricle 4. Superior vermis 5. Tentorium 6. Posterior temporal lobe 7. Choroid plexus within lateral ventricle 8. Posterior frontal lobe Coronal Section of the Brain at the level of IV Ventricle Post Contrast Coronal T1 Weighted MRI

Meninges dura mater the outer layer arachnoid mater the middle layer pia mater the inner layer inseparable from the brain The cranial dura is formly adherent to the periosteum of skull bones The arachnoid mater is loosely adherent to the dura mater Between the arachnoid and the pia is the subarachnoid space

A double layer of dura projects into the cranial cavity. These dural folds form: Falx cerebri Tentorium cerebelli Diaphragm of sella turcica

meninges: Falx cerebri dura Tentorium cerebelli Subarachnoid space Falx cerebri dura arachnoid Tentorium cerebelli pia mater Diaphragm of sella turcica

cerebral falx

cerebral falx Tentorium cerebelli

ventricular system and cerebrospinal fluid Anterior horn of lateral ventricle third ventricle Lateral ventricle Interventriculer foramen Foramen of Monroe Cerebral aqueduct Fouth ventricle posterior horn of lateral ventricle inferior horn of lateral ventricle inferior horn of lateral ventricle posterior horn of lateral ventricle

pineal body

Cerebrospinal fluid circulation and cistern Produced by the choroid plexus in all ventricles Foramen of Monro Cerebrospinal fluid the lateral ventricle the third ventricle cerebral aqueduct the fouth ventricle Median and lateral aperture of fourth ventricle Subarachnoid space arachnoid granulation Superior sagittal sinus

cistern： At several sites where the surface of the brain is deeply fissured, the subarachnoid space is wider than at other sites. bilateral： interhemispheric cistern cistern of lateral sulcus cisterna ambiens cistern of pedunculus cerebellaris pontinus

Answers 14 13 12 Post Contrast sagittal T1 Wtd M.R.I. 11 Section at the level of Pons 17 10 Answers 16 15 9 13. Internal Carotid Artery 14. Cavernous Sinus 15. Middle Cerebellar Peduncle 16. Internal Auditory Canal 17. Temporal Lobe 8. Cerebellar Hemisphere 9. Vermis 10. IV Ventricle 11. Pons 12. Basilar Artery 8 Post Contrast Axial MR Image of the brain

facial nerve acoustic nerve

cisterna venae magnae cerebri unilateral： dorsal cisterna venae magnae cerebri quadrigeminal cistern ventral cistern of chiasma interpeduncular cistern consecutive suprasellar cistern

suprasellar cistern chiasma Cerebral peduncle hexagon interpeduncular cistern

suprasellar cistern posterior communicating artery basilar artery anterior cerebral artery Vertebral artery middle cerebral artery basilar artery posterior cerebral artery internal carotid artery

cranial sinuses

Pituitary gland neurohypophysis adenohypophysis posterior pituitary anterior pituitary

Pituitary gland MR thin slice scan Coronal and sagittal scan Height:<7millimeter superior margin: flat or depressed Pituitary stalk:<4millimeter

9. Internal carotid artery 10. Cavernous sinus 11. Sphenoid sinus 2 3 4 5 6 1. Frontal lobe 2. Corpus callosum 3. Frontal horn 4. Caudate nucleus 5. III ventricle 6. Optic nerve 7. Pituitary stalk 8. Pituitary gland 9. Internal carotid artery 10. Cavernous sinus 11. Sphenoid sinus 12. Nasopharynx 8 7 9 11 10 12 Coronal Section of the Brain at the level of Pituitary gland Post Contrast Coronal T1 Weighted MRI

Contrast enhancement ： Normal calcification： pineal body 、cerebral falx、choroid plexus、globus pallidus Contrast enhancement ： pituitary gland、pineal body、dura、 choroid plexus

Answers 41 40 Post Contrast sagittal T1 Wtd M.R.I. Section at the level of Corpus Callosum 39 Answers 39. Splenium of corpus callosum 40. Choroid plexus within the body of lateral ventricle 41. Genu of corpus callosum Fig. 1.7 Post Contrast Axial MR Image of the brain

2. Cerebellar hemisphere 3. IV ventricle 4. Superior vermis 8 7 6 3 5 2 4 1 1. Cerebellar tonsil 2. Cerebellar hemisphere 3. IV ventricle 4. Superior vermis 5. Tentorium 6. Posterior temporal lobe 7. Choroid plexus within lateral ventricle 8. Posterior frontal lobe Fig. 1.11. Coronal Section of the Brain at the level of IV Ventricle Post Contrast Coronal T1 Weighted MRI

Abnormal changes of CT scan 　a、hyperdense：calcification、hemorrhage、tumor　 b、 hypodense ：edema、 tumor 、cystis、liquefactive necrosis、lipoma、 fluid　 c、 isodense ：chronic hamorrhage、 tumor d、heterogeneous density ：

calcification value >100Hu exceed

b. hypointensity：edema、fluid、tumor、fibrosis and calcification Abnormal change of MRI A、T1WI： 　a. hyperintensity：fat or lipoid、melanin、constrast medium 　b. hypointensity：edema、fluid、tumor、fibrosis and calcification B、T2WI： 　a. hyperintensity ： edema、fluid、tumor 、 　b. hypointensity ： fibrosis and calcification 、 melanin C、mass effect

mass

mass

evolution of hematoma and intensity of MRI T1WI　　　　 　T2WI ferrohemoglobin 　　iso-　　　　　　 iso- ferrohemoglobin 　　iso-　　　　　　hypo- methemoglobin akaryocyte　　 hyper-　　　　　hypo- membranolysis　 hyper- 　　　　 hyper- hemosiderin 　　 hypo- 　　　　 hypo- 　

Acute A week later

methemoglobin

hemosiderin

1、obstructive hydrocephalus Hydrocephalus (increased volume of cerebrospinal fluid) 1、obstructive hydrocephalus 2、communicating hydrocephalus 3、exterior hydrocephalus

Cerebral aqueduct communicating hydrocephalus

obstructive hydrocephalus

exterior hydrocephalus

exterior hydrocephalus

white matter and grey matter edema type location cause water vasogenic edema white matter Tumor inflammation trauma hydrated water cytotoxic edema white matter and grey matter acute infarction few

vasogenic edema

cytotoxic edema

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