Show:
MRI of the Brain
Treatment of Spinal Diseases
Vascular Disease
100

What are some Common MR pulse sequence used in Brain MRI?

  • T1WI (T1-Weighted Image)

  • T2WI (T2-Weighted Image)

  • FLAIR (Fluid Attenuation Inversion Recovery)

  • T2*WI (T2-star Weighted Image)

  • DWI (Diffusion Weighted Image)

100

What neurologic symptoms can be seen in spinal cord myelopathy?

  1. loss of motor power and balance

  2. loss of dexterity- objects slipping from hands

  3. UMN deficit: rigidity, hyperreflexia, positive babinski

  4. slow progressive step wise deterioration

100

What are some of the arteries in with large arterial infarction occur in?

  1. Middle cerebral artery (MCA); most common

  2. Anterior cerebral artery (ACA)

  3. Posterior cerebral artery (PCA)

  4. Vertebral artery (VA)

200

What are the features of T1WI?What shows bright on T1WI?What shows dark on T1WI?

  1. Short TR and TE time

  2. Fat- appears bright

  3. fluid appears dark

part 2 

fat

Subacute and chronic hemorrhage

melanin

protein-rich-fluid

slowly flowing blood

paramagnetic substances:gadolinium,manganese,copper

calcification(rarely)

part 3 

Increased water,asinedema,tumor,infarction,inflammation, infection, hemorrhage (hyperacute or chronic)

low proton density,calcification

flow void

200

What are some disorders of the spine?

  1. degenerative spine disease

  2. Spinal cord or root entrapment ( herniated lumbar disc)

  3. Spinal deformity

  4. Osteoporotic vertebral fracture

  5. Destructive (infectious and tumor related)

200

What are common sites of cerebral aneurysms?

  1. Anterior communicating artery (A-com) 30~35%

  2. Posterior communicating artery (P-com) 30~35%

  3. Middle cerebral artery (MCA) 20%

  4. Posterior circulation About 15%

300

What are some normal structures seen with the Intravenous contrast enhancement by Gadolinium? What are some pathological conditions seen with Intravenous contrast enhancement by Gadolinium

  • Arteries

  • Veins

  • Cerebral sinuses


Non brain structures 

  • Tentorium

  • Falx

  • Choroid plexus

  • Nasal and paranasal sinus mucosa

  • Normal brain tissues is not enhanced due to BBB

Part 2 

  • Tumors

  • Vascular diseases (aneurysm, AVM)

  • Capsule of brain abscess, empyema

  • Chronic subdural hematoma

  • Margin of recent infarction

  • Margin of radiation necrosis

300

What do degenerative changes that occur in C3-C7 presents as?

  1. axial pain

  2. myelopathy

  3. radiculopathy

  4. stiffness (lost of ROM)

  5. weakness

  6. loss of sensation

  7. hyperreflexia, hypertonia

  8. Spurlings sign

300

What are some types of vascular malformation?

  1. Arteriovenous Malformation

  2. Cavernous Malformations

  3. Mixed Malformations

  4. Telangiectasis

  5. Vein of Galen Malformation

  6. Venous Malformations

400

What are the features of T2WI?What shows bright on T2WI?What shows dark on T2WI? 

part 1 

  • TR: long

  • TE: long

  • fat: intermediate-bright

  • fluid: bright

part 2 

  • increased water, as in edema, tumor, infarction, inflammation, infection, subdural collection

  • methemoglobin (extracellular) in subacute hemorrhage

Part 3 

  • low proton density, calcification, fibrous tissue

  • paramagnetic substances: deoxyhemoglobin, methemoglobin (intracellular), iron, ferritin, hemosiderin, melanin

  • protein-rich fluid

  • flow void



400

What are the conservative treatments for disc herniation?

period of rest

NSAID

Physiotherapy

epidural corticosterioid injection

400

What are some common complications of aneurysm?

  • Vasospasm within 14 days of rupture Secondaryinfarction

  • Hydrocephalus

  • Seizure

500

Match the images to what they are showing 

Image 6- T1WI hemorrhagic mass with perifocal edema 

Image 7 T2WI edema and chronic hematoma

Image 8 Small lesions distributed in subcortical, external capsuled, deep white matter with few periventricle lesions 

Image 9 -Normal brain MRS vs MRs of malignant glioma

500

What are the surgical indication for disc herniation and what is the surgical procedure?What are the surgical indications for spinal stenosis and what is the name of the procedure?

part 1 

  1. cauda equina syndrome

  2. motor deficit

  3. failure of 2 months of conservative treatment

  4. Discectomy (only the herniated part)

Part 2 

  1. acute motor weakness

  2. failure of 6 months of conservative treatment

  3. spinal decompression: laminectomy

500

What are common diagnostic tools used to evaluation of vascular diseases? 

  • carotid duplex (ultrasound)

  • Computed tomography (CT)

  • Magnetic Resonance Imaging (MRI)

  • Magnetic Resonance Angiogram (MRA)

  • Cerebral angiograph

  • Doppler ultrasound

  • Functional • Electroencephalogram (EEG)

  • Biochemistry • Lumbar puncture (spinal tap)