Neurodiagnostic

Procedures
Junchen Zhang
 Who is he ？

 Bruce Lee is Hong Kong kungfu

star. He was borned in San
Francisco in November 1940 .His first
film was called The birth of Mankind,
his last film which was uncompleted at
the time of his death in 1973 was
called Game of Death( 死亡游戏） .
 There are and the numerous different theories on how he died.
Original cause of death listed as “marijuana poisoning,” later changed to
“death by misadventure.”

 Resently,some scholar think cerebral aneursym was the cause of lee’s

death.

How to identify the cause of lee’s

death?
 神经外科疾病
 损伤 craniocerebral trauma
 肿瘤 brain tumors
 血管性疾病 cerebral vascular disease
 感染性疾病 infection
 先天性疾病 congenital [kɔn'dʒenitl]
disease
 How to diagnosis the CNS
disease?

Neurodiagnostic Procedures is
necessary to diagnosis and
guide the therapy of neurologic
disorders.
 Plain film radiography
 Computed tomography[tə'mɔgrəfi]
 MRI （核磁共振）
 DSA （脑血管造影）
 Myelography （脊髓造影）
 PET （正电子发射断层扫描）
 Ultrasound( 超声）
 1 Plain film radiography
 Are useful in the initial assessment of
spinal trauma
 Are useful in suspected [səs'pektid]
infection
 Are useless in cases with neurologic
deficits
2 Computed tomograthy
 X-ray

 The Basic principle

the CT image is a computer-generated
across-sectional representation of anatomy
crected by analysis of the attennuation of X-
ray beams that have been passed through
various points around a section of the brain
 X-ray attenuation
X-ray
(X- 光的 衰減 )

Greater x-ray attenuation caused by bone results in

areas of high density
CT 切面的角度

Canthomeatal line
眼角 - 外耳道連線
(150) (red line)
CT is useful in imaging
 osseous-structures （骨性结构）

 Hemotomas

 Cerebral atroophy

 Hydrocephalus

 cerebral infarction
 Because of 颅底骨易造成伪影， lesions
situated nera the skull base are more
difficult to delineate with CT
 CTA

 Multidetector CT
( 多平面 CT ）
 3 Ultrasound(US)
 The US is the standard technique for
evaluating the premature infant for
hydruocephalus.
 Intraoperative ultrasound can also be
used to help position the ventricular
catheter ['kæθitə] during shunting
4 Magnetic resonance imaging(MRI)
 The Basic principle
the imges that are created reflect the density of
hydreogen protons as well as their relaxation rates.

利用磁场原理，把人体置于强大而均匀的静
磁场中，再利用特定的电波脉冲，激发人体组织
内的氢原子核。由于人体内的许多分子都含有氢
原子核，这些氢原子核又具有磁场特性，如同一
个小小的磁场。若使用仪器改变人体内的氢原子
核的旋转排列方向，原子核就会吸收释放能量，
能量激发后放出电磁波信号，再经过电脑分析组
合成影像，这就是一般所看到的 MRI 影像。
 常用的序列有
 T1 images

 T2 images

 FLAIR images are sensitve for cortical

lesion and meningeal processes.

 EPI images is the most sensitive for

indentifying aacute infarcion and perfusion
imaging .
 T1 images T2 images FLAIR images

EPI images
 Gadolinium [gædə'liniəm] are often
used to increase the sensitivity of MR
to various disease.
GD-
DTPA
强化
 MRA delineate the major
extracranial and intracranial vessels
without the need for contrast
agents.

不用造影剂血管成像
MRI is useful in imaging
 trauma

 tumor

 Cerebral vascular disease

 Spine and spinal cord

 infection
 5 myelography
 Is a radiographic study
thay outlines the spinal
canal and its contents.

 Water-soluble nonionic
contrast material is
injected into the
subarachniod space via
a lumber punctre
6 Digital aubtraction
angioraphy(DSA)
 Definition[defi'niʃən]
Radiographic visualization of the
arterial and venous systems of the
neck,brain,and spinal cord is
accomplished by intra-arterial injection
of a water-soluble iodinated contrast
agent.
 Methods

 DSA is the best procedure for
characterizing aneurysms and AVM.
 MRA and CTA have improved in
recent years,making possible
noninvasive assessment of many of
these vascular disorders.
6 Radionuclide imaging
 Introduction
 Noninvasive
 Utilizes radiopharmaceuticals
(radioisotopes)
 Evaluates pathophysiology of
systems
 Most common systems scanned are:
skeleton, lungs, liver, thyroid and
heart
 Usually done in combination with X-
ray, CT or MRI
 Radionuclide Imaging
 Several modalities of imaging systems
• Bone scan/bone scintigraphy
• SPECT (single photon emission computed
tomography)
• Ventilation/perfusion scans
• Myocardial perfusion scans
• PET (positron emission tomography)
 Bone scan is the most commonly
performed procedure
 Pathological Findings
 Bone scans are useful for diagnosing the following
conditions:
• Metastatic disease
• Trauma
• Infection
• Paget disease
• Hypertrophic osteoarthropathy
• Reflex sympathetic dystrophy
• Avascular necrosis
• Spondylolysis
• Venous obstruction
• Extraosseous
Normal Bone Scan
Prostate Metastasis
Neuroblastoma
 SPECT Imaging
 SPECT (single photon emission computed
tomography)
 Three dimensional images
• Axial, coronal and sagittal slices
• Gamma camera is rotated around the patient in all three
anatomical planes
 Competing signal from overlying structures is
eliminated
 Accurate detection of subtle signal changes and
better spatial resolution of signal changes
 Useful for detecting occult pars/spinous fractures
Spinous Process Fractures
 PET
 PET (positron emission tomography)
 Physiologic imaging method
• Neuroimaging
• Oncological imaging
 Radionuclide used is fluorodeoxyglucose
(18F-FDG)
 Utilizes beta decay
 Expensive study
 Utilized mostly in research settings but
PET is gaining acceptance outside of
research
 PET
 Positron is emitted by beta plus decay
 Electron is emitted by beta minus decay
 Positron collides with electron
 2 gamma rays are emitted
 Gamma rays are detected by a ring of
detectors around the patient
 PET is now commonly being combined with
dual MRI/PET scanners and CT/PET,
CT/PET Fusion scans
PET Scanner Diagram
CNS Lymphoma-MRI/PET Scan
CNS Lymphoma-Color PET
Scan