(radiology) RADIOLOGI.ppt

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    NEUROPSYCHIATRY

    Dr. Muh. Ilyas, Sp.Rad

    DEPARTEMENT OF RADIOLOGY

    MEDICAL FACULTY

    HASASUDDIN UNIVERSITY

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    Introduction

    Radiologic modality for detected the abnormalityin Neuropsiciatry are :

    Plain foto of the skull

    CTscan MRI

    Ultrasonography (Intracranial Doppler)

    Angiography

    Myelography

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    Introduction

    Indication for radiology examination in

    Neuropsychiatry diseases :

    Chronic Cephalgia

    Vertigo

    Occult edema pupil or combination

    Dysartr

    Visus Defect and memory problem

    Epilepsy

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    SKULL PLAIN FOTO

    Some intracranial defect cannot detected withthis examination

    Routine position AP & Lateral

    Skulll foto can give information about :- The shape & the size of the calvaria

    - Calcification, erosion or local sclerotic.

    - Shape & size of sella turcica

    - Suture

    - Vascularisation

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    Skull foto, lateral position :Normal

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    Skull Foto AP/lat : Normal Calsification

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    The Abnormality

    Increase of intracranial pressure make thecalvaria change

    - dyastasis (find in children )

    - Erosion of dorsum sella

    - Local erosion or local hyperostosis

    - Impressio digitatae (thumb printing)

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    Primer tumor

    The characteristic of primer tumor in skull photoare

    Abnormal Calcification

    Local erosion/sclerotic

    Erosion of Sella turcica

    Dilatation of the vein that effected by abnormal

    vascularisation of the tumor. Displacement of glandula pinealis.

    Sign of increase intracranial pressure

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    Lateral skull Foto : Increase ofintracranial pressure

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    Skull foto (AP) : Astrocytoma

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    Metastatic Tumor

    Multiple coin lesion appeareance

    Sign of Increase intracranial pressure

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    Hydrocephalus

    Radiology finding in skull photo are :

    Change of shape & size of the skull

    Suture Dyastasis

    Erosion of the calvaria

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    Skull foto AP/Lat : Hydrocephalus

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    Brain CT Scan

    The Lesion density divided by :

    High density (hyperdens) if the density

    of the lesion is more than the normal brain Isodensity if the density of the lesion is

    same with the normal brain.

    Low density (hypodens) if the densityof the lesion is lower than the normalbrain.

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    Abnormality that can find inHead CT Scan :

    Brain Tumor

    Abnormality in cerebrovasculer

    Anomali Infection diseases

    Cerebral atrophy/degenerative

    diseases

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    CT Scan Finding of the Brain tumor :

    Mass Effect (sign of emphasis,

    displacement and obstruction ) Perifocal Edema

    Calcification

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    a. b.

    Meningitis Tuberkulosa : a. CT, b. MRI

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    ENCHEPHALITIS

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    Cerebrovasculer Abnormality

    cerebrovasculer Abnormality is consisted of :

    Intracerebral Hemorragic hypertension

    InfarkAneurysm

    Arteriovenous malformation

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    Miliary Tuberculosis

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    Tuberculoma

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    Alzheimers Disease

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    Encephalitis : a. CT non contast, b. CT contrast

    a. b.

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    Intracerebral Hemorragic ByHipertension

    Caused by ruptured of microaneurysmaarteriole.

    In acute fase the blood density is hyperdensor isodens, oval/irrreguler.

    The lesion is surrounded by perifocal edema,sometimes with mass effect (compression orherniation).

    In Chronic fase the density of the hematoma

    is isodens or hypodens , the ventricle syst. andthe sulci dilated caused of atrophy

    CT + contras homogen enhancement or ringenhancement.

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    Left Intracerebri Hemorragic & Bilateral

    Intraventricular Hemorragic

    CLINIC: LEFT LATERALISATION EC HS

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    CLINIC : TRAUMA CAPITIS (GCS = 9)

    SUBDURAL HEMATOMA with SUB FALK HERNIATION

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    KLINIS : KESADARAN MENURUN

    PERDARAHAN SUBARACNOID,

    INTRAVENTRIKULAR BILATERAL DAN PON

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    Infark cerebri

    Happen by occlusion of cerebral vein thatmake necrotic of the brain.

    Necrotic/ischemic of the brain caused by :

    - Thrombosis- Emboli

    In acute stage usually there is no

    abnormality in ct scan.After 4 days There is hypodens area,

    rounded/oval/irreguler.

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    Infark Cerebri

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    KLINIS : KESADARAN MENURUN

    INFARK CEREBRI KANAN

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    Infark Haemorrhagic : a. CT, b. MRI T1Wi

    a. b.

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    Aneurysm

    Angiography is the best modality fordiagnose because aneurysm is a vascularabnormality.

    CT Scan good for detected the

    complication of aneurysm ,like :Intracerebral hematoma, infark & edema

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    Coronal

    Axial

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    Arteriovenous Malformation

    AVM blood flow from artery to venouswithout passing the capillary.

    In CT without contras

    there iscalcification, sometimes hyperdenslesion and hydrocephalus.

    CT scan + contrast

    there is tubularenhancement/tortuous.

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    Central Nerve System Anomaly

    CNS Anomaly :

    Congenital Hydrocephalus

    Agenesis Corpus Callosum Sturge-weber synd.

    Sclerosis tuberous (Bournevillediseases)

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    Congenital Hydrocephalus

    Caused of aquaduct stenosis or stenosis osfomanen magendi & Luscka and anomaly offossa posterior structure.

    CT scan dilated of ventricle lateralis & 3rdventricle in aquaduct stenosis but the 4thventricle still normal.

    Dandy Walker synd dilated of ventricle

    lateralis , 3rdventricle & 4thventricle.

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    Hydrocephalus

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    Hydrocephalus

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    KLINIS ; HIDROCHEPHALUS

    HYDRANENCHEPALY

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    Agenesis Corpus Callosum

    Caused of corpus callosum not growth ,maybe caused by a trauma in firstsemester of the pregnancy.

    CT scan finding agenesis of corpuscallosum, agenesis septum pellucidum,with position of 3rdventricle is higher ,

    the right & left lateral ventricle areseparate.

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    Cerebral Abcess

    Caused by sprending infection of otitismedia/ mastoiditis.

    soliter or multiple

    CT scan finding hypodens area in thecortex or corticomedullar junction

    CT + contras ring enhancement

    surrounding the hypodens area. There isperifocal edema out of the ringenhancment .

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    a. b.

    Abces Cerebri : a. CT non contrast, b. CT contrast

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    Cerebral atrophy

    CT scan finding The space betweentabula interna & the outer margin of the

    cortex cerebri more wider.Sulci, Silvii fissure & cistern basalis arewider too.

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    Atrofi Cerebri

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    M R I

    One of Radiology modality produced picture of human body scan

    without X ray but used magnetic.

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    1. Isointens

    2. Hypointens

    3. Hiperintens

    There is 3 intensity in MRI :

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    Example :

    Water : hypointens in T1 & becomehyperintens in T2

    Fat or blood : hyperintens in T1 & T2

    Calsification : hypointens in T1 & T2

    T1 : longitudinal relaxation time (TR short dan TE

    short)T2 : transversal relaxation time (TR long dan TElong)

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    Pesawat MRI

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    The Advantage of MRI

    1. No X ray2. No damage to body if the use is right3. Many examination can do without contrast, not

    invasif and not used iodium contrast4. MR can show biologic parameter

    (spectroscopy), for example ; can show thedifferent of solid mass, fat/non fat, fluid, & theage of the hemorragic.

    5. Can produce 3 D scan/direct multi planarwithout change the patient position .6. Very sensitive for soft tissue morphology

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    The Loss of MRI

    1. Expensive

    2. Take more time for examination

    3. Cannot use to Patient with metal(pacemaker, ferromagnetic)

    4. Klaustrophoby

    5. Need more cooperation from the patient,sometimes need general anesthetic forunstable patient & children.

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    MRI : Lacunar Infark

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    Indication for Brain MRI

    1. Tumor

    2. Hemorrhagic Infark /non hemorrhagicperdarahan.

    3. Demyelinisation diseases ( multiplesclerotic)

    4. Vascular abnormality.

    5. Infection

    6. Metastasis.

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    Brain MRI : normal

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    MRI : Subdural Hemorrhage, pre & post kontras

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    MRI : Hydrocephalus

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    Myelography

    Myelography radiology modality which

    can show the structure of canalis spinaliswith inject contras in to the canalis

    spinalis. Contras can divede in to 2 group :

    - Contras negatif : air

    - Contras positif : - water soluble

    - oil soluble

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    The abnormality in myelography:

    Hernia nucleus pulpous (HNP)

    Tumor, :

    - Extradural tumor

    - Intradural tumor , divided into :

    - intramedular

    - extramedular

    Congenital abnormality (malformasi):

    - meningochele- meningomyelochele

    Arachnoiditis

    Hernia Nucleus Pulposus

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    Hernia Nucleus Pulposus

    HNP : protrusion of the disc to posteriorwhich can compress the nerve, medullaspinalis neurological sign.

    HNP can find in younger or older patient In younger patient usually caused by

    trauma or gravitation of column vertebrawhich receive more weight barring

    In older patient usually caused bydegenerative disc process, starting with

    disc inertia and then loss of elasticity ofnucleus and degenerative of chondraljoint

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    MRI : Nucleus Pulposus

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    G di f H i

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    Grading of Hernia:

    - Protruded intervertebral discProtrution of Nucleus menonjol to one direction withoutannulus fibrous damage

    - Prolaps intervertebral discDisplacement of Nucleus but still in annulus ring.

    - Extruded intervertebral discNucleus out from the annulus and residing belowthe lig. longitudinal post.

    - Sequestrated intervertebral disc

    Nucleus penetrate the lig.longitudinal post.

    KLINIS : CEFALGIA EC TUMOR OTAK

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    MACROADENOMA HIPOFISE

    KLINIS : CEFALGIA EC. TUMOR OTAK

    KLINIS : HEMIPARESE SNISTRA EC NHS

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    ASTROCYTOMA

    KLINIS : HEMIPARESE SNISTRA EC. NHS

    KLINIS : CARSINOMA THYROID

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    KLINIS : CARSINOMA THYROID

    CARSINOMA THYROID KANAN

    KLINIS : TONSILOPHARINGITIS AKUT

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    KLINIS : TONSILOPHARINGITIS AKUT

    POLIP SINUS MAXILLARIS KIRI

    SINUSITIS SPHENODALIS DA N FRONTALIS

    KLINIS : CEPHALGIA + SINUSITIS

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    KLINIS : CEPHALGIA + SINUSITIS

    PANSINUSITIS

    KLINIS : OMSK

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    CHOLESTIATOM SINISTRA

    KLINIS : SUSPEK POLIP NASI

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    SINUSITIS MAXILLARIS KANAN

    KLINIS : SUSPEK POLIP NASI

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