Neuro curs fundeni
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Transcript of Neuro curs fundeni
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NEURORADIOLOGIANEURORADIOLOGIA
CraniuCraniu- encefal+meningeencefal+meninge
Col.vertebralaCol.vertebrala - maduva spinariimaduva spinarii
- meninge,radacinimeninge,radacini
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METODE DE EXPLORAREMETODE DE EXPLORARE
1. Metode radiologice standard1. Metode radiologice standard ce cuprind la rândul lor: ce cuprind la rândul lor:metode neinvazive ce au ca exponent metode neinvazive ce au ca exponent radiografia standardradiografia standardmetode invazive ce utilizează substanţe de contrast iodate metode invazive ce utilizează substanţe de contrast iodate nonionice utilizate în angiografia cerebralănonionice utilizate în angiografia cerebrală
2. Metode imagistice2. Metode imagistice reprezentate de: reprezentate de:Doppler cervicalDoppler cervicalEcografia transfontanelarăEcografia transfontanelarăDoppler transcranianDoppler transcranianEcografia orbitelorEcografia orbitelorComputertomografia (CT)Computertomografia (CT)Imagistica prin rezonanţă magnetică (IRM) şi angiografia prin Imagistica prin rezonanţă magnetică (IRM) şi angiografia prin rezonanţă magnetică (ARM).rezonanţă magnetică (ARM).
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Expl.RX.standardExpl.RX.standard cuprinde minim 2 clisee cuprinde minim 2 clisee ex.in incidente perpendiculare una pe cealaltaex.in incidente perpendiculare una pe cealalta
Incidenta de fataIncidenta de fata
sinusuri frontalesinusuri frontale
orbite+fante sfenoidaleorbite+fante sfenoidale
parte din boltaparte din bolta
planseul seiiplanseul seii
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Incidenta de profil (bitemporala)Incidenta de profil (bitemporala)
std.celor 3 etaje(ant.mijl.post.)std.celor 3 etaje(ant.mijl.post.)
saua turceascasaua turceasca
jonctiunea cranio-cervicalajonctiunea cranio-cervicala
vertexvertex
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INTERESUL DIAG.AL RG.STD.INTERESUL DIAG.AL RG.STD.
1.Traumatisme1.Traumatisme
2.Afect.sinusiene2.Afect.sinusiene
3.T.cerebrale-HIC3.T.cerebrale-HIC
4.Asimetrii craniene4.Asimetrii craniene
5.Calcificari intracraniene5.Calcificari intracraniene
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Diagnosticul calcificarilor icDiagnosticul calcificarilor ic
A.FIZIOLOGICEA.FIZIOLOGICE- epifiza- epifiza- coasa creierului- coasa creierului- plexuri coroide- plexuri coroide- cortul cerebelului- cortul cerebelului- lig.interclinoidiene- lig.interclinoidiene
B.PATOLOGICEB.PATOLOGICE- tumorale- tumorale- vasculare- vasculare- infectioase- infectioase- facomatoze- facomatoze- b.Fahr- b.Fahr
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EXPLORAREA RADIOLOGICĂA COLOANEI VERTEBRALE
Incidenţa de faţă permite examinarea:
Contururilor corpilor vertebrali;Poziţiei pediculilor vertebrali;
Apofizelor transverse;Apofizelor spinoase
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EXPLORAREA RADIOLOGICĂA COLOANEI VERTEBRALE
Incidenţa de profil permite analiza :
Corpilor vertebrali;Pediculilor;Apofizelor spinoase;Unor detalii ale articulaţiilor mici;Spaţiilor intervertebrale;Curburilor coloanei vertebrale;Calcularea diametrului antero-posterior alcanalului vertebral.
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Examenul radiografic standard al coloanei vertebrale poate evidenţia:
- Modificari de structura osoasa (eroziuni corporeale sau pediculare) - Existenţa de tasări vertebrale - Lărgirea diametrului antero-posterior sau interpedicular- Existenţa anomaliilor congenitale (spina bifida, hemivertebre)- Modificari degenerativ artrozice
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2.ANGIOGRAFIA CEREBRALA2.ANGIOGRAFIA CEREBRALA
exista 2 sisteme arteriale:exista 2 sisteme arteriale:- sist.carotidian.- sist.carotidian.
- sist.vertebro-bazilar- sist.vertebro-bazilar
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Tehnica actuala:Tehnica actuala:
arteriografie selectivaarteriografie selectiva
metoda Seldinger==> pe cale femuralametoda Seldinger==> pe cale femurala
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Interesul diag.al arteriografiilorInteresul diag.al arteriografiilor
patologia vasculara a gatuluipatologia vasculara a gatului
malformatii vasculare intracerebralemalformatii vasculare intracerebrale
hematoamehematoame
tum.intracranienetum.intracraniene
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MAV
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Avantajele şi limitele angiografiei cerebrale
Avantaje Limite
Studiu completStudiul art. comunicanteAnaliza ramurilor corticaleAnaliza supleanţelor
Complicaţii neurologiceIradiereCantitate mare de produs de contrast iodatNu există vedere în plan axialNu există informaţii asupra structurii parietale
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Tomografia computerizataTomografia computerizata
Se bazeaza pe 2 principii: Se bazeaza pe 2 principii: 1.calc.coef.de atenuare al fasc de RX 1.calc.coef.de atenuare al fasc de RX 2.reconstr.unui ob.plecand de la 2.reconstr.unui ob.plecand de la proiectiile sale diferite proiectiile sale diferite
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Elem.imp.ptr.interpretareElem.imp.ptr.interpretare
Istoria clinica: antecedentele Istoria clinica: antecedentele
traumaticetraumatice
inflamatii ORLinflamatii ORL
sdr.metastatic-t.primarasdr.metastatic-t.primara
serologie HIV+serologie HIV+
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In raport cu parenchimulIn raport cu parenchimulcerebral o leziune poate fi:cerebral o leziune poate fi:
HIPERDENSAHIPERDENSA
HIPODENSAHIPODENSA
IZODENSA (se evidentiaza IZODENSA (se evidentiaza injectare iv. de p.de contr.) injectare iv. de p.de contr.)
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Descriem:Descriem:
- Forma leziunii- Forma leziunii- StructuraStructura- ContururiContururi- DimensiuneaDimensiunea- LocalizareLocalizare- Unica/multiplaUnica/multipla- Efect asupra structurilor adiacenteEfect asupra structurilor adiacente
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HIPODENSA
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HIPERDENSA
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Localizarea:Localizarea:
IntraparenchimatoasaIntraparenchimatoasa
ExtraparenchimatoasaExtraparenchimatoasa– sp.subarahnoidiensp.subarahnoidien– meninge meninge – oase cranieneoase craniene– Structuri vasculareStructuri vasculare
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TUMORA FRONTALA
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Anevrism TB
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DISPLAZIE FIBROASA
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Determina:Determina:
- sdr.de masa- sdr.de masa
- sdr.de pierdere de - sdr.de pierdere de subst.cerebr.subst.cerebr.
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HeterogenaHiper/ hipodensa
Sdr. de MASA
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ATROFIE CEREBRALA
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Se incepe intotdeauna cu un ex. CT simpluSe incepe intotdeauna cu un ex. CT simplu
- std.elem anat.N.- std.elem anat.N.- morfologia parenchimului- morfologia parenchimului- densitometria diferitelor str- densitometria diferitelor str..
+/-CT cu subst.de contrast iv.+/-CT cu subst.de contrast iv. (1ml/kg corp) vizualizarea (1ml/kg corp) vizualizarea
- str.vasc,- str.vasc,
- cort, coasa, - cort, coasa,
- epifiza, antehipofiza, plexuri corioide- epifiza, antehipofiza, plexuri corioide- impregnarea str.patologice- impregnarea str.patologice
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TCC
Fereastra de os
Fereastra de parenchim
Recon 3D
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1.HIPODENSE1.HIPODENSE
pierdere neuronala=AVC ischemicpierdere neuronala=AVC ischemic
patologie demielinizanta/abs.mielineipatologie demielinizanta/abs.mielinei
incarcare hidrica-edemincarcare hidrica-edem
tes.tum./necrotic/chisttes.tum./necrotic/chist
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AVCAVC
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CHIST
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2.HIPERDENSE2.HIPERDENSE
Singele proaspat:densit.:60-80 UHSingele proaspat:densit.:60-80 UH * hematoame * hematoame * hemoragii * hemoragii * MVC:angioame,anevrisme * MVC:angioame,anevrisme
tes.tumoraltes.tumoral
calcificari(densit.>100 UH)calcificari(densit.>100 UH)
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MAV
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3.IZODENSE3.IZODENSE
singele degradat (Z10-Z20)singele degradat (Z10-Z20)
tes.tumoraltes.tumoral
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HEMORAGIE subacuta tardiva
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Incarcarea cu contrast a unei Incarcarea cu contrast a unei leziuni traduce:leziuni traduce:
hipervascularizatie tum.hipervascularizatie tum.
vas cu singe circulant(angiom,anevr.)vas cu singe circulant(angiom,anevr.)
BHE ruptaBHE rupta
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ANEVRISME
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TUMORA- MENINGIOM
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Indicaţiile examenului computer-tomografic în patologia cranio-cerebrală
- Patologie traumatică - Patologie vasculară
Hemoragii intraparenchimatoase, meningee Accidente vasculare ischemice; Malformaţii vasculare cerebrale: anevrisme, MAV;
- Patologie infecţioasă (bacteriană, virală, parazitară, micotică).
- Tumori intracraniene (primitive, secundare).- Patologie atrofică şi degenerativă- Malformaţii cranio-cerebrale
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TCCTCC
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HEMORAGIE
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IRMIRM
nu exista scari de densitatenu exista scari de densitate
opereaza cu notiunea de semnalopereaza cu notiunea de semnal - izo - izo - hipo / semnal (intensitate) - hipo / semnal (intensitate) - hiper - hiper
contrastul de referinta este dat:contrastul de referinta este dat: - de subst cenusie in et.cerebral - de subst cenusie in et.cerebral - de maduva spinarii in et.rahidian - de maduva spinarii in et.rahidian
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Incidentele utilizate:Incidentele utilizate:
in orice planin orice plan
achizitie 3 Dachizitie 3 D
Secventele T1 permit:Secventele T1 permit: - std.morfologic - std.morfologic
SecventeleT2:SecventeleT2: - dif.subst.albe/cenusie - dif.subst.albe/cenusie - analiza comp.unei leziuni - analiza comp.unei leziuni - la nivel medular=efect mielografic - la nivel medular=efect mielografic
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T1 SE
T1 SE
T2 FSE
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Imaginisursă 3D TOF- MIP
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T1- Malformatie cerebrala
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T2 Cavernom
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Sensibilitatea IRM>s.CTSensibilitatea IRM>s.CTSpecificitatea IRM limitataSpecificitatea IRM limitata
maj.leziunilor:maj.leziunilor: * hipointense T1 * hipointense T1 * hiperintense T2 * hiperintense T2
Prod.de contrast:Prod.de contrast:- paramagnetice-Gd.- paramagnetice-Gd.- amelioreaza contrastul tes.N/tes.patol.- amelioreaza contrastul tes.N/tes.patol.- N se incarca: cortul,coasa,plex.cor.- N se incarca: cortul,coasa,plex.cor. antehip.,tija pituitara antehip.,tija pituitara
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T2 T1
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TUM. UNGHI PONTO-CEREBELOS (Neurinom)
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IRM avantaje:IRM avantaje:
f.buna rezolutie in contrastf.buna rezolutie in contrast
std.in 3 planuristd.in 3 planuri
nu exista artefacte-std.FCPnu exista artefacte-std.FCP
nu exista iradierenu exista iradiere
risc exceptional de soc anafilacticrisc exceptional de soc anafilactic
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Contraindicatii IRMContraindicatii IRM
clipuri metaliceclipuri metalice
valve metalicevalve metalice
peacemakeripeacemakeri
corpi strainicorpi straini
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RMN dezavantaje:RMN dezavantaje:
rezolutie spatiala IRM< CTrezolutie spatiala IRM< CT
timp de ex.lungtimp de ex.lung
anomaliile osoaseanomaliile osoase
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Indicatiile RMN:Indicatiile RMN:
Patol.tumoralaPatol.tumorala
Afectiunile subst.albeAfectiunile subst.albe
Patol.infectioasaPatol.infectioasa
Patol.vascularaPatol.vasculara
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T1
T2 FSE
T2 EG
Anevrism ACoA