&=
copy;
2006 Neurodiagnostic Consultants, LLC.
P=
ATIENT INFORMATION<=
/p>
<=
/span>
<=
/span>
NEUROIMAGING
TECHNIQUES
<=
o:p>
Major technological developments in neuroradiology hav=
e resulted
in the detection and characterization of neurological diseases that were not
demonstrated with earlier imaging methods.=
The advent of computed tomography (CT) in the 1970s and Magnetic
Resonance Imaging (MRI) had a major impact on how neurological disorders are
diagnosed and confirmed by visualization of the tissues on the nervous
system. Information below is
provided for general education purposes and is purposefully simplified for a
lay reader. It does not endorse a particular technique for a diagnosis of a
particular symptom, disease or condition.&=
nbsp;
Selection of imaging techniques should be done by a qualified physic=
ian
after an evaluation of each individual patient.
Neuroimaging techniques provide information about the
structure of an area of interest, and may provide limited functional
information, particularly when blood flow or metabolite uptake need to be
evaluated. Therefore, one or =
more
of these techniques may be indicated when changes in structure and relevant
function are suspected or need to be verified.
<=
o:p>
COMPUTED TOMOGRAPH=
Y (CT)
![](3D"file:///C:\E2CA6113\Neuroimagingtechniques_files\image003.jpg")
Computed Tomography provides=
a
cross-sectional image of the body.
The images produced by this technique depend on how tissues absorb
X-rays. Although it is simila=
r in principle
to the X-ray image, the image produced by computed tomography is not the sa=
me
as a routine X-ray image. CT
provides greater spatial definition of tissues and offers greater resolving
power, particularly when soft tissues (rather than hard ones, like bones) a=
re
analyzed. Rather than a more
familiar contrasty black-and-white X-ray photograph, a CT image is a mix of
shades of gray. It also allow=
s for
a3-dimentional visualization, something that routine X-ray is simply not
capable of.
<=
o:p>
Addition of contrasts (special
fluids are introduced into the body through a vein and will be visible on t=
he
CT image) provides for greater specificity and sensitivity of CT in compari=
son
to non-contrast studies. This=
is
particularly important when a breach in the blood-brain barrier is suspected
– normally, not all substances can enter the brain tissue from the bl=
ood,
but if this “barrier” is breached, as is the case in tumors or
inflammatory processes, the contrast liquid will enter the brain tissue tho=
se
this breach and will be identified on a CT scan.
<=
o:p>
<=
o:p>
F=
or
additional information about Computed Tomography, please refer to the
Radiological Society of North America by following this link.
<=
o:p>
MAGNETIC RESONANCE
IMAGING![](3D"file:///C:\E2CA6113\Neuroimagingtechniques_files\image004.jpg")
(MRI)
<=
o:p>
In Magnetic Resonance Imaging, the images result from
radio-waves reflected from the tissues in response to radio-wave pulses
produced by the MRI machine. =
In
addition to both creating pulses of radio waves and recording their reflect=
ions
from the body, the MRI machine creates a magnetic field of through which th=
ese
waves travel. By changing the
strength of this magnetic field, one can “focus” an MRI machine=
on
a particular depth in the body.
Although patients do not see these changes of magnetic fields, they =
hear
them quite well – it is the loud clicking noise than every MRI machine
makes and is one of the reasons why most MRI facilities offer headphones or=
ear
plug to patients.
Most MRI machines still require that a patient be lie =
down
on a table that will be moved in and out of the MRI “tube”, whe=
re
the magnetic field is created.
Because it is important that the magnets be located as close of the
patient’s body as possible, the tube’s diameter is not much gre=
ater
than the shoulder width. Being
confined motionless in a tube may make some patients quite uncomfortable and
even cause them to panic, a condition known as claustrophobia, or fear of being in a confined space.
<=
o:p>
Contrasts may also be used during an MRI, as they
are used in Computed Tomography. Contrast MRI can help in the evalu=
ation
of relative differences in brain blood volume over time, which is important=
in
conditions where changes in blood flow are suspected (hemorrhage or ischemi=
a).
<=
o:p>
Patients with metal objects imbedded in their bodies (=
due
to prior surgery, for example, when pins, screws or staples are used to con=
nect
bones) or electric devises (such as pacemakers) should make this known to t=
he
physician, who is referring them for an MRI, as the magnetic field in which=
MRI
is conducted may interfere with the function of these imbedded objects or
devices, or the shadow of such metallic object may interfere with the
interpretation of the resultant image.
<=
o:p>
F=
or
additional information about Computed Tomography, please refer to the
Radiological Society of North America by following this link.
<=
o:p>
ANGIOGRAPHY
![](3D"file:///C:\E2CA6113\Neuroimagingtechniques_files\image007.jpg")
Translated from its Greek roots, angiography means “recording of blood vessels”. Unfortunately, blood and blood ves=
sels
record poorly (if at all!) in conventional imaging techniques. In order to visualize blood vessel=
s, one
has to inject a contrast in the blood stream and take an X-ray photograph, =
a CT
or an MRI scan of the area those blood vessels supply with blood. This technique is needed when CT o=
r MRI
cannot produce a clear picture of the blood vessels and when the structural
integrity of blood vessels is being questioned. Among some indications for this im=
aging
methods are hemorrhage, vasculitis (infectious, drug-induced or inflammator=
y),
tumors, thromboembolitic stroke, vascular occlusive diseases, primary vascu=
lar
abnormalities arterial dissections, congenital lesions of the vascular syst=
em
or trauma of brain, neck or spine.
<=
o:p>
M=
ultiple
images may be taken, at even time intervals, to help identify arterial and
venous circulation of blood.
<=
o:p>
Magnetic Resonance Angiography is particularly suited =
in
situations when the need to detect and characterize blood flow has arisen.<=
span
style=3D'mso-spacerun:yes'> It produces a “blood flow
map” where visualization of a blood vessel is based on differences in
physical properties between moving and stationary particles. There are technical variations of =
this
method that produce both 2-dimensional and 3-dimensional images that allow
attainment of images of high resolution and identification of areas of even
very slow flow.
<=
/p>
F=
or
additional information about Computed Tomography, please refer to the Radio=
logical
Society of North America by following this link.
<=
o:p>
MYELOGRAPHY=
=
This technique is used to visualize the spinal cord and
fluid-filled space immediately surrounding the spinal cord. The procedure involves an injectio=
n of
an iodine-based contrast material into the subarachnoid space around the sp=
inal
cord. Similarly to an angiogr=
am, an
X-ray, CT or an MRI image may be produced to visualize defects in the spinal
cord, nerve roots and structures in the immediate vicinity.
<=
o:p>
F=
or
additional information about Computed Tomography, please refer to the
Radiological Society of North America by following this link.
<=
o:p>
ULTRASOUND
U=
ltrasound
can be used not only to reveal the structure of an area of interest, but al=
so
to identify patterns of blood flow:
whereas normal blood vessels move blood at a relatively constant spe=
ed, any
changes in the lumen of the vessel – dilation or constriction –=
can
introduce changes to this patter and make blood flow more or less
turbulent. These changes in how the blood flows may be recorded
using ultrasound technology. =
In
addition, any structural changes of the blood vessel lumen (stenotic or
embolitic changes) may be visualized by ultrasound.
<=
o:p>
S=
ome uses
of ultrasound in neurological practice are, but not limited to the
following: acute stroke, rece=
nt
stroke, chronic cerebrovascular disease, aneurismal subarachnoid hemorrhage=
.
<=
o:p>
F=
or
additional information about Ultrasound, please refer to the Radiological
Society of North America by following this link.
<=
o:p>
POSITRON EMISSION =
TOMOGRAPHY
(PET)
![](3D"file:///C:\E2CA6113\Neuroimagingtechniques_files\image008.jpg")
PET belongs to the category of imaging techniques that
assess function. The principle
behind this method is fairly simple:
attach a radioactive tag to something you want to track that is
otherwise “invisible” and trace this tag using a material that =
is
sensitive to radioactive materials.
When one applies this idea in Neuroimaging, one can trace the
distribution of certain molecules and their consumption by nerve cells and =
from
that judge whether a nerve cell is viable or not, or whether it perform its
function that necessitates molecule uptake.
One of the areas of neurology that has made extensive =
use
of functional imaging techniques is neurodegenerative disorders and
dementia. The goal is not jus=
t to
confirm considerable neuronal attrition at a late stage of a disorder, when
clinical signs are overwhelming, but to be able to identify metabolic chang=
es before debilitating clinical
symptoms develop.
Some functional parameters, such as glucose and oxygen
uptake by nerve cells can be measured, for instance, in Alzheimer’s
diseases, and subtle changes may be identified before significant cognitive
changes ensue. In movement
disorders, where significant structural changes are not easy to identify by
structural methods (especially in early stages), functional assessment of t=
he
tracers of the dopaminergic system may be useful to establish suspected cha=
nges
in these disorders) – for instance, in Parkinson’s disease,
progressive supranuclear palsy, multiple system atrophies and other conditi=
ons
when nerve cells degenerate, a decrease in the uptake and retention of a
substance called 18F-dopa in certain areas of the brain may be
found.
<=
o:p>
F=
or
additional information about Ultrasound, please refer to the Radiological
Society of North America by following this link.
<=
o:p>
<=
o:p>
<=
o:p>
<=
o:p>
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