Neuroimaging in Neurology

An Interactive Approach

David C Preston, MD
Professor of Neurology

Barbara E Shapiro, MD, PhD
Associate Professor of Neurology

Department of Neurology
Case Medical Center / University Hospitals
Case Western Reserve University
Cleveland, Ohio

Welcome to Neuroimaging in Neurology, An Interactive Approach. Below is a collection of more than 600 images collected from normal individuals and patients with a variety of neurological and neurosurgical disorders. The goal of this teaching file is threefold: 1) to learn normal neuroanatomy from normal imaging; 2) to recognize the imaging features of the most common and classic neurological disorders; and 3) to learn some key clinical points about each disorder.

Neuroimaging in Neurology is divided into several sections.

The first section is NORMAL IMAGING, which includes:

•  Magnetic Resonance Imaging (MRI) of the Brain

•  MRI of the Spine

•  Magnetic Resonance Angiography (MRA)

•  Magnetic Resonance Venography (MRV)

•  Computed Tomography (CT) of the Brain

•  Conventional Angiography

For all of the images, the native scan is first shown without labels or pointers. However, all the pages are interactive and have buttons or embedded "hot spots" to point out the anatomy. For the MRI and CT scan slices, if one places the cursor over any part of the image, the anatomic name of the structure will appear. For the MRA, MRV and Conventional Angiography images, the native picture will again appear first. Each image is accompanied by a series of blue buttons, each with a labeled structure. By "hovering" the cursor over a blue button, the structure named on the button will be highlighted on the image in a bright color.

The next section consists of five POWERPOINT SLIDE SHOWS that review normal MRI brain slices (sagittal, axial and coronal anatomy), normal CT brain slices, and normal MRA anatomy of both the extracranial and intracranial circulations. The PowerPoint presentations are an alternative way to review normal imaging and learn normal neuroanatomy.

The final and largest section is COMMON AND CLASSIC CONDITIONS. The emphasis in this collection is on conditions most commonly seen in Neurology and Neurosurgery, and not the incredibly rare or esoteric. On the top of each image is a brief narrative of how the patient presented and the reason that the imaging study was done. Below the narrative is the native image without any labels or arrows. Beneath each image is an explanation of the radiologic image, including the modality, the view, and the pertinent findings. This is followed by a brief review of some of the most important clinical points pertinent to the disorder. In addition, each image has one or more blue buttons immediately below it. By "hovering" the cursor over these blue buttons, different parts of the native image are highlighted with coloring, arrows or labels. As soon as the cursor is moved off the button, the native image is instantly restored.

The interactive approach is used in order to allow the reader to be presented first with the clinical information and native image, and then decide for yourself what is normal or abnormal, and point out to yourself the key findings in the image, before they are highlighted. Then you can use the interactive buttons to see if your analysis of the native image is correct. You will also be able to learn key facts about the radiology and clinical presentations of the various disorders.

NORMAL IMAGING

     •  Magnetic Resonance Imaging (MRI) - Brain

Basics of MRI

Sagittal T1-weighted

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 Mid-sagittal (hot spots)

 Mid-sagittal (buttons)

Axial T2-weighted (hot spots)

Coronal T1-Weighted (hot spots)

Coronal MP-RAGE (hot spots)

MP-RAGE (Magnetization Prepared RApid Gradient Echo) is a rapid gradient-echo technique used to enhance contrast. These are very similar to the T1-weighted images above, but have a higher signal intensity and image contrast that allows for better visualization of anatomy.