Imaging the Brain & Spinal Cord

Question 1

What are the 3 main imaging modalities used for imaging the brain?

1 - ultrasound, CT, MRI
2 - X-ray, CT, PET-scan
3 - X-ray, CT, MRI
4 - X-ray, CT, doppler ultrasound

Answer 1

3 - X-ray, CT, MRI

Question 2

Is X-ray an effective imaging modality for first line investigation for trauma?

Answer 2

• no

- mainly involved in hard tissue only

Question 3

Can X-ray be used to investigate the physical abuse in children?

Answer 3

• yes

- can show bone fractures

Question 4

Label the arrows from the X-ray below using the labels below:

• frontal sinus
• ethmoid sinus
• mandibular condyle
• maxillary sinus
• occiptal bone
• mastoid air cells
• sphenoid sinus
• sella turcica (pituitory gland sits here)
• air in nasopharynx

Answer 4

1 - frontal sinus
2 - maxillary sinus
3 - ethmoid sinus
4 - sphenoid sinus
5 - sella turcica (pituitory gland sits here)
6 - occiptal bone
7 - mastoid air cells
8 - air in nasopharynx
9 - mandibular condyle

Question 5

If a patient has a suspected injury to the brain from trauma, what imaging modality would be appropriate 1st?

1 - MRI
2 - CT
3 - X-ray
4 - ultrasound

Answer 5

2 - CT

Question 6

If a patient has been involved in trauma and has suspected head injury, why would a CT be performed over an MRI?

Answer 6

• lots of contraindications for an MRI

- patient would need to answer questions to ensure risk factors for MRI, may be unconscious

Question 7

When a CT of the head is performed, lots of sections are imaged before being combined together. They eyes are avoided, why?

Answer 7

• to avoid radiating the orbits

Question 8

From MRI and CT, which imaging is best for bone and soft tissue?

Answer 8

• bone = CT scan

- soft tissue = MRI

Question 9

Why does white matter show up on MRI well?

Answer 9

• high fat content

Question 10

What is a subcortical structure of the brain?

Answer 10

• anything below the cerebral cortex of the brain

Question 11

Label the structures in the MRI coronal image of the brain numbered 1-8 using the labels below:

• medulla
• lateral ventricle
• cerebellum
• midbrain
• third ventricle
• hippocampus
• corpus collosum
• pons

Answer 11

1 - lateral ventricle
2 - third ventricle
3 - corpus collosum
4 - midbrain
5 - hippocampus
6 - pons
7 - cerebellum
8 - medulla

Question 12

What is the basal nuclei, also commonly known as the basal ganglia?

Answer 12

• group of subcortical nuclei
• nuclei are clusters of neuronal bodies
• important for movement co-ordination

Question 13

What is a fossa?

Answer 13

• depression or hollow space

Question 14

There are 3 folds in the brain that are created by space between the 2 layers of the dura mater, periosteal layer – lines the inner surface of the bones of the cranium and then meningeal layer – located deep to the periosteal layer. What are the 3 layers called?

1 - Falx cerebri, Tentorium cerebelli, Falx cerebelli
2 - Falx meningeum, Tentorium cerebelli, Falx cerebelli
3 - Falx cerebri, Tentorium cerebelli, cerebelli plexus
4 - Falx cerebri, Tentorium superspinatum, Falx cerebelli

Answer 14

1 - Falx cerebri, Tentorium cerebelli, Falx cerebelli

Question 15

There are 3 folds in the brain that are created by space between the 2 layers of the dura mater, periosteal and meningeal layer – lines the inner surface of the bones of the cranium and then meningeal layer – located deep to the periosteal layer. The 3 layers are:

• Falx cerebri
• Tentorium cerebelli
• Falx cerebelli

What do each of the layers separate?

Answer 15

1 - Falx cerebri = seperates left and right hemispheres
2 - Tentorium cerebelli = separates the occipital lobes from the cerebellum
3 - Falx cerebelli = separates the right and left cerebellar hemispheres

Question 16

What are the 3 parts of the midbrain from top to bottom?

Answer 16

1 - midbrain
2 - pons
3 - medulla oblongata

Question 17

In between the 3 meninges of the brain, the dura, arachnoid and pia mater there are 3 main spaces. What are they called and what do they separate?

Answer 17

1 - epidural space = separates dura and cranium
2 - subdural space = separates the periosteal layer of dura mater and arachnoid mater
3 - subarachnoid space = space between arachnoid and pia mater

Question 18

In the MRI image we can see below, we are able to see the facial and vestibulocochlear nerve, both cranial nerves. When looking at a transverse section such as this how can you remember which nerve is vestibulocochlear and cranial nerve?

Answer 18

• 7up = 7th nerve cranial nerve is highest
• coke down = 8th nerve vestibulocochlear
• cranial nerves 1-10 start raustrally and move caudally, only the 11th and 12th cranial nerve are switched around

Question 19

The circle of willis can be identified well on an MRI. What can be detected well and is present on the image below?

1 - blocked artery
2 cerebral oedema
3 - brain aneurysm
4 - cerebral infarct

Answer 19

3 - brain aneurysm

Question 20

When looking at an MRI image of the spine, why is the middle dark and the outside lighter?

Answer 20

• interior is dark as it is cell bodies

- exterior is whiter as it contains fat from myelin

Question 21

An MRI is a very useful imaging modality for what degenerative disease/disorders?

Answer 21

• neurodegenerative

Question 22

If a patient attended accident and emergency with trauma and experiencing pins and needles in the arms and/or legs, what would be the most suitable imaging modality, providing no contraindications?

1 - MRI
2 - CT
3 - X-ray
4 - ultrasound doppler

Answer 22

1 - MRI

- suggests damage to cervical spine

Question 23

During an MRI scan there are T1 and T2 sections. In a T1 section, what colour will the water and fat be?

Answer 23

• fat = bright white

- water = dark

Question 24

During an MRI scan there are T1 and T2 sections. In a T2 section, what colour will the water and fat be?

Answer 24

• water = white/light grey

- fat = darker