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RAD614 > Image interpretation Book - physics, Head and spine > Flashcards

Image interpretation Book - physics, Head and spine Flashcards

(49 cards)

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1
Q

Which is the correct order of tissue densities?
1. Air < fat < fluid < Soft tissue < Bone
2. Air < fat < soft tissue < fluid < bone
3. Air < fluid < soft tissue < fat < bone
4. Air < fluid < fat < soft tissue < bone

A
  1. Air< fat< fluid< Soft tissue < Bone
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2
Q

How many times more radiation do you get from a AXR compared to a CXR?
1. 0.3
2. 3
3. 30
4. 300

A
  1. 30
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3
Q

Is air bright or dark on US?

A

bright

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4
Q

What is the monro-kellie law?

A

The total volume of brain matter, CSF and intercranial blood must be constant
If one increases another must decrease

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5
Q

How does a plain CT head appear in very early ischemic stroke?

A

normal

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6
Q

What is an intercranial haemorrhage?

A

A bleed inside the skull

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7
Q

What are the types of intercranial haemorrage?

A

Intra- axial - within the brain itself
Extra - axial - between the brain and the skull

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8
Q

Which bleeds are intra-axial?

A

intraparencymal and intraventricular

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9
Q

Which bleeds are extra-axial?

A

Extradural, subdural and subarachnoid

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10
Q

What is a extracranial haemorrhage?

A

outside the skull eg soft tissue bruising or hematoma

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11
Q

What are signs of mass effect on brain tissue?

A

midline shift,
ventricular effacement - slit like ventricles
Sulci effacement - loss of definition of sulci
herniation

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12
Q

How does different stages of blood appear on CT?

A

Acute (hours to days) = white
Sub acute (days to weeks) = grey
Chronic (weeks to months) = old blood = dark

Acute on chronic creates a layering effect

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13
Q

what is an Extradural haemorrahge?

A

A bleed that lies between the skull and the dura matter
Arterial bleed
Lemon / lenticular shaped

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14
Q

What are common causes of extradural haemorrhages?

A

Head trauma - particularly to the pterion which tears the middle menigeal artery.

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15
Q

What is a sub-dural haemorrhage?

A

A bleed that lies between the dura matter and the arachnoid matter.
Venous bleed
Banana / crescent shaped

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16
Q

What are common causes of sub-dural haemorrhages?

A

Common in alcoholics and elderly who have cerebral atrophy. There is more strain on the veins which tear with minor trauma.

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17
Q

What is a subarachnoid haemorrhage?

A

Bleed in the subarachnoid space
resembles a spider web

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18
Q

What are common causes of sub-arachnoid haemorrhages?

A

can occur after trauma or patients with AVMs or berry anyrysms.

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19
Q

What symptom do patients complain of if they have a sub-arachnoid haemorrhage?

A

thunderclap headache

Blood in the subarachnoid space can cause meningeal irritation and shows similar symptoms to meningitis.

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20
Q

What is the appearance of a subarachnoid haemorrhage?

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A

High density blood in the sulci, basal cisterns and fissures
It may also extend into the ventricles

21
Q

What is an intraparenchymal haemorrhage?

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A

Intracerebral bleeds are found within the brain matter itself.

22
Q

What are common causes of intraparenchymal haemorrhage?

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A

Hypertension, trauma or haemorrhagic stroke

23
Q

what is the appearance of an intraparenchymal haemorrhage

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A

Area of high density within the brain matter

24
Q

What is an intraventricular haemorrhage?

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A

Bleed within the ventricles - can be primary or secondary extending from a subarachnoid bleed

25
How does a intraventricular bleed appear?
Bright blood within the ventricles. can be a CSF-blood level as denser blood sinks
26
Symptoms of Ischemic strokes: what arteries are affected and what symptoms are associated with TACS - total anterior circulation stroke
Anterior / middle cerebral artery all 3 of: higher dysfunction hemiparesis hemianopia (loss of visual field)
27
Symptoms of Ischemic strokes: what arteries are affected and what symptoms are associated with PACS - partial anterior circulation stroke
anterior / middle cerebral artery any 2 of: higher dysfunction hemiparesis hemianopia (loss of visual field)
28
Symptoms of Ischemic strokes: what arteries are affected and what symptoms are associated with POCS - posterior circulation stroke
posterior cerebral artery any 1 of: cerebellar symptoms LOC hemianopia
29
Symptoms of Ischemic strokes: what arteries are affected and what symptoms are associated with LACS - Lacunar stroke
small vessel disease hemiparesis / hemiparaesthesia
30
What are the appearances of ischemic strokes on CT?
low density area - takes hours to develop loss of differentiation of grey/white matter sulcal effacement bright MCA sign old infarcts have lower density than acute
31
What are the appearances of ischemic strokes on MRI?
DWI best to detect - on DWI Infarct is bright area that develops within minutes
32
What are the appearances of brain tumors?
Appearances vary but they are usually heterogenous (non-uniform texture) solid lesions. sometimes lesions aren't seen but vasogenic oedema or other signs eg midline shift is seen Tumors generally enhance with contrast
33
What is the most common differential diagnosis from appearance compared to a lesion?
brain abscess
34
What is small vessel disease?
Due to age atherosclerosis affects the small arterioles in our brains which supply the subcortical, periventricular and lacunar areas. Those areas become ischemic and low density on CT. It can lead to vascular dementia.
35
How does small vessel disease appear?
Generalised low attenuation of ischemic white matter. associated with age related cerebral atrophy - signs = enlarged ventricles and widened sulci
36
What causes alzheimers?
Accumulation of amyloid plaques and neurofibrillary tangles
37
What are the signs of a venous sinus thrombosis?
Headaches and neurological signs. most occurring in people with prethrombotic risk factors. It can progress to a cerebral infarct and secondary haemorrhage.
38
How does venous sinus thrombosis appear?
On a CT venogram -filling defect within a contrast enhanced venous sinus. known as an empty delta sign
39
How do cerebral aneurisms appear?
localised dilatation along a cerebral vessel
40
What are the types of skull fractures?
* linear ( uncomplicated) * Depressed (pushed in) * Diastatic ( suture widening) * Basilar (Base of skull)
41
What are the signs of a basilar skull fracture?
Bruising around the eyes (racoon eyes) and the mastoid processes ( battle sign) and CSF leakage from nose (rhinorrhoea) and ears (otorrhoea)
42
What is important when looking for skull fractures?
They can be confused for sutures so its important to follow the line to see if it runs in a suture line
43
What causes vertebral compression fractures?
Trauma or pathological reason eg osteoporosis, lytic mets
44
How do spinal compression fractures appear on imaging?
X-Ray/ CT - looking for a cortical break and loss of height MR - oedema of the bone (bright on T2) NM bone scan - high uptake
45
What are the common causes of spinal cord compression?
vertebral fractures, disc prolapse, mass or lesion
46
How does spinal cord compression appear?
Bright edematous areas within dark cord on T2 Bright CSF signals surrounding the cord is lost
47
what is the name of the spinal cord at the level of L1/2 and below?
L1/2 = conus medullaris Below = cauda equina
48
What is MS? How is MS diagnosed?
multiple sclerosis - a chronic demyelinating disease of the CNS (brain + spine). No definitive tests but MRI and CSF analysis are used
49
How does MS appear on imaging?
Bright plaques on MR (T2 or FLAIR) Finger like appearance around the ventricles in sagittal view. plaques can be found in the cerebellum, brainstem and spinal cord. Plaques enhance with contrast - indicates current disease activity

RAD614 (8 decks)

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