Imaging Of The Brain/vasculature

Question 1

25 y/o male presents to the ER with head trauma. Diagnostic test of choice?

Answer 1

CT brain without contrast

Question 2

Which imaging modality of the brain causes no radiation exposure to the patient?

Answer 2

MRIq

Question 3

55 y/o female presents to the ER with unilateral weakness, onset 30 minutes ago. Initial diagnostic test of choice?

Answer 3

CT brain without contrast

Question 4

What are the imaging options for the brain?

Answer 4

• CT

- MRI

Question 5

CT

Answer 5

• high radiation dose to patient
• quick examination
• expensive
• mainstay and test of choice in the initial imaging of the brain in trauma and stroke like symptoms (WITHOUT CONTRAST)

Question 6

What is the mainstay and test of choice in the initial imaging of the brain in trauma and stroke like symptoms (without contrast)?

Answer 6

CT

Question 7

What kind of tests would you do a CT without contrast?

Answer 7

Trauma, stroke-like symptoms

Used in assessment of altered mental status, headache, dizziness, vertigo, evaluation of the paranasal sinuses

Question 8

CT brain with contrast

Answer 8

• not performed in initial assessment
• used in assessment of abnormal enhancement patterns such as masses, vascular abnormality. MRI also used in similar capacity. MRI more sensitive than CT

Question 9

What is used in assessment of abnormal enhancement patterns such as masses, vascular abnormality such as avascular malformation?

Answer 9

CT with contrast

Question 10

which is more sensitive? MRI or CT?

Answer 10

MRI

Question 11

What parts of the brain anatomy should you see in a CT of a healthy brain?

Answer 11

• midline flax
• frontal horns of lateral ventricles
• third ventricle
• basal cistern
• skull
• scalp

Question 12

What part of the brain would you need to scan if someone complained of vision problems?

Answer 12

Occipital

Question 13

MRI

Answer 13

• no radiation
• very expensive
• takes longer than CT therefore motion sensitive
• DWI: most sensitive sequence in radiology in the assessment of acute ischemia
• typically done with and without contrast

Question 14

When do you typically do MRI?

Answer 14

After you do a CT and it shows something abnormal

Question 15

TPA

Answer 15

• very dangerous
• make sure they aren’t bleeding anywhere
• extreme blood thinner
• not goof to look for blood

Question 16

Which takes longer? MRI or CT?

Answer 16

MRI

Question 17

DWI

Answer 17

Most sensitive sequence in radiology in the assessment of acute ischemia

Question 18

Contraindications of MRI

Answer 18

-pacemaker, radioplate foreign bodies, claustrophobia

Question 19

Welders and MRI

Answer 19

Must do an xRay on eyes to make sure there is no metal pieces lodged in eye before getting into MRI so as to not rip through optic nerve and ophthalmic artery

Question 20

What contrast used in CT?

Answer 20

Iodine contrast

Question 21

What contrast used in MRI?

Answer 21

MGd

Question 22

What is good for people who are allergic to contrast?

Answer 22

MGd. It contains gadilium. Very rare to have allergy with this

Question 23

Imaging options in the assessment of the cerebral vasculature

Answer 23

• CTA
• MRA
• ultrasound
• digital angiography

Question 24

CTA contraindications

Answer 24

Allergy, renal insufficiency

Question 25

How do you get around patients having an allergy to iodine when you must do a CTA?

Answer 25

Harvard Prep hours before CT

Question 26

How do you get around renal insufficiency when a CTA must be done?

Answer 26

Hydrate pt well or dialysis

Question 27

What kind of images can you get with CTA?

Answer 27

-axial, coronal, sagittal, reformatted

Question 28

What is the number one place that saccular aneurysms occur?

Answer 28

Anterior communicating artery (posterior is second)

Question 29

MRA

Answer 29

Good to assess vascular without contrast

Question 30

Contraindications of MRA

Answer 30

Same as MRI

Question 31

Time of flight sequences in MRA

Answer 31

Allows assessment of the vasculature WITHOUT using contrast

Question 32

Ultrasound

Answer 32

Used in the assessment of vascular flow within the vertebral arteries -shows antegrade vs retrograde flow

Question 33

What direction should bloodflow be?

Answer 33

Antegrade

Question 34

When will you see retrograde blood flow in US

Answer 34

In subclavian steal syndrome

Question 35

Digital angiography

Answer 35

- High radiation dose | - abnormalities such as aneurysms/AVM can be fixed at time of angiography

Question 36

Contraindications of digital angiography

Answer 36

-allergic to contrast, renal insufficiency

Question 37

Complications of digital angiography

Answer 37

Vascular trauma, pseudoaneurysm, small risk of death (coils are sharp)

Question 38

Imaging options of the spinal column

Answer 38

- CR - CT - MRI

Question 39

What is the test of choice in the initial assessment of trauma to the neck/ c-spine, thoracic spine and lumbar spine?

Answer 39

CR because of low radiation dose and cheap

Question 40

If CR negative and patietns symptoms persist and/or clinical suspicion high for abnormalities what's the next test of choice?

Answer 40

``` Generally CT (especially ER setting) MRI (if one wants to rule out cauda equine syndrome) ```

Question 41

Imaging options of the spinal cord

Answer 41

- MRI (best) | - CT myelogram

Question 42

CY myelogram

Answer 42

Flip patient upside down, but don't let it pass the cervical part of spine. Will cause awful headache if it gets in brain