NEURORADIOLOGY

By Thamrin Syamsudin, dr., Sp.S(K)

Definition :
Radiological examination that used to support or
confirm the diagnosis of neurological disorder
Two types of examination :
Non-invasive :
Skull X-Ray,
Vertebrae X-Ray
Invasive (use contrast agent) :
Angiography
Myelography

Skull X-Ray
Projection :
Postero-Anterior (PA) in varies angle
Antero-Posterior (AP)
Right or Left Lateral
Basis Cranium
Other special photos :
Paranasal Sinus,
Sellar photo

Skull X-Ray
Assess
1. Skull bone
external tabulae
intenal tabulae
diploe
digital markings
In meningioma : endostosis or
protrusion into internal tabulae
2. Sutures : sagital, coronary, lambdoid
Children : have not closed completely

Synostosis : sutures close in earlier time

Space Occupying Process : widening
sutures
3. Sella tursica :
Sellar tubercle
Dorsum of sellae
Anterior and posterior clinoid process
In chronic increased ICP destruction of
sellae : thinning of the dorsum first
Hypophyseal tumour : ballooning sellae

4. Temporal bone :
Often fractures in head injury
Dangerous : rupture of middle meningeal
artery subarachnoid bleeding (dead if
massive)
Vascular markings
5. Paranasal sinus :
Infection/inflammation opacities

Abnormalities in Skull X-Ray :

Congenital : microcephaly, macrocephaly,
cranio-synostosis
Fracture : in head injury
Bone disease : osteoporosis, osteoblastic
Calcification :
Normal in pineal gland, choroid plexus,
duramatter
Abnormal AVM, brain tumour,
tuberculoma, advanced hemorrhagic
lesion

Signs of increased Intra Cranial Pressure

(ICP)
Sellae destruction
Impressiones digitatae
Widening sutures (in children)
Increased vascular markings

Vertebra X-Ray
Projection :
AP, PA
Lateral, and
Obligue
Consist of : 7 cervical segments
12 thoracal segments
5 lumbal segments
5 sacrals segments

Vertebral X-Ray
Assess :
Shape
Lordosis (normal in cervical and lumbal)
Scoliosis : HNP
Kyphosis : Tuberculous spondylitis
Vertebral body
Destructive lesion in metastatic tumour,
inflammation
Compressive lesion in trauma
Intervertebral space
disc protrusion in HNP

Vertebra X-Ray
Pedicles
Attach to vertebra body : eroded and
destroyed by tumour
Articular process : luxation
Intervertebral foramina : widened in
neurinoma
Spinal process
Laminae : erosion narrowed intervertebral
space
Spinal canal : stenosis if narrowed

Disorder of vertebral collumn

Congenital anomaly
Fracture/Dislocation
Inflammation
Tumour, etc
Patient preparation especially for lumbosacral
photo : laxantia in previous night.

Myelography
Definition :
Introducing the contrast media into
subarachnoid space in order to
investigate CSF pathway
Procedure :
Point of insertion via
lumbal puncture in ascending
myelography
cisternal puncture in descending
myelography

Take out CSF in same as contrast agent

volume (about 10-20 mL)
Inject the contrast agent slowly
Take X-ray photo in various projections needed
(AP, Lateral, Obligue)