BLOCK 2: RADIOLOGY 250

Lecture 6: CT/MRI
OUTLINE I. Definition of Terms II. History III. CT Scan 1. Parts of a CT Scan Machine 2. Basic CT Scan Principles 3. Advantages 4. Indications IV. MRI 1. MRI Hardware 2. Basic MRI Principles 3. Advantages 4. Indications V. CT Scan VS MRI

Dr. Cupino

EXAM 1
4. 5. 6. 7. Imager Processor Developer Generator Basic CT Scan Principles
y y y y y y y y y

DEFINITION
1. 2. 3. CAT Scan Computed Axial Tomography CT Scan Computed Tomography or Computerized Tomography MRI Magnetic Resonance Imaging

HISTORY
y

Table 1. Brief History of CT Scan and MRI CT Scan MRI 1970 - British engineer 1936- Dutch physicist C.J. Godfrey Hounsfield Gorter introduced concept of Nuclear Magnetic Resonance (NMR) 4 generations of CT scanners 1973 Lauterbur suggested the modern clinical uses of NMR Numerous advancements aimed at reducing costs, increasing technical capabilities and the number of clinical indications

CT scan uses x-rays and depends on the absorption differences. Parallel detector and x-ray tubes 1 slice=1 rotation 256-slice CT: 1 rotation = 256 slices Spiral CT scan= coils/ continuous As the x-ray beam passes body, it undergoes attenuation Tissues have different attenuation properties depending on the atomic number and density While passing through the gantry, the patient is continuously exposed to x-rays from the x-ray tube Depending on the varying densities of the structures in the human body, x-rays are deflected, absorbed, or pass through X-rays that pass through the human body are recognized by the detectors Data gathered is passed by the detectors to the computer system which converts it to an image Hounsfield Units used in CT; the image produced depends on the density of the structure; arbitrary

Table 2. CT Number. Water is the Baseline at 0. All (-) numbers indicate density values less than that of water, making it hypodense (darker in CT scan). Those with (+) are more dense than water, making them hyperdense (whiter in CT scan) Tissue Air Fat Water CSF White Matter Gray Matter Blood CT Number -1000 -100 0 15 46 13 40 1000

Conventional to spiral Single slice to multislice Single detectors to multidetectors

CT SCAN
Parts of a CT Scan Machine

Dense bone

Window y range of greyscale y depends on the CT number and the manipulation of contrast y Ex: If center is at 0 and window is 10, the range would be: +5 to -5. Anything below -5 is dark; anything above +5 bright. In this example, fat and air will appear the same. y Bone window o Center: 1000 o Window: 2000 o >1000 will be light, <1000 will be dark y Soft tissue window: to delineate fat and soft tissue y Lung window: the center is negative (air CT number is negative 1000) Terminologies: [1] hyperdense [2] hypodense [3] isodense Advantages

Figure 1. CT Scan Machine Parts 1. 2. 3.

Gantry (X-ray tube and detectors) the donut CT Table where the patient is lying down Console

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WEDNESDAY| 7 October 2010
JD, Topher

BLOCK 2: RADIOLOGY 250

Lecture 6: CT/MRI
y y y y

Dr. Cupino

EXAM 1
1. Magnets a) Permanent magnets, resistive magnets have lower tesla (Tesla: SI unit for magnetic field) b) Superconducting magnets most MRI use this Radiofrequency coils Volume coils, shim coils, gradient coils, surface coils

Good for bone Shorter time to perform (5 minutes vs 30 minutes in MRI) MRI cannot be done for claustrophobic Cheaper than MRI Indications

2. Trauma Staging and surveillance of a neoplastic process Diseases which require detailed anatomic evaluation including vascular studies Imaging guided diagnostic or therapeutic procedures

y y y y

Figure 2. MRI Machine

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4. 5. 6.

7.

Trauma y detect brain haemorrhages y subdural vs epidural bleed y Ex: Pelvic ct, thoracic ct, vertebral fracture, renal laceration Acute neurologic disease Ex: Spontaneous bleed in the brain (usually the basal ganglia) Detection of tumors y Lungs: CT replaces bronchography y pneumonia vs tumors: tumors have irregular margins + presence of enlarged lymph nodes y tumors of the mediastinum: CT is the best modality y presence of fat around an organ excludes tumor infiltration/invasion of the tumor to that organ. Staging of malignancies Viewing the paranasal sinuses CT Stonogram y starting to replace IVP y can identify the type of stone base on CT number Interventional procedures Ex: Paracentesis guided by ct, biopsy of mediastinal tumors

Note: MRI has bigger gantry and smaller opening compared to CT machine.

1.

2. 3. 4.

Basic MRI Principles Uses powerful magnet and pulsing radiowaves and impulses generated by water brought to misalignment by each radiowave pulse. The patient is placed in a magnet. A radiowave is sent. When the radiowave is turned off, the patient emits a signal, which is received and used for reconstruction of the picture.

Terminologies: [1] Isointense [2] Hypointense [3] Hyperintense Advantages

y y

Examples: Acute hemorrhagic stroke appears hyperdense Epidural hematoma appears lentiform (biconvex) Subdural hematoma follows the shape of the brain (concave) Perirenal space hematoma - blood not as hyperdense as in blood in the brain Neoplasms - Exophytic mass in colon; lymphoma (normally, aorta should appose the vertebra) Detailed anatomic evaluation liposarcomas have different densities on CT (hypo with areas of iso/hyperdensities) Image guided techniques biopsy (for TB); for draining abscesses
Notes: In CT scan - cerebral infarcts show hypodensity - blood vessels are hyperdense PET CT a combination of the features of PET and CT - measures the perfusion of O2 and water so functional and anatomic diagnostic features are combined MULTI-SLICE CT has the ability to reconstruct images

Better imaging for soft tissues Ability to change the contrast of the images Indications

y y

MRI
MRI Hardware
y y

Neuro: Brain, Spine Musculoskeletal: Upper/Lower Limbs, Joints o For sports injuries (as more of these injuries are soft tissue) o Can visualize edema o Special sequence o Ligament tears o Cartilage Imaging o Meniscus o Spine (disc hernation spondylolysthesis) Vascular: Neuro, Body, Peripheral o CT helpful in 6 hours for strokes vs MRI which almost immediately detects stroke. Hemorrhagic strokes are detected early however by CT. o White matter Disease MRI is best o Seizure Disorders o Good for viewing pituitary microadenomas which are usually less than 1 cm. o Bag of worms = AV malformation Body: Breast, Upper Abdomen, Pelvis Cardiac: Anatomy and Function

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WEDNESDAY| 7 October 2010
JD, Topher

BLOCK 2: RADIOLOGY 250

Lecture 6: CT/MRI
y y

Dr. Cupino

EXAM 1

Spectroscopy: Brain, Prostate Functional MRI: Diffusion, Perfusion, Bold (In a diffusion weighted image, stroke appears whiter than the brain parenchyma; the darker an area is, the lesser it is perfused; If you put the two together, check if there is a Diffusion-Perfusion mismatch the areas where there is no overlap is the part of the brain which is still salvageable)

Notes:

MRI is not good for imaging the lungs because minor movements secondary to respiration may cause degradation of the image. CT would therefore be better in imaging the lungs. Resolution in MRI is measured in Tesla. MRI machines with higher Tesla units are better for viewing the abdomen and pelvis.
In MRI - normal fat is hyperintense (white) - subacute hemorrhages also appear hyperintense on MRI T1-weighted images: used for defining anatomic structures T2-weighted images: used for determining pathologic states.

Useful Mnemonic: WWII water appears white in T2; or T2 = TUBIG DW Diffusion weighted Functional MRI - determines activity in sellar or pituitary masses VASCULAR NEURO MRI blood flow is unenhanced due to movement of blood there are flow voids MRA magnetic resonance angiography

Ex. Subdural Hematoma (Left: CT. Right: MRI)

CT SCAN vs MRI
Table 3. Comparison Between CT Scan and MRI CT Scan Fast image acquisition Ideal for emergency and trauma cases Good soft tissue resolution Good cortical evaluation MRI Slower image acquisition Excellent soft tissue resolution Good marrow evaluation Does not require contrast for evaluation of vascular structures Currently more expensive than CT Scan

Requires contrast for evaluation of the vascular structures

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WEDNESDAY| 7 October 2010
JD, Topher