MRI SAFETY GUIDELINES

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Epidural Hematoma

                       CLINICAL RADIOLOGY

                       Epidural Hematoma

                                        Epidural or extra Dural hematoma is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the Dura mater and the skull. The Dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space and compress delicate brain tissue. The condition is present in one to three percent of head injuries. Between 15 and 20% of epidural hematomas are fatal. 
                          

                      The most common location of an EDH is over temporoparital convexity, as the thin temporal squamosa easily fractures and causes damage to the partially embedded middle meningial artery.

CT imaging for Epidural Hematoma

EDH in CT

>CT scanning is the study of choice in evaluating intracranial EDH, this modality is limited in the evaluation of spinal EDH because of the difficulty in examining long segments of the spine with axial CT images and because of the low attenuation of sub acute or chronic EDH
 >CT scan appearance of EDH depends on the source of bleeding; the time elapsed since injury, the severity of hemorrhage, and the degree of clot organization and breakdown.^[
 >Classically a biconvex (elliptical, idly shaped) hyper dense collection bounded by cranial sutures and associated with a skull fracture.
>may be heterogeneous or atypical if active bleeding is occurring.



MR imaging for Epidural Hematoma
                                                                                                                                     

SPINAL EDH in MRI

> MRI demonstrates a biconvex mass separated from the overlying Dura by a thin rim of extruded serum lying between the clot and the Dura. This stripe is hyper intense on both T1- and T2-weighted images.
 >Acute EDH is iso intense to minimally hypo intense on T1-weighted images and markedly hypo intense on T2-weighted images
>Sub acute EDH is hyper intense on T1-weighted images,. On T1-weighted images, the Dura may be seen as a thin, hypo intense stripe that the hematoma displaces inwardly.
 >In spinal EDH, MRI demonstrates a biconcave, elongated mass in the epidural space with variable degrees of cord compression separated from the spinal cord by low-intensity Dura. The signal intensity of spinal EDH varies with the age of the hemorrhage and parallels that of the brain.
                                                                                                                                             

Treatment 

                     
 As with other types  of  intracranil hematomas.the blood may be removed surgically to remove the mass and reduce the pressure it puts on the brain. The hematoma is evacuated through a  burr hole or craniotomy. If transfer to a facility with neurosurgery is prolonged trephination may be performed in the emergency department.

                                                                                                                                                     


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CLINICAL RADIOLOGY
                                                                                                              
Cerebral Arteriovenous Malformations
                                                   

                                      A cerebral arteriovenous malformation (AVM) is an abnormal connection between the arteries and veins in the barin  .it is a vascular anomaly..

                     The most frequently observed problems related to an AVM are headaches and seizures while at least 15% of the population at detection have no symptoms at all. Other common symptoms are a pulsing noise in the head, progressive weakness and numbness and vision changes.

                        In serious cases, the blood vessels rupture and there is bleeding within the brain (intracranial hemorrhage). Nevertheless in more than half of patients with AVM, hemorrhage is the first symptom. Symptoms due to bleeding include loss of consciousness, sudden and severe headache, nausea, vomiting, incontinence, and blurred vision, amongst others. Impairments caused by local brain tissue damage on the bleed site are also possible, including seizure, one-sided weakness (hemi paresis), a loss of touch sensation on one side of the body and deficits in language processing (aphasia).Minor bleeding can occur with no noticeable   

 symptoms.

AVM in the BRAIN 

                                    AVMs in certain critical locations may stop the circulation of the cerebrospinal fluid, causing accumulation of the fluid within the skull and giving rise to a clinical condition called hydrocephalus. A stiff neck can occur as the result of increased pressure within the skull and irritation of the meninges.

                                       An AVM diagnosis is established by NEUROIMAGING studies after a complete neurological and physical examination. Three main techniques are used to visualize the brain and search for AVM:

1) Computed tomography (CT),

2) Magnetic resonance imaging (MRI),

3) Cerebral angiography.(DSA)

AVM in CT IMAGE 

CT findings:

      ·         Vascular tangles are serpiginous and hyperdense        without contrast from the blood pool effect.
      ·         AVMs may contain punctate or curvilinear    
              calcification.
      ·         AVMs will enhance

T2WI in MRI 

  

       MRI findings:

•   ·         Curvilinear flow voids
•   ·         MRA for mapping

AVM in DSA 

Angiogram (DSA):

  ·    Should demonstrate the three

       components of the enlarged 

       feeding       artery, core/nidus,

       and enlarged draining vein.

                ·      Smaller AVMs may simple 

                   demonstrate early venous 

                   filling during the arterial phase 

                   of enhancement

      

            Associated syndromes

  ü    Sturge Weber

  ü  Wyburn Mason

  ü  Klippel-Trenaunay-Weber

  ü  Osler Weber Rendu

 Complications

   ·         Hemorrhage

   ·         Steal phenomenon where blood 
        supply  is  preferentially delivered
        to AVM the cost of  normal brain 
        parenchyma and can lead to focal 
        neurological symptoms, seizure 
        and focal  atrophy.                                                                          

   ·        Aneurysms can form and become a source of   
         hemorrhage

Treatment

1. ·         Endovascular embolization
2. ·         Surgery
3. ·         Radiation therapy

                                                                                  

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A glimpse to the "WORLD OF RADIOLOGY"

Dear friends,

                     

                     This blog is a small attempt  to share my ideas during my academic career. this will be a common plat form to discuss,share and update our knowledge about radiology and medical imaging Technics.and for improving academic excellence .i hope this  will guide you to mold a good radiologic profession.                                                 

                                                             As you know  Radiology comprises different imaging modalities and processes to image human body for diagnostic and treatment purposes and therefore has an important role in the improvement of public health in all population groups. Furthermore, medical imaging is justified also to follow the course of a disease already diagnosed and/or treated. Area of medical imaging is very complex and, depending on a context, requires supplementary activities of medical doctors, medical physicists, bio medical engineers as well as technicians.
                                                

                                                                                                       Medical imaging, especially X-ray based examinations and ultrasonography, is crucial in every medical setting and at all levels of heath care. In public health and preventive medicine as well as in curative medicine, effective decisions depend on correct diagnosis. Though medical/clinical judgment maybe sufficient in treatment of many conditions, the use of diagnostic imaging services is paramount in confirming, correctly assessing and documenting course of the disease as well as in assessing response to treatment.

                          With improved health care policy and increasing number of available medical equipment, the number of radiological medical procedures are increasing considerably. Effective and of good quality imaging is important for further medical decision making and can reduce unnecessary procedures. Reports from some countries indicate that a significant portion of all abdominal surgical interventions (explorative laparotomy) may have been avoided if simple diagnostic imaging services such as ultrasound had been available.

    i would like to share may knowledge as much as possible with and hope you will also share your knowledge with me.

with regards 

shabeer kodiyathur