Brain imaging course – 2 – Choosing brain imaging

Introduction

This video is the second in a series of a brain imaging course. In this video, we talk about when to order different types of imaging and the relative advantages of each type of imaging. This includes head CT, brain MRI, and the different types of vascular imaging like CT angiography and MR angiography.

Check out the entire course if you haven’t already.

Head CT

Head CT is one of the most commonly performed neuroradiology exams. It’s a common screening exam that is performed for indications like trauma, new neurologic symptoms (such as weakness or sensory symptoms), or the worst headache of someone’s life. Head CT is also very commonly performed on patients with known brain abnormalities to investigate whether they are changing.

CT vessel imaging

CT can be performed with timing to evaluate arteries (angiography) or veins (venography). CT angiography (CTA) is frequently performed for acute stroke, trauma, or if the patient has a hemorrhage.

CT venography (CTV) is done to evaluate the veins. This is most commonly done if a patient has elevated intracranial pressure (or papilledema), an atypical hemorrhage that could be due to venous thrombosis, or if there is trauma near a dural sinus.

MRI brain

MRI of the brain is the workhorse of neuroradiology. You would want to order an MRI of the brain if a patient had a known abnormality that was found on a head CT. An MRI can give you much more information about the underlying abnormality.

If the patient has continued symptoms but a normal head CT, that is another reason to get an MRI. It is much better at seeing small or subtle abnormalities in the brain. In general MRI is a better exam for indications with it is not time-sensitive.

When do MRIs need contrast?

It’s a constant question of when patients should get contrast on MRI of the brain. For low probability screening exams for conditions like headache, stroke, or dizziness, an MRI without contrast is usually adequate. For higher probability of a significant abnormality, you may need contrast. For example, if a patient has concern for meningitis or intracranial abscess, contrast is helpful. Contrast is also usually used when patients have tumors or possible metastatic disease.

In general contrast is needed when there is a higher suspicion of an acute abnormality.

MR vessel imaging

MR angiography (MRA) and venography (MRV) is most commonly used when vascular abnormalities need to be evaluated, but time is not a major concern. This is often done in cases of strokes when the patient has had symptoms for a while (often more than 24 hours). MRA is great for evaluating aneurysm and vascular malformations. MRV can see venous thrombosis and other abnormalities.

Summary

Thanks for tuning in to the video. Hopefully you learned a lot about how to choose the best brain imaging for your patients. The next video will cover basic concepts about reviewing brain imaging on your own.

See all of the search pattern videos on the brain course playlist.