Brain Anatomy on CT & MRI. Department of Radiation Oncology

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1 Brain Anatomy on CT & MRI Rebecca L. Frame, BS, CMD Rebecca L. Frame, BS, CMD Department of Radiation Oncology

2 Objectives 1. Brain Facts 2. MRI Imaging Techniques 3. How the Various Imaging Helps Us in Treatment Planning 4. Locate and Identify Pertinent Cerebral Anatomy on CT and MRI Images 5. What is a Functional MRI and What it Tells Us

3 MD Anderson Facts & Figures MD Anderson Main Campus Main Center Ambulatory Clinic Building Proton Therapy Center 4 Regional Cancer Centers Greater Houston Area Albuquerque New Mexico Istanbul, Turkey MD Anderson Banner Cancer Center, AZ Opening Fall 2011

4 MD Anderson Facts & Figures Physicians 63 Dosimetrists 48 Radiation Therapists 99 Average Patient Treatment per Day 679 New Patient Treatments per Year 7000

5 Brain Exercise #1 Q. Who is Samuel Clemens? A. More familiarly known as Mark Twain, was born in Florida, Missouri and grew up in nearby Hannibal. Beginning his career as a printer s apprentice for the Missouri Courier in Hannibal, he eventually wrote for the Keokuk, Iowa Saturday Post. Soon thereafter, however, he abandoned his literary career and spent 18 months as a riverboat pilot on the Mississippi River. After the Civil War, he returned to writing for newspapers and magazines, before writing his novels based on life on the Mississippi River, such as Tom Sawyer and The Adventures of Huckleberry Finn.

6 The Brain The human brain has various parts that are used to control various functions of our body Brain of an average adult about 1000 billion neurons weighs about 1300 grams Protected in the brain box, cranium or skull Covered by three membranes called meninges

7 The Brain Space between membranes is filled by cerebrospinal fluid Serves as a shock absorbing medium Protects the brain against mechanical shocks Maintains constant pressure in and around the brain Helps in the exchange of nutrients and waste products between the nerve tissue and the blood

8 Parts of Brain and Their Control Forebrain: Cerebrum The most specialized largest part of brain Highly folded to increase surface area Made up of two hemispheres called cerebral hemisphere Made of grey matter

9 Parts of Brain and Their Control ohsu.edu Different areas of cerebrum control different body parts and functions Occipital Lobe: Region for sight Temporal Lobe: Region for hearing Frontal Lobe: Region for speech, facial muscular activities and mental activities Parietal Lobe: Region for taste, smell, touch, temperature and consciousness There are some areas in each lobe which control thinking and memory Store information & experience Cerebrum controls all voluntary activities.

10 Parts of Brain and Their Control Mid - Brain: Controls reflex movements of the head, neck and trunk in response to visual and auditory stimuli Connects the hind brain with forebrain and conveys impulses

11 Parts of Brain and Their Control Hind Brain: Posterior, Small part of the brain Differentiated into three parts: pons, cerebellum medulla oblongata deryckthake.com

12 Parts of Brain and Their Control Pons: Thick, white, rounded ridge dorsally covered by the cerebellum. Carries impulses from medulla oblongata to fore brain and from one lobe of cerebellum to other lobe. bionoid.net

13 Parts of Brain and Their Control neuroanatomy.ca Cerebellum: Largest part of hind brain, present below the cerebrum and above the medulla oblongata behind the pons. Consists of two large lateral lobes called cerebral hemisphere. It has to maintain body balance and posture. It controls and coordinates muscular activity.

14 Parts of Brain and Their Control Medulla Oblongata: Continuation of upper part of spinal cord and forms the lower part of brain stem Relays motor and sensory impulses between other parts of brain and spinal cord 1. Anterior median fissure 2. Olive 3. Pyramids 4. Cerebellum anatomy.med.umich.edu

15 Parts of Brain and Their Control Controls involuntary activities as follows: Regulates heart beat, breathing and blood vessel diameter Coordinates reflexes such as swallowing, vomiting, coughing, sneezing and hiccuping phoenixrising.me

16 Brain Exercise #2 Q. What is the capitol of Missouri? A. The present Missouri Capitol in Jefferson City was completed in 1917 and was the sixth in Missouri history. The first seat of state government was housed in the Mansion House in St. Louis, the second was in the Missouri Hotel in St. Louis, St. Charles was designated as temporary capital of the state in 1821 and remained the seat of government until 1826 when Jefferson City became the permanent capital city. The current building was the third in Jefferson City as the first burned in 1837, the second burned in 1911.

17 MRI Imaging Techniques Magnetic Resonance Imaging Provides good contrast between the different soft tissues of the body, which make it especially useful in imaging the brain, muscles, the heart, and cancers. Unlike CT scans or traditional X- rays, MRI uses no ionizing radiation. mriscan.blogspot.com/

18 health.howstuffworks.com

19 MRI Imaging Techniques T 1 -weighted MRI Standard basic scan, in particular differentiating fat from water - with water darker and fat brighter A contrast agent is also commonly use, with scans before and after contrast is given In the brain T 1 -weighted scans provide good gray matter/white matter contrast radiopaedia.org

20 MRI Imaging Techniques A. T1-weighted MRI B. T2-weighted MRI ispub.com T 2 -weighted MRI A standard basic scan. Like the T 1 -weighted scan, fat is differentiated from water. Fat shows darker, and water lighter. A contrast agent is also commonly used Well suited to imaging edema

21 MRI Imaging Techniques FLAIR Fluid attenuation inversion recovery Suppress the signals generated by fluids in the body Unwanted signals from cerebrospinal fluid in the brain, and darken the portions of the images containing this fluid Used in cerebral MRI for edema imaging

22 MRI Imaging Techniques

23 Various Imaging Helps Us in Treatment Planning

24

25 Brain Exercise #3 Q. What does the Jefferson National Expansion Memorial consist of? A. Jefferson National Expansion Memorial consists of the Gateway Arch, the Museum of Westward Expansion, and St. Louis Old Courthouse. During a nationwide competition in , architect Eero Saarinen's inspired design for a 630-foot stainless steel arch was chosen as a perfect monument to the spirit of the western pioneers. Construction of the Arch began in 1963 and was completed on October 28, 1965.

26 Pertinent Cerebral Anatomy on CT and MRI Images

27 Pertinent Cerebral Anatomy on CT and MRI Images

28 Pertinent Cerebral Anatomy on CT and MRI Images

29

30

31 Regions of the Brain Clivus/ Pituitary Area Frontal Midbrain Parietal & Occipital Temporal Parietal & Occipital BS Clivus/ Pituitary Area BS Cerebellum Frontal, Parietal/Occipital, Temporal, Midbrain, Brainstem, Cerebellum, & Clival/Pituitary Regions

32 Functional MRI Functional MRI is a very powerful method to map brain functions Determine precisely which part of the brain is handling critical functions such as thought, speech, movement and sensation

33 Functional MRI The Patient is asked to perform a particular task during the imaging process. This causes increased metabolic activity in the area of the brain responsible for the task. This activity, which includes expanding blood vessels, chemical changes and the delivery of extra oxygen, can then be recorded on MRI images.

34 Functional MRI In treatment planning it is useful to map these functions, particularly speech, in order to minimize radiation induced damage Pediatric patients

35 Example

36 Brain Exercise #4 Q. What is the largest beer producing plan in the US? A. Anheuser-Busch brewery in St Louis, Missouri is the largest beer producing plant in the nation. You can take a free tour of the Anheuser-Busch You can take a free tour of the Anheuser-Busch Brewery ( which includes stops at the Brew House, Budweiser Clydesdales' stables, the lager cellar, packaging plant, and the A-B gift shop. At the end of the tour, guests ages 21 and over can sample a variety of Anheuser-Busch brands, and those under 21 years of age can enjoy complimentary soft drinks and snacks.

37 References Matt Palmer, MBA, CMD Anita Mahajan, MD Technical Basis of Radiation Therapy by Seymour H. Lewis, p 64 Basic Atlas of Sectional Anatomy, 3 rd Edition, Bo, Walter J./ Wolfman, Neil T./ Krueger, Wayne A./ Carr, J. Jeffrey/ Bowden, Robert I./ Meschan, Isadore How The Body Works, General Editor Dr. Peter Abrahams Atlas of Anatomy, Ullmann

38 References Wikepedia IMAIOS ehow Mayoclinic.org Brainethics.org Cedar-sinai.edu Howaboutbeer.com LegendsofAmerica

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