Neuroradiology

The Neuroradiology makes neurological structures in the human body visible through the imaging processes of sonography (ultrasound), computed tomography (CT) and magnetic resonance tomography (MRT). It is a branch of radiology.

What is Neuroradiology?

Neuroradiology makes neurological structures in the human body visible through the imaging processes of sonography (ultrasound), computed tomography (CT) and magnetic resonance tomography (MRT).

Neuroradiologists are specialists in radiology who have an additional qualification as a neurologist. In Germany only larger university clinics and hospitals have a permit for further training in neurology. This specialist field deals with the neuroradiological diagnosis of changes and diseases of the central and peripheral nervous system using induced radiation protection.

To do this, the doctors use diagnostic imaging techniques. Imaging processes (ultrasound, X-ray, tomography) are sectional images of a body part. In addition, interventional methods for eliminating identified diseases are available in this field.

Treatments & therapies

Neuroradiology enables a precise look into the human brain as well as into the central and peripheral nervous system. It is not only important in the area of ​​diagnosis, but is also used in gentle therapies. With the help of imaging diagnostics, the neuroradiologist can inject pain-relieving medication through catheters or needles precisely to the affected areas.

Many different diseases can be recognized and treated using neuroradiology. If the patient suffers from back pain, pain-relieving medication is injected into the spine through small needles under local anesthesia. Aneurysms (cerebral hemorrhage) are treated neurosurgery (invasive removal) or endovascular (occlusion by catheters with platinum coils). In the case of a stroke, the impaired blood flow to the brain is eliminated. A stent is inserted from the groin through a catheter to widen the blood vessels or to remove a blood clot.

The neurologists recognize and treat strokes, tumors (oncology), epilisias, Parkinson's, dementias (Alzheimer's), multiple sclerosis, cerebral haemorrhage, edema, vascular occlusions, vascular malformations, hemodynamically relevant vascular stenoses (internal carotid artery, carotid artery), thrombosis and the smallest tissue changes. Modern neuroradiology is important for the early detection of dementia, because not all memory disorders can be traced back to a dementia syndrome such as Alzheimer's. Neuroradiology can detect dementia at an early stage, because in contrast to a stroke, in which the tissue of the brain is no longer supplied with blood within a few minutes and disappears, dementia slowly builds up and is often recognized too late.

Individual brain regions are negatively changed by amyloid plaques (protein deposits), through which the nerve cells die off over a long period of time. In addition, neurofibrils (thread structures) are formed, which disrupt brain activity. The imaging processes do not make these processes visible, but they allow a final diagnosis. If there is a suspicious pattern of disease, functional magnetic resonance imaging (fMRI) makes the final diagnosis.

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Diagnosis & examination methods

The diagnostic methods of neurology are diverse:

• X-ray examinations
• Skull Base CT (CCT)
• CT angiography (head and neck)
• computed tomographic examination of the temporal bone
• virtual otoscopy (endoscopy of the middle ear)
• CT perfusion (strokes)
• magnetic resonance imaging examinations
• Diffusion imaging (determination of the molecular movement of water molecules)
• functional magnetic resonance imaging (measurement of changes in tissue perfusion in the brain regions)
• Perfusion imaging (quantification and display of blood flow to tissues and organs)
• Magnetic resonance spectroscopy (measurement of tissue composition)
• Diffusion Tensor Imaging (measurement of the diffusion movement of water molecules in body tissue)
• Tractography (non-invasive examination of the brain),
• Angiography
• Sonography (ultrasound examination)
• Myelography (radiological contrast imaging of the spinal canal and the spine)
• Pneumoencephalography (visualization of the cerebrospinal fluid spaces).

During the examination using these imaging methods, the patient can be treated in parallel if a catheter is inserted into the brain in order to close ruptured vessels (aneurysms) or to open occluded blood vessels. Medicines can also be injected into the area to be treated (e.g. spine) using needles. In addition to these classic diagnostic options, interventional measures to eliminate pathological conditions are possible: expansion of vascular stenoses, recanalization of vascular occlusions (thromboses), closure of vascular malformations (aneurysms).

A patient is sent to a neuroradiologist whenever it is important to understand what is going on in the brain. Has the patient had a brain bleeding, stroke, or suspected Parkinson's, MS, or a brain tumor? The neuroradiologist uses the imaging procedures to find out which disease is present. Even in acute cases of injury, for example after an accident, patients are taken to the neuroradiology department to find out whether there is a circulatory disorder and what nature it is. Neuroradiology still uses X-ray diagnosis, but it has stepped back in favor of modern diagnostic methods, as it cannot make the brain itself visible.

However, the representation of the skull bones is very precise, which is why this examination method is often used in accident patients with suspected skull base fracture. Angiography is the standard for investigating cerebral hemorrhages in the form of vascular sacs (aneurysms). It is also based on X-rays, in which the vessels are marked with a contrast medium in order to create an X-ray image on this basis. Computed tomography (CT) detects both the bones of the brain and what is happening inside, such as bleeding. The patient is pushed through an X-ray tube. This involves making sectional or layered images.

With CT angiography, the arteries that are responsible for blood supply to the brain can also be visualized after a contrast agent has been assigned. However, when displaying minimal changes or injuries, the CT reaches its limits and an MRI is then induced. Magnetic resonance tomography (MRT) makes the brain visible in the form of density differences inside the brain tissue in a high visual resolution using iodine-containing contrast media. Hydrogen atoms are excited by the use of a strong magnet and straighten up in an external magnetic field, whereby the atomic nuclei send out the signals necessary for the investigation and enable the creation of cross-sectional images.

Functional magnetic resonance imaging (fMRI) shows how the brain works and shows increased blood flow. The functions of the brain are measured indirectly by means of blood flow. Nerve cells need energy to function properly. The brain is the organ that uses the most energy. Positron emission tomography produces slice images just like MRT. The difference, however, is that artificial tracers are injected that visualize the metabolic process of the brain. The doctor first clarifies whether the patient has ever shown allergic reactions to contrast media, individual components or tracers in the past.

Some diabetes medication such as Juformin, Siofor, Glucophage or Diabesin are contraindications to the contrast media. In the case of renal insufficiency, imaging procedures based on contrast media must not be used, as these are excreted via the kidneys. If the patient takes medication on a regular basis, he is not allowed to take it off before the examination, but has to consult his family doctor. Tracers are radioactive, exogenous (artificial) or endogenous substances that are used to treat or visualize cancer cells.