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Measurement of Brain...Pdf بسم الله الرحمن الرحيم Sudan University of Sciences & Technology College of Graduated Studies Measurement of Brain Ventricular Dimensions using Magnetic Resonance Imaging قياس أبعاد التجاويف الدماغيه بإستخدام التصوير بالرني النغناطيس A Thesis Submitted for Partial Fulfillment of M.Sc. Degree in Diagnostic Radiology Technology By: Badawi Mustafa Badawi Suliman Supervisor: Dr. Asma Ibrahim Ahmed Assistant professor 2016 الهيه قال تعالى : (يا أَيها ا ّل ِذين آمنوا ِإذا ِقيل لكم تفسحوا ف ِ ي ا ْلمجا ِل ِس فا ْفسحوا َ ّ َ َ َ ُ َ َ َ ُ ْ َ َ ّ ُ َ َ َ َ ُ ي ْفس ِح الّله لكم و ِإذا ِقيل انشوا فانشوا يرف ِع الّله ا ّل ِذين آمنوا ِمنكم وا ّل ِذين َ َ ُ َ ُ ْ َ َ َ ُ ُ َ ُ ُ َ ْ َ ُ َ َ ُ ُ ْ َ َ ( ِ ُأو ُتوا ا ْلع ْل َم َدرَ َجا ٍت َوالّل ُه ِب َما َت ْع َم ُلو َن َخِبيٌ (سورة الجادله(11 2 Dedication To; my mother, the star that lightened my life. To the great teacher who sacrifice all for me and my brothers to help and support, my father. 3 Acknowledgment First of all, I thank Allah the Almighty for helping me complete this project. I thank Dr. Asma Ibrahim Ahmed, my supervisor, for her help and guidance. I would like to express my gratitude to Dr. Mohamed Ahmed Alfaki, Dr. Kmal Alraih Sanhori and the whole staff of Nelien 4 medical diagnostic center and Antalya center for their great help and support. Finally, I would like to thank everybody who helped me to prepare and finish this study. Table of Content Topic Page number Dedication I Acknowledgement II Table of contents III English Abstract V Arabic Abstract VI List of abbreviation VII List of figures VIII List of tables X Chapter One: Introduction 1-1 Introduction 1 1-2 Problem of the study 3 1-3 Objectives 1-4 Importance of the study 3 1-5 Overview of the study 4 Chapter Two: Literature Review 2-1 Anatomy of the ventricular system 5 5 2-2 Histology 19 2-3 Embryology 21 2-4 pathophysiologic variants 23 2-5 Radiological changes in the brain with normal 29 aging 2-6 Previous study 35 Chapter Three: Material & Methodology 3-1 Material 40 3-2 Methodology 41 Chapter Four: Results Results and Analysis 46 Chapter Five: Discussion, Conclusions and Recommendations 5-1 Discussion 57 5-2Conclusion 62 5-3 Recommendations 63 References 64 Appendices 69 6 Lest of Figure Fig.2.1. Lateral view of the ventricular system relative to brain tissue (FitzGelard and Folan 2002)............................................................................................................... 16 Fig.2.2. Cadaveric dissection of the brain at the level of the basal ganglia and thalamus (axial section) [Standring (2008)].............................................................16 2.4. Pathophysiologic Variants:..............................................................................18 2.4.1. Hydrocephalus:........................................................................................18 The old classification divides hydrocephalus into 2 types: noncommunicating and communicating. In noncommunicating or obstructive hydrocephalus, the CSF accumulates within the ventricles as a result of an obstruction within the ventricular system (most commonly at the level of cerebral aqueduct). In communicating hydrocephalus, the CSF flows freely through the outflow foramens of the fourth ventricles into the arachnoid space. Current imaging techniques, including computed tomography (CT) scanning and magnetic resonance imaging (MRI) (see the image below), make inferences about the level of obstruction, depending on the presence or absence of ventriculomegaly, especially fourth ventricle dilatation. Fourth ventricle dilatation implies 7 obstruction distally, usually at the level of the subarachnoid space. A small fourth ventricle suggests obstruction proximal to the fourth ventricle...............18 ........................................................................................................................... 18 Fig. 2.4.1. Coronal magnetic resonance image shows a colloid cyst (arrow) in the roof of the third ventricle. The patient has mild hydrocephalus...............................18 Management: Treatment of hydrocephalus is very diverse, including conservative and surgical approaches, depending upon the underlying abnormality and the site of obstruction. In patients with normal pressure hydrocephalus, large-volume lumbar puncture with removal of 40-50 mL of CSF is followed by clinical improvement and high convexity tightness, as seen on CT scan or MRI, indicate a potential benefit with shunting procedures. Isotope cisternography and perfusion tests are additional tests used in selecting surgical candidates. For idiopathic intracranial hypertension, the treatment is directed at lowering CSF pressure and volume. The mainstays of medical treatment include weight reduction, low sodium diet, and diuretics (acetazolamide). A surgical approach is recommended in the setting of failure of standard medical treatment, including shunting, optic nerve fenestration, and, more recently, venous sinus stenting. In obese patients with idiopathic intracranial hypertension, there have been reports that suggest a potential benefit in resolution of symptoms after bariatric surgery. CSF leak and low pressure may occur after lumbar puncture, dural surgical procedures, or as a spontaneous thecal tear. A headache that worsens in the upright position is the clinical hallmark of CSF leaks. Treatment depends on the etiology and includes bedrest, hydration, and an autologous blood patch.........................................................18 2.5. Radiologic Changes in the Brain with Normal Aging:...................................19 Fig. 1.-Linear ratios used in ventricular measurements. ..........................................19 Fig. (3.1) GE Signa HDx 1.5T ....................................................................................20 Fig. (3.2) Axial IR T1-weighted image using a TI of 700ms with the level of the cuts demonstrated in sagital T1 weighted images (left)..................................................20 Fig.3.3. Level of fourth ventricles measured at coronal section (right) in our study left image as standard where the measurement is based........................................21 Fig.3.5. Level above the interventricular foramen showed our length of lateral ventricular measures in Right image (axial MRI)......................................................21 3.2.2. Study Design:.................................................................................................21 Figure (4.1) showed the age difference between the three classes of study including gender and age of the child......................................................................................24 Figure (4.2) correlation between the Left lateral ventricular widths with Aqua duct widths in children.....................................................................................................24 Figure (4.3) correlation between the RT lateral ventricular widths with AD widths in children..................................................................................................................... 24 Figure (4.4) correlation between third ventricle widths with AD widths in children..24 8 Figure (4.5) correlation between the Left lateral ventricular widths with AD widths in male population........................................................................................................25 Figure (4.6) correlation between the RT lateral ventricular widths with AD widths in male......................................................................................................................... 25 Figure (4.7) correlation between the third ventricle widths with AD widths in male. 25 Figure (4.8) Correlation between the lateral ventricular width and length...............25 Figure (4.9) correlation between the right ventricular width and lateral ventricular width......................................................................................................................... 26 Figure (4.10) correlation between the right lateral ventricular length and patient age ................................................................................................................................. 26 Figure (4.11) simple error bar showed the difference in lateral ventricular length between the male female, and children...................................................................26 Figure (4.12) simple error bar showed the difference in lateral ventricular width between the male female, and children...................................................................26 Figure (4.13) simple error bar showed the difference in AD width between the male, female, and children.................................................................................................26 Figure (4.14) simple error bar showed the difference in fourth ventricle width between the male female, and children...................................................................26 Figure (4.15) simple error bar showed the difference in fourth ventricular length between the male female, and children...................................................................26 Figure (4.16) simple error bar showed the difference in RT ANT horn of lateral ventricle between the male female, and children.....................................................26 ................................................................................................................................. 27 Figure (4.17) simple error bar showed the difference in
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