Neuroradiology
Lecture I
Connie Fazio, DVM, DACVR
Clinical Assistant Professor of Radiology
University of Tennessee
[email protected]
Office C138B in Radiology
VM 855 Veterinary Radiology
Fall 2019
Neuroradiology
•Head/Skull
• Cranial bones
• Facial bones
• Nasal/oral cavities
• Teeth
•Ears
•Spine
General Principles
• Know the normal
anatomy
• Normal variation
• Know the radiographic
views
• Use general anesthesia to
ensure correct positioning
• Symmetry!
The Head
Neoplastic abnormalities
Skull neoplasia
Primary bone neoplasia
• Malignant tumors
• Osteosarcoma most common
• Fibrosarcoma and chondrosarcoma occasionally seen
• Multilobular tumor of bone (MLO)
• Benign tumors
• Osteoma
>
Neoplastic abnormalities
Skull neoplasia
•Osteosarcoma
• Most common primary bone
tumor
• Can be primarily destructive
or primarily proliferative
• Usually accompanied by
periosteal reaction
• May have a large degree of
soft tissue swelling / mass
Neoplastic abnormalities
Skull neoplasia
•Multilobular tumor of bone
aka multilobular
osteochondrosarcoma,
•
MLO
Characteristic stippled mineral
appearance
• Soft tissue mass containing stippled
mineralization
• Occipital common location
• Locally invasive
• can cause brain compression
• Nuero signs
Neoplastic abnormalities
Skull neoplasia
•Osteoma
• Opaque, circumscribed,
solid mass
• Smooth bony
proliferation
• Little or no adjacent
reaction
Neoplastic abnormalities
Soft tissue neoplasia
Soft tissue neoplasia
• Malignant soft tissue tumors can invade
adjacent bones
• Soft tissue mass
• Variable amount of destruction
• Squamous cell carcinoma (esp cats)
• Soft tissue sarcoma
Neoplastic abnormalities
Soft
This is the right
tissue neoplasia
hemimandible
The left hemimandible is Notice the large associated soft tissue
gone! mass
Neoplastic abnormalities
Soft tissue neoplasia
R
Rt hemimandible
Lt hemimandible
should be here
L
This oblique projection should free-project the left hemimandible (projected
without any superimposition). This bone, however, has been destroyed.
Also, notice the large soft tissue mass.
Neoplastic abnormalities
Oral neoplasia
• Originate in the oral cavity
• Can be malignant or benign
• Even benign may destroy adjacent bone by
pressure necrosis or local invasion
Malignant examples: Melanoma, squamous cell
carcinoma
Neoplastic abnormalities
Oral neoplasia
The left I3 is missing and I1, I2
and C are displaced (compare
with the other side).
I2 I1
I3
Notice the large area of lysis
surrounding the left upper canine (C)
and extending rostrally.
Neoplastic abnormalities
Tumors of dental origin
•Ameloblastoma
• Young animals
• From dental laminar epithelium
• Expansile, lace-like,
multiloculated lesion with
resorption of adjacent tooth roots
Neoplastic abnormalities
Tumors of dental origin
The key feature of ameloblastomas is a
lytic, expansile lesion with lace-like
appearance, in a young animal.
Neoplastic abnormalities
Tumors of dental origin
Displaced canine
The key feature of ameloblastomas is a
lytic, expansile lesion with lace-like
appearance, in a young animal.
Neoplastic abnormalities
Tumors of dental origin
•Odontoma
• Tumor-like masses
near or on the crown
of a tooth
• Contain multiple
elements of teeth
within the mass
Congenital abnormalities
Hydrocephalus
• Dome-headed miniature
and brachycephalic breeds
• Congenital or acquired
• Abnormal accumulation of
CSF
• The most severe radiographic signs are seen
when hydrocephalus develops BEFORE
complete ossification of the calvarium!
• Adult onset hydrocephalus shows no radiographic
abnormalities.
Congenital abnormalities
oming of the cranial vault
Normal
Congenital abnormalities
Thinning of the calvarium
Congenital abnormalities
Decreased prominence
of the internal
convolution marks of
the calvarium
Normal
Notice how smooth the skull is compared to the
normal dog on the left.
Congenital abnormalities
Open fontanelle
and cranial
sutures
Fontanelle
Cranial sutures
Congenital abnormalities
Caudal displacement of the
tentorium osseum cerebelli
Normal
Congenital abnormalities
Hydrocephalus
• Ultrasound CT/MRI
• Quick and easy, no • General anesthesia
anesthesia • Excellent
• Through open anatomical
fontanelle or thin evaluation (MR>CT)
temporal bone
Miscellaneous abnormalities
Craniomandibular
osteopathy
• Westies and other Terriers
• Unknown cause
• Onset at 3 – 10 months
(younger)
• Difficulty and pain
opening mouth and
chewing food
• Bilateral (rarely unilateral)
swelling along the jaw
Miscellaneous abnormalities
Craniomandibular
osteopathy
• Periosteal new bone
proliferation
• mandible
• osseous bullae and petrous
temporal bone
• Solid, non-aggressive,
chronic appearance
• Thickening of the calvarium
• Atrophy of the temporal and
masseter muscles
Miscellaneous abnormalities
Craniomandibular
osteopathy
In both cases, notice the typical, chronic, abundant and benign periosteal
proliferation along the mandible of these West Highland White Terriers
Miscellaneous abnormalities
Craniomandibular
osteopathy
• Proliferation does not occur on the TM joints
• Mechanical impingement by the surrounding bony proliferation
TMJ
The bone proliferation is caudal and lateral to the
TMJs.
Metabolic abnormalities
Hyperparathyroidism
• Primary
• Rare
• PTH secreting parathyroid adenoma
• Secondary nutritional
• Young animals fed diet with high phosphorus or
low calcium
• Secondary renal
• “Rubber jaw”, renal osteodystrophy, renal
fibrous osteodystrophy
• Older animals with chronic renal disease
• Changes in skull predominate
Metabolic abnormalities
Secondary Renal
Hyperparathyroidism
• Radiographic signs depend on severity and
duration of the imbalance (Ca:P)
• In early cases
• Loss of lamina dura around the teeth
• Later
• Osteopenia of the skull with cortical thinning
• Impression of radiopaque teeth “floating” in soft tissue
• Mandible can appear very thin or absent
• Elsewhere, bone demineralization
• Vertebral osteopenia with prominent endplates
Metabolic abnormalities
Secondary Renal
Hyperparathyroidism
Normal
Notice the
marked
lucency of
this
Hyperparathyroidism mandible
Metabolic abnormalities
Secondary Renal
Hyperparathyroidism
Teeth “floating” in
space
Metabolic abnormalities
Secondary Renal
Hyperparathyroidism
In the spine, the vertebral bodies are extremely radiolucent and
the endplates are prominent because they are the thickest part of
the vertebrae.
The Nasal Passages
Normal dog
Palatin
e
Maxillary fissure
turbinates
Ethmoid Vomer
turbinates
The Nasal Passages
Distinction between non-destructive and destructive
processes:
Non-destructive Destructive
rhinitis: VS rhinitis
NO bony destruction
& nasal
neoplasia:
Affected area is more
opaque. Osteolysis!
Affected area can be less
or more opaque.
The Nasal Passages
Non- Destructive
destructive rhinitis:
rhinitis: Aspergillus fumigatus (young
dolichocephalic dogs)
Allergic Cryptococcus (cats)
Viral (Calicivirus, feline Chronic foreign body
rhinotracheitis) Actinomyces spp. (usually
Acute foreign bodies associated with foreign
Bacterial (primary or body)
secondary to dental Chronic inflammation (young
disease) dolichocephalic dogs)
Granulomatous Penicillum spp. (rare in dogs)
(Cryptococcus,
Mycoplasma)
Secondary to pneumonia,
esophagitis, bronchitis
Infectious disorders
Non-destructive rhinitis
• Radiographic signs:
• Acute rhinitis may be radiographically
normal!
• Increased opacity of the affected nasal
passage
• Often bilateral
• Blurring of bony details of the turbinates
• Positive silhouette effect with exudate
• Intact vomer bone, no deviation of the nasal
septum
• No destruction of maxilla or hard palate
Infectious disorders
Non-destructive rhinitis
Notice the areas of increased
Normal dog opacity in both nasal passages
Bilateral
disease
Infectious disorders
Non-destructive rhinitis
Notice the areas of
increased opacity in both
nasal passages and intact
turbinates.
Normal dog
Bilateral
disease
Infectious disorders
Destructive rhinitis
• Radiographic signs:
• Areas of increased and decreased opacity within
the nasal passages
• Decreased opacity especially with fungal rhinitis
• Loss of normal trabecular detail of the bony
turbinates
• Necrosis and sloughing of mucosa and turbinates
• Sometimes:
• Punctuate lytic lesions
• Destruction of the nasal septum
• Can extend into the frontal sinuses (increased opacity,
possible lysis)
Infectious disorders
Destructive rhinitis Soft tissue opacity with lysis
of the turbinates in the right
nasal passage
Soft tissue opacity in the right frontal
sinus
Unilateral
disease (R)
Infectious disorders
Destructive rhinitis
soft tissue opacity with bony lysis on
the left side
Unilateral
Infectious disorders
Destructive rhinitis
bilateral lysis
soft tissue nodular opacities are
fungal granulomas!
Bilateral
disease
Fungal rhinitis
Infectious disorders
Destructive rhinitis
Fungal
rhinitis:
increased opacity
of the right frontal
sinus
bony proliferation
of the affected
frontal bone with
increased
thickness -
hyperostosis
Neoplastic abnormalities
Nasal neoplasia
• Nasal soft tissue tumors with secondary
bony invasion/lysis are MORE COMMON
than primary bone tumors
• Mostly carcinomas
• Adenocarcinoma – most common Sarcomas
1/3
• Squamous cell carcinoma – cat > dog
• Lymphoma – cat Carci-
nomas
2/3
Neoplastic abnormalities
Nasal neoplasia
• Radiographic signs
• Increased soft tissue opacity (mass) in the nasal
passage
• Often start unilateral
• Frequent erosion / displacement of the nasal
septum
• Can cross septum
• Bony turbinate destruction
• Frequent invasion of adjacent bones
• Can have a periosteal reaction too
• External soft tissue mass / facial deformities
• Erosion / invasion of the frontal sinuses
• Can invade intracranially (CT/MR)
Neoplastic abnormalities
Nasal neoplasia
Multifoc
al lysis
Erosio Soft
n of tissue
the nodule
nasal
septu
m
Neoplastic abnormalities
Nasal neoplasia
marked maxillary osteolysis and
complete loss of turbinates (L>R)
soft tissue mass causing facial deformity
Connie Fazio, DVM, DACVR
Clinical Assistant Professor of Radiology
University of Tennessee
[email protected]
Office C138B in Radiology
