journal reading radiologi ella

8/18/2019 Journal Reading Radiologi Ella

1/44

JOURNAL READING

DISUSUN OLEHElla Putri Saptari - 1161050203

DOKTER PEMBIMBINGdr. Tri Hara!t" Sp.Rad

#EPANITERAAN #LINI# $AGIAN IL%U RADIOLOGIPERIODE 1& DESE%$ER 2015 ' 23 JANUARI 2016

(A#ULTAS #EDO#TERANUNI)ERSITAS #RISTEN INDONESIA

JA#ARTA2015ELLA PUTRI SAPTARI - 1161050203


2/44

*a+ !+ ! ,u -Str"-Wester !"#r$% of Emergency Medicine

&"%#'e (II) "* 1 + ,er#$r. 2011

ELLA PUTRI SAPTARI - 1161050203


3/44

ABSTRA/T



4/44

I'$ te $#te sett "4s#sete str"7e s $'"rt$t t" t" $%%

-*-r+-!,/ p/i,ia!

!-ur"l"+it!-ur"ur+-"! a!d!-ur"radi"l"+it.

We t "'es t" '$) Te A'er$ /"%%ee "4 R$"%". 8A/R9"t#$%%. #$tes ts #e%es 4"r'$ $t:$.s tr"# te A/R

Ar"r$teess /rter$* Ts $rt%e s $eer$% re;e: "4 te '$ '"$%tes#rret%. #se t" $ssess $ e% #e tetre$t'et "4 str"7es*



5/44

NONONTRAST O%PUTEDTO%OGRAPH4

R$ e;$%#$t" "4 $#te str"7e $tets :%%

re$se $s te "#%$t" $es $ $#te

ter$es e


6/44

(i+ur- 1* Le4t '%e erer$% $rter. 8M/A9 4$rt"* A


7/44

• Tree '$ st$es $re #se t" esre te /T '$4est$t"s "4 str"7e+

$#te 8%ess t$ 2? "#rs9) s#$#te 82? "#rs t" 5 $.s9 $ r"

8:ee7s9*

• A#te str"7e reresets ,/t"t"7i, -d-*a) $ te $es $ e s#t%e

#t $re s=$t. They are also termed “early ischemic changes“ and were

formerly termed “hyper-acute”. It is intracellular edema and causes loss of

the normal gray matter/white matter interface (dierentiation and

eacement of the cortical sulci.

• ! throm"us in the pro#imal middle cere"ral artery (M$! is sometimes seen

in the acute phase and appears as hyperattenuation. ! su"acute stro%e

represents &asogenic edema' with greater mass eect' hypoattenuation and

well-dened margins. Mass eect and ris% of herniation is greatest at this

stage. $hronic stro%es ha&e loss of "rain tissue and are hypoattenuating.



8/44

• A ""tr$st e$ /T '$. et4. te e$r%. ss "4

str"7e) #t '"st '"rt$t%. :%% e


9/44

(i+ur- 2* M$ss;e s#$r$" $ tr$;etr#%$r e'"rr$e* A


10/44

(i+ur- 3. H.ertes;e tr$$re.'$% e'$t"'$* N"e$e

"'#te t"'"r$. s":s $ %$re rt $s$% $%" e'$t"'$ 89"t$ $ # # %e;e% $rr": *



11/44

(i+ur- &* H.ertes;e tr$$re.'$% e'$t"'$ :t s#4$%e er$t"*N"e$e $


12/44

O%PUTED TO%OGRAPH4ANGIOGRA%

• Ne:er eer$t" '#%t-s%e /T s$ers $re e"' '"re

re$%. $;$%$%e*

• /T $"r$' 8/TA9 s $ ''$%%. ;$s;e st#. t$t reJ#res $

t'e "t'e r$ et" "4 tr$;e"#s "tr$st $ t-

set" e%$% /T '$es $re "t$e te $rter$% $se*

• S"4t:$re $%%":s t-set" $


13/44

(i+ur- 5. H.ertes;e tr$$re.'$% e'$t"'$ :t s#4$%eer$t"* /"r"$% t:"-'es"$% re"str#t" 4r"' $ "'#te

t"'"r$. $"r$' e'"str$tes tr$s4$%e er$t" 8$rr":s9 t" te%e4t #e t" %$re rt se tr$$re.'$% e'"rr$e* S$'e $tet $s



14/44

• Te et=$t" "4 $re$s "4 ste"ss "r "%#s" "4 ;esse%s

$%%":s 4"r r$ $ $#r$te $"ses $ es"s te

%$% $re$* /T $"r$'s t$t et4. "%#e %""

;esse%s te r$ $ssst te e#r"%"st $ e'ere.

.s$ tre$t'et es"s*

• We te /T $"r$' re;e$%s $ "%#s" "4 $ '$"r

erer$% %"" ;esse% :t te tree "#r t'e %'t) te

te es" t" $'ster tr$;e"#s tss#e %$s'"e

$t;$t"r 8TPA) se=$%%. $%te%$se9 $ e '$e :t

'"re "=ee $s te $#se "4 te str"7e s '"re

$#r$te%. et=e*



15/44

• Itr$-$rter$% $'str$t" "4 tr"'"%.ts "r 'e$$% %"t re'";$% #s

$teter $"r$. 't e ee=$% $tets reset %$ter t$ tree

"#rs 4 $ %$re $ $ess%e tr"'#s s et=e $ t e"'es te es" "4

te s7%%e ter;et"$% e#r"r$"%"st "r e#r"s#re" t" "ser tese $tets

4"r e


16/44

(i+ur- 6. B$s%$r t $rter. $e#r.s'* /"'#te t"'"r$. $"r$' te $


17/44

(i+ur- 8. Ater"r "''#$t $rter. 8A/"A9 $e#r.s'*8A9/ere$% "'#te t"'"r$. $"r$' 8/TA9 tree-'es"$%

r"et" :t s7#%% s#r4$e ";er%$. e'"str$tes $ $ter"r

"''#$t $rter. $e#r.s'*8B9 De$te '$es 4r"' /TA "4 te /r%e "4 W%%s s"%$tes te $e#r.s'ELLA PUTRI SAPTARI - 1161050203


18/44

(i+ur- 9. S#$r$" $ tr$;etr#%$r e'"rr$e #e t" ;$s#%$r'$%4"r'$t"*

S$t$% re4"r'$tte '$es 4r"' "'#te t"'"r$. $"r$'e'"str$tes te e$ ;$s#%$r '$%4"r'$t" 8$rr":9) : :$s te



19/44

O%PUTED TO%OGRAPH4PER(USION

• /T er4#s" s '"re :e%. $;$%$%e t$ '$et res"$e '$ 8MRI9 $

$ e er4"r'e J#7%. " $. st$$r e%$% /T s$er rt $4ter

#e$e /T* D#r /T er4#s" $ r$ tr$;e"#s 4#s" "4 "tr$st s

$'stere $ set"s "4 te r$ $re ree$te%. '$e* B$se " te t"t$%

$'"#t $ see t$t %"" ":s t" >eret ;$s#%$r terrt"res "4 te r$ ts

teJ#e $ $ssst et4. $ str"7e $ "tet$% $re$s "4 re;ers%e $

s$%;$e$%e r$ tss#e te se' e#'r$*

• Te erer$% %"" ": 8/B,9 s eJ#$% t" te erer$% %"" ;"%#'e 8/B&9 ;e

. te 'e$ tr$st t'e 8MTT9* Te MTT s te t'e >eree et:ee te

$rter$% ": $ ;e"#s "#t":* MTT s te '"st sest;e 'e$s#re #se t"

e;$%#$te 4"r ": $"r'$%tes* It s r"%"e "t"s s# $s ."tes"

$%" :t "%#e $ ste"t %"" ;esse%s* T'e t" e$7 8TTP9 s s"'et'es

#se %$e "4 MTT*



20/44

• D#r $ str"7e) te $re$ "4 te r$ #er" 4$rt" $s "t

ere$se /B, $ /B&* Dere$se t"t$% /B& s te '"st se=

$t"r 4"r $ $re$ $t#$%%. #er" rre;ers%e se'$ "r 4$rt

$ s " s$%;$e$%e*

• Are$s "4 te r$ t$t $re $t rs7 4"r #r. 7": $s te se'

e#'r$ s": ere$se /B, :t "r'$% t" re$se /B&* Ts

"tet$%%. s$%;$e$%e $re$ "4 te r$ '#st $;e $ t$t erer$%

$#t"re#%$t" s.ste' t" '$t$ "'e"st$ss* /erer$%

$#t"re#%$t" $#ses te %$t" "4 te "%%$ter$% %"" ;esse%s $

re$ses te /B& t" te $re$s "4 te r$ t$t $re "'r"'se .

ere$se /B,* 8,#re 9*



21/44

(i+ur- :. Le4t '%e erer$% $rter. 4$rt*8A9Re"$% erer$% %"" ": '$ 4r"' "'#te t"'"r$. er4#s"

s":s $ %$re er4#s" e4et te %e4t 4r"t$% $ te'"r$% %"es)e;ee . $ %$7 "4 "%"r s%$.*

8B9Re"$% erer$% %"" ;"%#'e '$ e'"str$tes $ e#'r$ "4ere$se er4#s" 8$te :t $rr":s $r"# %#e $re$s9 s#rr"#



22/44

• As $ eeret$te te "tet$% $#se"4 te ": $"r'$%tes* /#rret /T er4#s" te"%". s %'te t" t:" s%es tr"# te

r$* 8Her r": MD/T 6? s%e "r re$ter9 :%% e $%e t" '$e $ re$ter ;"%#'e "4 r$

tss#e* /T er4#s" r"#es $ re$ter $'"#t "4 r$$t" e


23/44

%AGNETI RESONANEI%AGING

• "!


24/44

(i+ur- 10. Rt '%e erer$% $rter. 4$rt"* ,$st s e" T2-:ete 4$t s#resse '$e e'"str$tes re$se s$% test. $

e>$e'et "4 te rt te'"r$% %"e) "sstet :t s#-$#te 4$rt*



25/44

• ,%# $tte#$te ;ers" re";er. 8,LAIR9 seJ#ees $re ese

t" s#ress s$% 4r"' te /S, s" t$t t :%% $e$r $r7* ,LAIR

'$es r";e "" "s#t. "4 $#te s#$r$" e'"rr$e)

$s "'$re t" ";et"$% T-1 $ T-2 :ete '$es $ $re

#se4#% te t$% e;$%#$t" "4 te $#te str"7e $tet s#sete

"4 $; $ s#$r$" e'"rr$e* S#$r$" e'"rr$e

$e$rs rt " ,LAIR '$es $ s" e"'es re$%. $$ret*

• Te r$et re$%%e e" 8GRE9 seJ#ee s $%s" #se4#% 4"r te

etet" "4 %"" r"#ts* H."test. #e t" $r$'$et

e>et "4 te e'"ser) "ter:se 7": $s @%""') $>ets

te '$et =e% $ ere$ses te s$%* Tere4"re %"" $e$rs

@%$7 " GRE '$es 8,#re 119*ELLA PUTRI SAPTARI - 1161050203


26/44

,#re 11* He'"rr$ r$ste' 4$rt*8A9Gr$et e" $


27/44

%AGNETI RESONANEDI((USION

• %R di?ui"! s $ teJ#e t$t s $; $ r$'$t $>et " te

$r"$ $ '$$e'et "4 $#te se' str"7e $tets* MR

>#s" s Di?ui"! @-i+t-d I*a+- D@I $ $ e "t$e

:t 10 '#tes $t s"'e eters $ r$'$t$%%. $%ter $re) s" te

%$% eter'$t" "4 se' str"7e $ e "=r'e J#7%.*

• DWI s #se t" etet e$r%. se' $es 8$#te str"7eQ e$r%.

se' $eQ .t"t"


28/44

• It s te $%t. t" J#$t4. te '"t" "4 :$ter '"%e#%es t$t '$7es

te r"ess "4 >#s" :ete MRI "ss%e* N"r'$% ##re

e#r"$% e%%s $%%": 4"r te eJ#$% '";e'et "4 :$ter et:ee e$%t.

e%%s* D#r $ $#te se' str"7e .t"t"eree te :$ter "tet $ te >#s" "4

:$ter et:ee #re $ ##re e%%s $ e 'e$s#re $ $%%":s

4"r te et=$t" "4 se' e%%s " >#s" MRI '$es* Tese

$re$s "4 $'$e $e$r rt " MR >#s" '$es*

• I "rer t" e% et4. $re$s "4 se'$) Appar-!t Di?ui"!

"-,i-!t AD '$s $re #se $ $re$s t$t $re rt "

>#s" $ $r7 " AD/ $re "sstet :t $#te 4$rt 8,#re 129*



29/44

(i+ur- 12. Rt '%e erer$% $rter. 4$rt" 8A $ B9*A*Restrte :$ter >#s" te re" "4 4$rt res#%ts $ re$se

s$% test. " >#s"-:ete '$*B*ere$se s$% " $$ret >#s" "eet '$*ELLA PUTRI SAPTARI - 1161050203


30/44

• MR >#s" '$ $%%":s %$s :" $re

e;$%#$t $%%e $tets :t e#r"%"$%

e=ts t" >eret$te et:ee t"se :"

$t#$%%. $;e $ $#te se' e;et ;ers#s

t"se :" " "t* It $ tere4"re e%>eret$te $ str"7e 4r"' "ter str"7e ''s

s# $s $ e'%e 'r$e e$$e) T"s

$r$%.ss 8se#re9 $ erer$% "r r$$%er;e s"rers*



31/44

%AGNETI RESONANEI%AGING PER(USION

• Pe4#s" '$ "4 te etre r$ s "e "4 te '$

$;$t$es "4 er4#s"-MR P-r>ui"! @-i+t-d

I*a+i!+ B P@I : MMT "r TTP er4#s"

'$s $re eer$te 4"r te etre r$* L7e /T

er4#s") t $ et4. te se' e#'r$* Te

e#'r$ s te DWI-PWI 's'$t* Te $#r$te

et=$t" "4 ts se' e#'r$ :%% e%

#e 4#t#re se' str"7e ter$. $ "tet$%%.

$e e


32/44

%AGNETI RESONANEANGIOGRAPH4

• M$et res"$e $"r$. 8MRA9 $ e er4"r'e

"'$t" :t r$ MRI te sett "4 str"7e t"

e% #e ter$e#t es" '$7* It $ etet

r$e $ter"s%er"t %es"s te e7 $ e$* It s$%s" e%4#% 4"r etet %ess "''" $#ses "4 se'

str"7e s# $s $r"t $ ;erter$% $rter. sset")

=r"'#s#%$r .s%$s$) $ ;e"#s tr"'"ss* As :t

"ter 4"r's "4 MRI '$ t $"t e #se $tets

:t $e'$7ers) s"'e 'et$%% '%$ts) $%%er. t" MR

"tr$st $ets) $ t"se :t se;ere %$#str""$*



33/44

SONOGRAPH4

• Tra!,ra!ial d"ppl-r TD e


34/44

(i+ur- 13. N"r'$% tr$sr$$% D"%er* /"%"r D"%er '$ "4 te %e4t

'%e erer$% $rter. e'"str$tes "r'$% ": $ :$;e4"r's) :t $ e$7;e%"t "4 1*2F ' s*



35/44

• Te $rteres est e;$%#$te $re t"se $t te $se "4 te

r$ 8M/A) $ter"r erer$% $rter.) $r"t s")

;erter$% $rter.) $s%$r $ "t$%' $rter.9* H":e;er)

# t" 30 "4 $tets $re #$%e t" e e


36/44

(i+ur- 1&. A#te -r$e ter$% $r"t $rter. 8I/A9 "%#s"*

L"t#$% "%"r D"%er '$e tr"# te ter$% $r"t $rter.e'"str$tes $ @str s) :t ;er. ''$% ": tr"# te I/A*ELLA PUTRI SAPTARI - 1161050203


37/44

(i+ur- 15. A#te "'%ete ter$% $r"t $rter. "%#s"* L"t#$%

s""r$' "4 te %e4t ter$% $r"t $rter. e'"str$tes "'%ete ": ;"):t " ere t%e :$;e4"r's*



38/44

ANGIOGRAPH4

• at-t-r; =a-d ,-r-=ral a!+i"+rap/ "r di+ital u=tra,ti"!

a!+i"+rap/ DSA s te st$$r $$st : $%% "-

;$s;e $ssess'ets "4 $r"t %#'$% $rr": $re "''"%.

"'$re $ re'$s te +"ld ta!dard >"r t- d-t-,ti"! ">

*a!/ t/p- "> ,-r-=r"


39/44

(i+ur- 16. Iter$% $r"t $rter. "%#s"* ,r"t$% r"et" 4r"' %e4terer$% $"r$' e%e$tes "'%ete "%#s" "4 te %e4t ter$% $r"t

$rter. t" te %e;e% "4 te "''" $r"t $rter. 8$rr":9* N"te te "r'$%

"$=$t" "4 te e


40/44

(i+ur- 18. Le4t '%e erer$% $rter. 8M/A9 re$$%$t"*8A9It$% %$ter$% '$e 4r"' erer$% $"r$' e'"str$tes $ $#t. "4;esse%s te M/A str#t"* 8B9 Ree$t %$ter$% $"r$' $4ter tr$-

$rter$% %.ss e'"str$tes re$$%$t" "4 ": $ "r'$%e er4#s"*ELLA PUTRI SAPTARI - 1161050203


41/44

ONLUSION

• A $#r$te $ r$t$% #erst$ "4 '$ '"$%tes s esset$% 4"r te

'$$e'et "4 te $#te str"7e $tet* D#e t" ts :e sre$ $;$%$%t. $

see) #e$e /T s$ re'$s te t$% st#. "4 "e 4"r e;$%#$t $

$#te str"7e $tet - t s #se 4"r %#s" rter$ $ t" r#%e "#t e'"rr$e* A4ter

ese "t "4 $re test s er4"r'e t" est$%s te $se%e re$te) /T

$"r$. $ e "t$e t" ;e $e 4"r'$t" " ste"t $ "%#e

%"" ;esse%s* I4 te /TA e'"str$tes $ %$re "r s=$t tr"'#s #re outside

the three hour time window then intrarterial or mechanical throm"olysis may "e an

indicated treatment which may "e performed "y the s%illed inter&entional

neuroradiologist.

• /T $ MRI er4#s" '$ $ $ssst et4. $ str"7e $ "tet$% $re$s "4

re;ers%e $ s$%;$e$%e r$ tss#e te se' e#'r$* Iet4.

$tets t$%%. outside of the three hour window or in those which the time of onset

is uncertain who ha&e an area of potentially re&ersi"le ischemia may still "enet "y

intra&enous' intra-arterial or mechanical reperfusion.ELLA PUTRI SAPTARI - 1161050203


42/44

• Tr$t"$% MRI re'$s $ ;t$% t""% te e;$%#$t" "4 te s#$#te

str"7e $tet) #e t" ts e#s" '$ $ "-

;$s;e%. etet se' $es $ $ e "t$e :t 10

'#tes $t s"'e eters $ r$'$t$%%. $%ter $re) s" te %$%

eter'$t" "4 se' str"7e $ e "=r'e J#7%.* MRI :t

>#s" s J#7%. e"' te "% st$$r $#te str"7e '$

#t ts #se s %'te e$#se "4 te #;ers$% %$7 "4 $ess t" ts

e


43/44

• S""r$. s #rret%. $ $#t '"$%t. 4"r str"7e e;$%#$t"

ert$ setts* A"r$. re'$s te "% st$$r $$st :

$%% "-;$s;e $ssess'ets "4 $r"t %#'$% $rr": $ '$.

t.es "4 erer";$s#%$r se$ses $re et=e $ tre$te * /$teter

$"r$. s $ '"rt$t t""% te $s "4 s7%%e ter;et"$%st

$ "t#es t" e te '"$%t. t" : e: ter$es str"7e $re

$re "st$t%. e;"%; $ e "'$re*

• W%e te A/R re4ers MRI t" /T 4"r $#te str"7e t s "t #rret%.

$;$%$%e $ r$t$% 4"r '"st eters* Te re"''ee MRI

seJ#ees $re T1)T2) ,LAIR) GRE 84"r B%""9) DWI 4"r $#te se'$)MRA) $ PWI 8 4"r e#'r$ '$9* M"st Ute St$tes e'ere.

e$rt'ets " "t $;e MR $;$%$%e 4"r $#te str"7e *It s "t

#"''" te ED t" #se DWI- MRI :e te $"ss "4 $ $#te

str"7e s #%e$r $ t $ e% "=r' te $"ss*ELLA PUTRI SAPTARI - 1161050203


44/44

journal reading radiologi ella

Documents