How to report a CT brain study

Item to be fulfilled: Ventricular system Mid line structures Cerebral parenchyma Posterior fossa structures Cortical sulci and extra axial CSF spaces Para nasal sinuses

Normal brain without contrast

Normal size and configuration of the ventricular system. No mid line shift. No intra cerebral or extra axial areas of abnormal attenuation values. Normal posterior fossa.
OR OR

Normal appearance of the brain stem and cerebellum. No evidence of posterior fossa abnormalities.

Scanned para nasal sinuses are clear.

Normal brain with contrast

Normal size and configuration of the ventricular system. No mid line shift. No intra cerebral or extra axial areas of abnormal attenuation values or
enhancing lesions.

Normal posterior fossa.

OR OR

Normal appearance of the brain stem and cerebellum. No evidence of posterior fossa abnormalities.

Scanned paranasal sinuses are clear.

Normal Brain [Trauma

Normal size and configuration of the ventricular system. No mid line shift. No intra cerebral or extra axial recent blood density. Normal posterior fossa.
OR OR

Normal appearance of the brain stem and cerebellum. No evidence of posterior fossa abnormalities.

Scanned paranasal sinuses are clear. No fracture lines seen.

NB f fractures are present mention the site !frontal" parietal" #$ and type !fissure" depressed" comminuted"#.$. %hen subgalial hematoma is present it should be mentioned. Normal Brain !"inusitis#

Normal size and configuration of the ventricular system. No mid line shift. No intra cerebral or extra axial areas of abnormal attenuation values. Normal posterior fossa.
OR OR

Normal appearance of the brain stem and cerebellum. No evidence of posterior fossa abnormalities.

Partial or total opacification of ##.sinuses by mucosal thic&ening

denoting sinusitis 'mention the affected sinuses" maxillary" ethmoidal"#( Normal Brain old a$e

Symmetrical dilatation of the ventricular system %ith prominence of the

extra axial CSF spaces.

 No mid line shift. No intra cerebral or extra axial areas of abnormal attenuation values. Normal posterior fossa.
OR OR

Normal appearance of the brain stem and cerebellum. No evidence of posterior fossa abnormalities.

Scanned Para nasal sinuses are clear.

%bnormal Brain
)o describe a lesion you should mention the follo%ing points* +efinition '%ell defined" ill, defined( Shape 'oval" rounded" irregular#( Size ',,,,,x,,,,,,x,,,,,, cm in maximal -P" transverse and cranio caudal diameters respectively( Site 'intra axial" extra axial" frontal"parietal" #..( Surrounding edema ' f present( Mass effect %hich includes o effacement of the cortical sulci o Compression of the ventricle o Midline shift Intra cerebral hemorrha$e

- %ell defined" oval shaped area of recent blood density is seen in the ,,,,,,
'mention the site" right or left" %hich part of the brain(

)he lesion measures ,,,,x ,,,,x ,,, cm maximal -P" transverse and
craniocaudal diameters respectively.

)he lesion exerts a mass effect in the form of effacement of the cortical
sulci compression of the ipsilateral ventricle contra lateral shift of the midline structures.

Normal posterior fossa !if the lesion is not in the posterior fossa$.

Scanned paranasal sinuses are clear.

&'traa'ial hemorrha$e

- %ell defined extra axial !elipitical or cresentric shaped$ area of recent

blood density is seen in the ,,,,,,,'mention the site(

)he lesion measures ,,,,x ,,,,x ,,,,cm maximal -P" transverse and
craniocaudal diameters respectively.

)he lesion exerts a mass effect in the form of effacement of the cortical
sulci compression of the ipsilateral ventricle contra lateral shift of the midline structures.

Normal posterior fossa !if the lesion is not in the posterior fossa$. Scanned paranasal sinuses are clear.
"ub arachnoids hemorrha$e

Fresh blood density is seen smearing the cortical sulci and extra axial CSF
spaces extension into the ventricular system also mention that the ventricular system is dilated denoting the presence of communicating hydrocephalus %hich is usually seen in cases of subarachnoid hemorrhage.

not included Normal posterior fossa !if the lesion is not in the posterior fossa$. Scanned paranasal sinuses are clear.
Brain infarction

- %ell defined hypodense area is seen in ,,,,,,,'mention the site(. Not included '%e do not usually measure the size of the infarct( )he lesion exerts a mass effect in the form of effacement of the cortical
sulci compression of the ipsilateral ventricle contra lateral shift of the

midline structures.
OR

)he lesion is associated %ith evacu dilatation of the ad.acent ventricle and cortical sulci 'in case of chronic infarction(

No intra cerebral or extra axial recent blood density seen.

OR

Foci of recent blood density are seen %ithin the lesion 'in case of hemorrhagic infarction(

Normal posterior fossa 'if the lesion is not in the posterior fossa(. Scanned paranasal sinuses are clear.
(acunar infarction

- small %ell defined hypodense focus is seen in the ,,,,,,,

exerting no

mass effect on ad.acent structures" OR exerting subtle mass effect on the ad.acent structures 'if there is appreciable signs of mass effect(. NB n cases of multiple lesions %e %rite Multiple %ell defined hypodense foci are seen in,,,,,,,, '/xamples* both cerebral hemispheres" cerebellum and brain stem"..( exerting no mass effect on ad.acent structures.

Normal size and configuration of the ventricular system %ith no midline

shift.
OR

Symmetrical dilation of the cerebral ventricles %ith prominence of

extra axial CSF spaces 'in old patients %ith brain atrophic changes(

No intra cerebral or extra axial recent blood density seen. Normal posterior fossa 'if the lesion is not in the posterior fossa(. Scanned paranasal sinuses are clear.
"ub cortical arteriosclerotic encephalopathy

/xaggerated peri ventricular %hite matter hypodensity due to sub cortical

arteriosclertic changes.

 Normal size and configuration of the ventricular system %ith no midline

shift.
OR

Symmetrical dilation of the cerebral ventricles %ith prominence of extra axial CSF spaces 'in old patients %ith brain atrophic changes(

No intra cerebral or extra axial recent blood density seen. Normal posterior fossa 'if the lesion is not in the posterior fossa(. Scanned paranasal sinuses are clear
"pace occupyin$ lesion [tumor) abscess)* Points to be evaluated* +efinition !%ell defined" ill,defined$ Shape !rounded" oval" irregular" #$ Size,,,,x ,,,,x ,,,,cm in maximal -P" transverse and cranio caudal diameters respectively Site !frontal" temproparietal " #" brain stem" cerebellum"..$!0eft or right$. /nhancement !no" homogenous" heterogenous" marginal" #$ Surrounding edema !if present$!grade " " $ 1rade 2 hypodense area less than 3 cm around the lesion 1rade 1rade 2 hypodense area more than 3 cm but less than 453 the 2 hypodense area more than 453 the cerebral

cerebral hemisphere in %hich the lesion is present. hemisphere in %hich the lesion is present Mass effect %hich includes* +enin$ioma /ffacement of the cortical sulci Compression of the ventricle Midline shift.

- %ell defined" oval shaped 'or any other shape( space occupying lesion is
seen in the ,,,,,,, !mention the anatomic site of the lesion$

 )he lesion measures

enhancement.

,,,,x ,,,,x,,,cm in maximal -P" transverse and cranio

Caudal diameters respectively and sho%s homogenous pattern of contrast foci of matrix calcifications are seen %ithin the lesion. localized reactive bone sclerosis is seen ad.acent to the lesion.

)he lesion is surrounded by grade ,,, perifocal brain edema hypodensity.

)he lesion and edema exert a mass effect in the form of ,,,,,,," ,,,,,,,," ,,,,,

Normal posterior fossa !if the lesion is not in the posterior fossa$. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the

,,,,",,,,, !mention the name of the affected sinuses $ denoting sinusitis. "pace occupyin$ lesion %strocytoma , -lioma

- %ell defined 'or an ill 6 defined(" ,,,,,,'mention the shape of the lesion
oval" irregular"#( shaped S70 is seen in the ,,,,,'mention the site of the lesion(

f the lesion is not enhanced then %rite 'Sho%ing no evidence of post contrast enhancement(
OR

Sho%ing heterogenous !or marginal$ enhancement %ith central areas of necrosis and brea&do%n. )he lesion is mainly cystic %ith an enhancing mural nodule measuring#.cm in maximal transverse diameters 'mention the measurement of the nodule(

OR

)he lesion is surrounded by grade ,,, perifocal brain edema hypodensity. )he lesion and edema exert a mass effect in the form of ,,,,,,," ,,,,,,,," ,,,

Normal posterior fossa !if the lesion is not in the posterior fossa$. Scanned Para nasal sinuses are clear

OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the

,,,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis. "pace occupyin$ lesion +etastatic deposits

Multiple %ell defined S70s are seen in

,,,,,,,,'mention the site of the

lesions( 'cerebral hemisphere" both hemisphere" cerebellum" brain stem" infratentonial" supratentorial" both##(.

)he lesions range in size bet%een ,,,,,,,'the smallest lesion( and ,,,,,,,'the
largest lesion( and sho%ed,,,,,,,,,'mention the pattern of enhancement. )he largest lesion measures ,,,,, x ,,,,, cm in maximal diameters and is located in ,,,, 'mention the site of the largest lesion(.

)he lesion is surrounded by grade ,,, perifocal brain edema hypodensity.

)he lesion and edema exert a mass effect in the form of ,,,,,,," ,,,,,,,," ,,,,,

Normal posterior fossa 'if no lesions in the posterior fossa(. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

NB

- solitary metastatic deposit !a patient &no%n to have primary malignancy is described in the same %ay as glioma$.

Cyst

- %ell defined cystic hypodense S70 is seen in the ,,,,,,!mention the site of
the lesion$.
&'.

-rachnoid cyst is usually present in the inferior temporal region against the greater %ing of the sphenoid bone. /pidermoid cyst is usually located in the cerebellopontine angle. +ermoid cyst is usually located in the midline and contains fat.

&'. &'.

-s above !note that most of the cysts do not enhance" then %rite sho%ing
no evidence of post contrast enhancement$

-lso note thet some cysts sho% matrix calcifications" then you have to mention that foci of matrix calcifications are seen %ithin the lesion. NB in cases of colloid cyst" you can say - %ell defined hyperdense S70 is seen in the midline plane in the region of the anterior part of the 8rd ventricle. )hen mention the size and say sho%ing no evidence of post contrast enhancement.

Most of the cysts are not surrounded by edema" but they

form of ,,,,,," ,,,,," ,,,,,,. NB NB

exert a mass9s

effect" then you have to mention the manifestation of the mass effect in the

Colloid cyst may be associated %ith hydrocephalus due to compression of the foramina of monro. n cases of dermoid cysts please loo& for fat globules in the subarachnoid spaces !sulci" fissures" cisterns$ as %ell as in the ventricles. f they are present this means that the cyst has ruptured into the subarachnoid space.

NB NB

:ydatid cyst is described follo%ing the steps mentioned for glioma. n cases of porencephalic cyst you should mention it9s communication %ith the ventricular system.

Normal posterior fossa 'if no lesions in the posterior fossa(. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

"pace occupyin$ lesion %costic neuroma

- %ell defined S70 is seen in the ,,,,,,, 'left or right( cerebello, pontine
angle region extending inside the ad.acent internal auditory canal %hich is %idened 'or not(

)he lesion measures ,,,, x

,,,, in maximal transverse diameters and sho%s

homogenous or heterogenous pattern of contrast enhancement. )he lesion is associated 'or not( %ith %idening ; pressure erosion of the ipsilateral internal auditory canal.

<sually there is no edema around the lesions" but there is a mass effect . Not mentioned because the lesion is located in the posterior fossa then
you can say = No supratentorial extension !in cases %ith large lesions$.
OR OR

= No supratentorial abnormality seen = Supratentorial hydrocephalic changes are seen secondary to compression of the >th ventricle by the lesion.

Scanned Para nasal sinuses are clear

OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

"pace occupyin$ lesion Crainiopharyn$ioma

- %ell defined partly cystic and partly solid S70 is seen in the supra sellar
area %ith it9s main bul& exactly in the midline plane 'or slightly to the left or right of the midline(

)he lesion measures ,,,, x

,,,, in maximal transverse diameters and

sho%s homogenous or heterogenous pattern of contrast enhancement. NB Note that the enhancement in craniopharyngioma is variable" the cystic component usually sho%s marginal or no enhancement %hile the solid component usually sho%ed homogenous or heterogenous enhancement %ith dense foci of calcification usually present.

<sually there is no edema" but mass effect is usually present in the form of
compression of the 8rd ventricle %ith conse?uent obstructive hydrocephalic changes of both lateral ventricles.

NB

)he lesion may extend inside the sella 'best seen in coronal images(or may extend into the para sellar area or even into the posterior fossa via the pre pontine cistern !rare$# )hese extension should be mentioned

Normal posterior fossa.

lesions

f the lesion has extended into the posterior fossa

then you can say = No evidence of cerebellar or brain stem parenchymal

Scanned Para nasal sinuses are clear

OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

"pace occupyin$ lesion Suprasellar meningioma" dermoid" #.. are described follo%ing the steps mentioned for craniopharengioma %ith careful attention to the difference in the enhancement pattern and the degree of mass effect as %ell as the variable extensions. "pace occupyin$ lesions Intrasellar pituitary adenoma

- %ell defined intrasellar S70 is seen extending !or not$ into the supra
sellar cistern.

)he lesion measures ,,,,x ,,,,x ,,,, cm in maximal diameter and sho%s ,,,,,
pattern of enhancement 'mention the type of enhancement(. NB )he extensions of the lesion should be mentioned in details specially the supra sellar extension %ith obliteration of the suprasellar cistern 'if present best seen in the coronal images(" compression of the

hypothalamus ' is &no%n if the 8rd ventricle is compressed" if not this possibility is better assessed by M@ ( -lso extension into the cavernous sinuses and affection of the internal carotid arteries. NB ntrasellar extension %ith erosion of the sellar floor and invasion of the sphenoid sinus usually indicate that this adenoma is invasive.

<sually there is no edema" but mass effect is usually present in the form of
compression of the 8rd ventricle %ith conse?uent obstructive hydrocephalic changes of both lateral ventricles.

f there is no retrosellar extension" you mention that the posterior fossa structures are normal

Scanned Para nasal sinuses are clear

OR

Scanned Paranasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

NB

n cases of microadenoma you can say

- %ell defined small focal lesion is seen %ithin the ,,,,, !left or right$ aspect
of the pituitary gland.

)he lesion usually sho%s less enhancement compared o the normal

pituitary tissue and may be associated %ith the follo%ing* Focal contour bulge of the superior or inferior surface of the pituitary gland !best seen in coronal images$. +eviation of the infundibular stal& to the opposite !or may be to the same side$!also seen in coronal images$.

)he lesion is totally enclosed %ithin the sella %ith no extrasellar

extensions" no edema" and no mass effect.

Mention that the cerebral parenchyma and ventricles

appear normal %ith no midline shift" also mention that the posterior fossa structures are normal

Scanned Para nasal sinuses are clear

OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

Intracranial calcification
Bilateral symmetrical basal $an$lia calcification

Ailateral almost symmetrical patchy areas of calcifications

dentate nuclei !in the cerebellum$. NB

are seen

affecting the basal ganglia" mainly the caudate lentiform thalami

Foci or patches of calcifications may be present in the cerebral parenchyma.

)he lesions exert no mass effect %ith no detectable perifocal brain edema.
)he lesions sho%ed no post contrast enhancement. 'if the patient %as in.ected %ith contrast material(

Normal size and configuration of the ventricular system %ith no shift of the
mid line structures.

Normal posterior fossa !if no lesions are present in the posterior fossa $. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

/eri0entricular calcifications

Multiple bilateral calcific foci are seen scattered in both cerebral

hemispheres mainly in the periventricular regions.

NB

Some calcific foci may be adherent to the %all of the ventricle" then you say that many or fe% of the calcific foci are subependymal in location.

)he lesions exert no mass effect and sho%ed no post contrast

enhancement.

Normal size and configuration of the ventricular system %ith no shift of the
mid line structures.

Normal posterior fossa !if no lesions are present in the posterior fossa $. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

-yral calcification

Bell defined unilateral !or bilateral $ gyral pattern of calcification is seen

affecting ,,,,,, !mention the site of the lesion$. NB -ssociated findings that should be mentioned if present = Focal atrophic changes related to the lesion. = )hic&ening of the overlying calverial bones. = /nlargement of the ipsilateral choroid plexus in the lateral ventricle.

)he lesions exert no mass effect and sho%ed no or minimal post contrast
enhancement

Normal size and configuration of the ventricular system %ith no shift of the
mid line structures.

Normal posterior fossa !if no lesions are present in the posterior fossa $.

 Scanned Para nasal sinuses are clear

OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

Intracrainal 1ascular lesions

%neurysm

- %ell defined rounded ,,,,,,x,,,,, cm 'mention the measurement of the

lesion( lesion is seen in the ,,,,,,, 'mention the site( common sites include* Suprasellar region to the left or right of the midline plane Bithin the sylvian fissure. n the prepontain cistern.

)he lesion sho%ed homogenous post contrast enhancement %ith no

perifocal brain edema around ; marginal curvilinear calcification. NB f the lesion is more than 3cm !giant aneurysm$" it may sho% internal thrombosis" then you can say that the lesion has a homogenously enhancing component %hich represents the patent lumen and a non enhancing component %hich represents the thrombosed part.

Normal size and configuration of the ventricular system %ith no midline

shift.

Normal posterior fossa !if no lesions are present in the posterior fossa $. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

%neurysm rupture

- %ell defined rounded ,,,,,,x,,,,, cm 'mention the measurement of the

lesion( lesion is seen in the ,,,,,,, 'mention the site( common sites include*

Suprasellar region to the left or right of the midline plane Bithin the sylvian fissure. n the prepontain cistern.

)he lesion is surrounded by an irregular shaped area of recent blood

density measuring ,,,,,,x,,,,, cm. -fter contrast in.ection the lesion sho%ed homogenous post contrast enhancement %ith prefocal brain edema seen around the hematoma

)he ventricles are usually dilated and may contain fresh blood density then
you can say* mild or moderate symmetrical dilatation of the supra and infratentorial cerebral ventricles periventricular edema due to retrograde transependymal CSF permeation intraventricular recent blood density seen in the ,,,,,,,,,,,, !mention the affected ventricles$.

f blood is present in the >th ventricle then you can say * normal appearance of the brain stem and cerebellum" but do not %rite the usual statement.

Scanned Para nasal sinuses are clear

OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

%rterio0enous malformation

- %ell efined area of abnormal vascularity is seen in ,,,,,,

'mention the site of the lesion( sho%ing serpigenous pattern of contrast enhancement curvilinear matrix calcifications.

Perifocal brain edema may present and a mild mass effect may be also
seen then you should mention these findings. NB :ypodense areas in the region of -VM usually represent ischemic areas due to direct blood shunting from the arterial to the venous side.

Normal size and configuration of the ventricular system %ith no midline

shift.

Normal posterior fossa !if no lesions are present in the posterior fossa $. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

Ca0ernous heman$ioma

- relatively %ell defined hyperdense lesion is seen ,,,,,, !mention the site of
the lesion $ sho%ing foci of matrix calcifications.

)he lesion sho%ed no evident enhancement after contrast in.ection and is

not surrounded by perifocal brain edema. NB No mass effect exerted by the lesion" if present you can say that the lesion exerts minimal mass effect on the ad.acent structures.

Normal size and configuration of the ventricular system %ith no midline

shift.

Normal posterior fossa !if no lesions are present in the posterior fossa $. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.

Intra 0entricular lesions

- %ell defined ,,,,,,,,, shaped !mention the shape of the lesion$ is seen ,,,,,
!mention the site of the lesion$. Possible sites include* Centered on the region of the >th ventricle midline posterior fossa.

Bithin the body or frontal horn of the lateral ventricle !left 5 @ight$. Centered at the anterior aspect of the 8rd ventricle.

)he lesion sho%ed homogenous5 heterogenous pattern of enhancement

%ith foci of matrix calcifications. )he surface of lesion appeared smooth or lobulated.

)he ipsilateral ventricle is dilated %ith ; per ventricular edema due to

retrograde transependymal CSF permeation. NB n cases of choired plexus papilloma " the %hole ventricular system is dilated due to communicating hydrocephalus secondary to CSF over production by the lesion. NB f the tumor has penetrated the %all of the ventricle it %ill initiate brain edema around" then maliganent transformation is suspected.

Normal posterior fossa !if no lesions are present in the posterior fossa $. Scanned Para nasal sinuses are clear
OR

Scanned Para nasal sinuses sho%ed mucosal thic&ening in the ,,",,,,,, !mention the name of the affected sinuses $ denoting sinusitis.