Imaging 1ST BLOCK

PHT
042
Studies 02
Leonedes Catibod | Dec 21, 2022

LESSON NO 1: CT SCAN BASICS

OUTLINE  CT uses x-rays to make cross-sectional axial

I. CT BASICS
images
II. CT Brain Axial View  Right is on left and left is on the right
III. CT BASICS-DENSITY
 Patient lying on a stretcher with feet coming
IV. Hyperdense things on CT
toward you and is slid through a large open
V. Isodense things on CT
ring (CT machine)
VI. Hypodense things on CT
VII. Normal Brain Anatomy
CT BASICS-DENSITY
VIII. Bones
IX. Approach to Reading a CT Scan- ABBBC Black
Structure / Hounsfield
X. B-Blood
Tissue Units
XI. Epidural Hematoma
Air -1000 to -600
XII. Subdural Hematoma (SDH)
Fat -100 to -60
XIII. Acute Subdural Hematoma
Water 0
XIV. ICH: Sites of Spontaneous ICH
CSF +8 to 18
XV. Traumatic Intracerebral hemorrhage
White matter +30 to 41
XVI. Intraventricular Hemorrhage Gray matter +37 to 41
XVII. Subarachnoid Hemorrhage Acute blood +50 to 100
Calcification +140 to 200
CT BASICS White
Bone +600 to 2000
 CT uses x-rays
 Provides axial brain view HYPERDENSE THINGS ON CT
 CT scan measures density of the tissue being
OCCULAR LENS BONE
studied ACUTE BLOOD
 The standard reconstruction for CT is axial
reconstruction

CT BRAIN AXIAL VIEW

Lateral view of skull is shown with imaging planes indicated by lines. BONE
The true horizontal plane is approximated by the orbitomeatal line, CALCIFICATION
while the typical CT imaging plane is angled slightly upward anteriorly
BONE
L1: CT SCAN BASICS | ABIA, N. 1
ACUTE METAL (BULLETS
BLOOD W STREAK CONTRAST (DYE)
ARTIFACTS)

FAT

AIR

CSF
(WATER)
)

 B-Bones:

ISODENSE THINGS ON CT

 Note that white matter is

less dense than gray matter
and therefore: white matter
is darker than gray matter

GRAY MATTER
(CEREBRAL CORTEX)

GRAY MATTER
(BASAL GANGLIA)

WHITE MATTER

L1: CT SCAN BASICS | ABIA,BRAIN

NORMAL N. ANATOMY 2
 Useful when trauma is suspected  Interventricular hemorrhage-inside
 Window your image for bone reading ventricles, can be isolated and or
 Recognize normal suture structures (usually secondary to SAH, ICH.
visible on both sides)  Subarachnoid hemorrhage-blood within
 If fracture suspected, inspect the opposite side the subarachnoid spaces (sulci, sylvian
for similar finding fissure, cisterns). Usually assumes shape
 If not present then look for abnormalities of the surrounding cerebral structure
associated with the fracture (air/
pneumocephalus, black spots within the Types of Intracranial Hemorrhage
hemorrhage)

 Approach to Reading a CT Scan-ABBBC
A. Air-filled structures (sinuses, mastoid air
cells)
B. Bones (fractures)
C. Blood (subarachnoid, intracerebral,
subdural, epidural hematoma)
D. Brain tissue (infarction, edema, masses,
brain shift
E. CSF spaces (sulci, ventricles, cisterns,
hydrocephalus, atrophy)

 A-Air-filled Structures
 Normal air spaces are black both on bone
and brain window (frontal, maxillary,
ethmoid, and sphenoid sinuses)
 Mastoids are spongy bone filled with tiny
pockets of air When these pockets are
opacified you will see a (gray or white)
shade
 Air-fluid levels in the setting of trauma  Epidural Hematoma
suggest a fracture  20% will have a lucid
 Mastoid opacification without trauma period before clinical
indicates mastoiditis worsening
 Note the soft tissue
 B-Blood swelling adjacent to the E
hematoma explaining the
Location and shape of the blood mechanism of the injury

 Epidural hematoma: over brain convexity,

not crossing suture line, lens shaped
(biconvex).  Arterial injury following
 Subdural hematoma: over brain convexity, head trauma
interhemispheric, along the tentorium,  Lens shaped
SDH will cross suture lines & it’s crescent  Confined
shaped. between the
 Intraparenchymal/Intracerebral sutures
hemorrhage: within the brain matter,  Most commonly
sizes/shape varies dependent on etiology middle meningeal
can be regular or irregular. artery

L1: CT SCAN BASICS | ABIA, N. 3

 Subdural Hematoma (SDH)  Traumatic Intracerebral hemorrhage
 Differentiate between acute, subacute, chronic,  Occurs at the time of
or acute on chronic impact
 Acute SDHBright white on CT  Diffuse axonal
1. Can only be removed with a craniotomy injury
2. Doesn’t always require surgery, depends  Inertial forces cause
on the patient’s neurological examination deformation of
and comorbidities the white matter,
3. Usually related to shearing of bridging aka shear injuries
veins between the dura and brain  Most commonly
leads to acute
 Acute Subdural Hematoma coma
 CT (not very
sensitive) may
reveal petechial
hemorrhages in
the central 1/3 of
the brain
(subcortical white
matter, corpus
collosum, basal
 Acute and Chronic Subdural Hematoma ganglia, brainstem, cerebellum)
 Patient may be  MRI to evaluate extent of injury
asymptomatic until  Focal parenchymal contusions
the event leading to  Coup, contra coup, intermediate coup
the acute component  CT: hemorrhagic core surrounded by low
 Chronic component density edema
can be drained using a  Variable CBF in and around contusion
bedside burr hole
device such as the
Subdural Evacuation  Intraventricular Hemorrhage
Port System (SEPS)  Variety of etiologiesAnticoagulation
 Hypertension
 Aneurysm
 ICH: Sites of Spontaneous ICH  Substance abuse
 Trauma (less likely)
 Often will need an external ventricular drain
with or without intraventricular tPA

L1: CT SCAN BASICS | ABIA, N. 4

 Subarachnoid Hemorrhage
 Always exclude an aneurysm even when head
trauma is obvious
 Aneurysmal SAH has a poorer prognosis than
traumatic subarachnoid hemorrhage
 Traumatic subarachnoid hemorrhage
 Rarely required surgical intervention
 Usually has a good prognosis

L1: CT SCAN BASICS | ABIA, N. 5