INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA

SUNGAI BULOH, SELANGOR.

TITLE:

CECT BRAIN - ARTERIOVENOUS MALFORMATION (AVM)

PREPARED BY MOHAMAD ALIF IRFAN BIN ZULKEFLI

MATRIX NO DPMI1/2021(07)-0012

PROGRAM DIPLOMA IN MEDICAL IMAGING

COURSE CODE MICT 2222

COURSE NAME MEDICAL IMAGING COMPUTED TOMOGRAPHY

PREPARED FOR ENCIK AZRUL HAKIMI BIN ABDULLAH

DUE DATE 6 AUGUST 2023

TABLE OF CONTENT

NO. CONTENTS PAGE

1. INTRODUCTION
1.1 Modality 1
1.2 Advantages between Computed Tomography and 2
Conventional Radiography
1.3 Pathology - Arteriovenous Malformations (AVM) 3

2. OVERVIEW OF CT BRAIN PROCEDURES 4

3. PATIENT PREPARATION & PATIENT CARE 5, 6

4. TECHNIQUE & PROTOCOL FOR ARTERIOVENOUS 7

MALFORMATION (AVM)

5. RELATED IMAGES 8, 9

6. CONCLUSION 10

7. REFERENCES 11
INTRODUCTION

MODALITY

Advancements in medical imaging have revolutionized the field of healthcare,

allowing for non-invasive and accurate visualization of internal structures. One of the
most important modalities in this regard is Computed Tomography (CT), which plays
a pivotal role in diagnosing and monitoring various medical conditions. Computed
Tomography with Contrast Enhancement (CECT) is a specific technique within CT
imaging that employs contrast agents to enhance the visibility of specific tissues or
structures within the brain. CECT brain imaging is a crucial diagnostic tool that
provides detailed insights into the brain's anatomy and pathology. It is widely
employed for investigating a spectrum of neurological conditions such as tumors,
vascular anomalies, infections, and traumatic injuries. The ability to differentiate
between normal and abnormal tissues with enhanced clarity makes CECT an
invaluable asset for neurologists and radiologists alike. CECT involves the
administration of a contrast agent, usually iodine-based, through an intravenous
injection. This contrast material absorbs X-rays differently than surrounding tissues,
leading to improved differentiation between various structures. After contrast
injection, a series of X-ray images are acquired from multiple angles, and a computer
reconstructs these images into cross-sectional slices. These slices are then
assembled to create a three-dimensional representation of the brain, allowing
healthcare professionals to visualize the structures and abnormalities.
ADVANTAGES OF CT COMPARE CONVENTIONAL RADIOGRAPHY

CT (Computed Tomography) and conventional radiography (X-ray imaging)

are both important diagnostic tools used in medical imaging, but they have distinct
advantages and disadvantages, particularly in brain imaging. Here are some
advantages of CT compared to conventional radiography in brain imaging. Firstly, CT
provides detailed cross-sectional images of the brain, allowing for better visualization
and differentiation of various brain structures, such as the ventricles, sulci, and gyri.
Conventional radiography provides only 2D images, which may not offer the same
level of detail. Secondly, CT can differentiate between different types of soft tissues
within the brain, such as gray matter, white matter, and blood vessels. This level of
differentiation is not achievable with conventional radiography. Thirdly, CT is more
sensitive to detecting various pathological conditions in the brain, such as tumors,
hemorrhages, and ischemic strokes. These abnormalities may be harder to detect or
characterize using conventional radiography alone. Fourthly, CT is better at Imaging
Complex Anatomy. CT is better suited for imaging complex anatomical structures in
the brain, such as the skull base, orbits, and sinuses. Conventional radiography may
not provide sufficient information about these areas. Fifthly, CT images can be used
to create three-dimensional reconstructions of the brain, aiding in surgical planning
and enhancing understanding of anatomical relationships. Conventional radiography
lacks this capability. Lastly, CT can easily incorporate contrast agents to enhance
visualization of blood vessels, tumors, and other abnormalities in the brain.
Contrast-enhanced conventional radiography is less common and may not provide
the same level of detail.
PATHOLOGY - ARTERIOVENOUS MALFORMATION (AVM)

A brain arteriovenous malformation (AVM) is a tangle of blood vessels that

connects arteries and veins in the brain. The arteries take oxygen-rich blood from the
heart to the brain. Veins carry the oxygen-depleted blood back to the lungs and
heart. A brain AVM disrupts this vital process. An arteriovenous malformation can
develop anywhere in the body but common locations include the brain and spinal
cord. But overall, brain AVMs are rare. The cause of brain AVMs is unknown. Most
people are born with them and form during fetal development, but they can form
later in life. Rarely, they can be passed down among families. A brain arteriovenous
malformation may not cause any signs or symptoms until the AVM ruptures, resulting
in hemorrhage. In about half of all brain AVMs, hemorrhage is the first sign. But
some people with brain AVM may experience signs and symptoms other than
bleeding, such as seizures, headache or pain in one area of the head, muscle
weakness or numbness in one part of the body. The cause of brain AVM is unknown.
An AVM is often found after a brain scan for another health issue or after the blood
vessels rupture and bleed which is hemorrhage. Once diagnosed, a brain AVM can
be treated to prevent complications, such as brain damage or stroke. Treatment
options include surgical removal, embolization, and radiation therapy, often chosen
based on the AVM's location, size, and the patient's overall health.
OVERVIEW OF CT BRAIN PROCEDURE

The CT brain procedure, a vital diagnostic tool in modern medicine, entails a

series of steps to capture comprehensive images of the brain and its surroundings.
The patient is comfortably positioned on a movable table, which then smoothly slides
into the central aperture of the CT scanner, a circular machine housing an X-ray
source. During the scan, the X-ray tube rotates around the patient's head, emitting
X-ray beams from various angles. To optimize image clarity, patients may be
prompted to momentarily hold their breath, minimizing motion artifacts. In certain
cases, a contrast dye might be administered intravenously to accentuate blood
vessels and specific brain structures, enhancing diagnostic accuracy. The emitted
X-rays are detected by sensitive sensors, and the collected data are processed by a
computer to generate detailed cross-sectional images, akin to slices of the brain.
These images, examined by specialized radiologists, aid in the identification of
neurological disorders, tumors, injuries, and other abnormalities. The results are then
conveyed to the patient's healthcare provider for analysis, potential treatment
planning, and further steps. Remarkably efficient and minimally invasive, the
procedure allows patients to promptly resume their daily activities, making it an
invaluable asset in modern medical practice.
PATIENT PREPARATION & PATIENT CARE

Pre-Procedure

I. Explains the examination to the patients. Instruct patients regarding eating

and drinking before the scan which is fasting for about 4 to 6 hours prior to the
examination. Typically, only for CECT brain procedures since contrast media
will be injected into them.
II. Patients' preparation of the examination based on medical necessity.
III. Confirm the patient's medical history and screening. Ask patients about their
medical history, allergies, recent illnesses, and any medications they are
taking. This information helps ensure the safety and effectiveness of the
procedure.
IV. Confirm the patient's contrast allergies. Ask patients about any history of
allergies, especially to iodine or contrast materials if a contrast dye is to be
used during the procedure,
V. Extra precautions may be required for patients who have renal issues or a
history of kidney disease. Before the surgery, kidney function tests may be
carried out to evaluate the patient's capacity to process the contrast medium.
VI. Patients who have a Claustrophobia should let their doctor know before the
scan. For these cases, special techniques or medications may be given.
VII. Remove metal objects from the scan area such as jewellery, watches, and
hairpins, as they can interfere with the CT imaging.
VIII. Ask the patient to change into a hospital gown.
During Procedure

I. Patient Positioning. Lies patients on a movable table that is positioned within

the CT scanner's circular opening, known as the gantry.
II. Contrast Injection if applicable. If contrast dye is used, an intravenous (IV) line
may be inserted into a vein in the patient's arm.
III. Ask patients to not move as much as possible to avoid any chances of artifact
to obtain clear images when performing the procedure, use movement
restricting equipment if needed. Patients also may be instructed to hold their
breath for a short duration to minimize motion artifacts during image
acquisition.
IV. If necessary, a chaperone can be brought into the examination room for the
patient to ensure the patient’s safety and comfort..
V. Observe and communicate with the patients during the scan through an
intercom system to avoid any unwanted accidents from occurring and ensure
they are comfortable and informed throughout the procedure.

Post-Procedure

I. Remove contrast if used. After the contrast-enhanced scan, the IV line is

removed, and the patient may be encouraged to drink fluids to help eliminate
the contrast dye from their system.
II. Examine the patient for any signs of adverse reaction to the contrast media.
Ask the patient to inform the doctor immediately if any adverse reactions
occur.
III. The collected images are processed by a computer and interpreted by a
radiologist. The radiologist generates a detailed report of their findings.
IV. Analyze and discuss the CT scan results with patients. Explain the findings
and potential implications for their health. Further diagnostic steps or
treatment plans may be recommended based on the results.
V. Follow-Up treatment. Depending on the findings, the patient may be advised
to undergo further tests, consultations with specialists, or specific treatments
to address any identified issues
TECHNIQUE & PROTOCOL FOR ARTERIOVENOUS MALFORMATION (AVM)
RELATED IMAGES

FINDINGS :

● Vascular tangles are serpiginous and hyperdense without contrast from the
blood pool effect.
● AVMs may contain punctate or curvilinear calcification.
● AVMs will enhance

FIGURE 1 : Unenhanced (top) and enhanced

(bottom) axial CTs of the brain shows a large,
serpiginous AVM in the left parietal lobe
adjacent to the tentorium.
FIGURE 2 : CT scan of the head showing a
left occipital arteriovenous malformation
(AVM), with multiple calcified phleboliths and
numerous hyperattenuating vascular
channels.

FIGURE 3 : CT scan of the head reveals a

right frontal lobe arteriovenous malformation
with scattered calcifications (arrow).
CONCLUSION

In conclusion, a cerebral arteriovenous malformation (AVM) assessment using

contrast-enhanced computed tomography (CECT) of the brain plays a vital role in
diagnosing and characterizing this intricate vascular anomaly. CECT provides
detailed images that aid in pinpointing the AVM's location, size, and vascular
architecture, guiding medical professionals in making informed decisions about
treatment options. The identification of an AVM through CECT underscores the
significance of early detection and appropriate management due to the potential
risks of hemorrhage and associated neurological complications. Collaborative efforts
among neurologists, neurosurgeons, and radiologists are essential to tailor a
personalized treatment plan, which may involve surgical resection, embolization, or
radiation therapy, all aimed at minimizing risks and optimizing the patient's overall
well-being. As technology advances, CECT continues to be an invaluable tool in
comprehending and addressing the challenges posed by cerebral AVMs, ultimately
contributing to improved patient outcomes and quality of life.
REFERENCES

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Murphy, A. (2023a, March 23). Computed Tomography: Radiology Reference Article.

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Murphy, A. (2023b, March 23). CT head (protocol): Radiology reference article.

Radiopaedia Blog RSS. https://radiopaedia.org/articles/ct-head-protocol

Pruthi, S. (2022, June 14). Brain AVM (arteriovenous malformation). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/brain-avm/symptoms-causes/
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Worsley, C. (2023, April 23). Brain Arteriovenous malformation: Radiology reference

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