CRA

NIAL
CT
SCANPresented by:
CC ABEGAIL IBAÑEZ
NEUROAN
ATOMY
 Frontal Bone

Superior frontal
gyrus
Coronal suture

Precentral sulcus
Falx cerebri
Precentral gyrus
Parietal bone
Central sulcus Paracentral lobe
Post central gyrus
Precuneus
Superior parietal lobule

Superior Sagittal Sinus

Sagittal Suture
WHENEVER THE BRAIN SWELLS , THE GYRI BECOME
LARGER AND THE SULCI SHRINK
LOBES OF THE BRAIN
MEDIAL SURACE OF THE BRAIN
CT SCAN

● Computed tomography is also known as "CAT scanning"

(Computed Axial Tomography).

● Tomography: from the Greek word "tomos" meaning

"slice" or "section" and "graphia" meaning "describing".

● Computed tomography is an examination that uses X-ray

and computer to obtain a cross sectional image of the human
body
PARTS OF CT SCAN
 Cranial-facial
Indications trauma
Acute stroke
Suspected subarachnoid or intracranial
hemorrhage
Evaluation of
headache
Evaluation of sensory or motor
function loss

Evaluation of sinus cavities

PRINCIPLE OF CT SCAN
• Uses X rays applied in sequence
of slices across the organ
• Images reconstructed from X ray
absorption data
• X ray beam moves around the
patient in a circular path
PRINCIPLE OF CT SCAN
● CT scan provides a 3D display of the intracranial
anatomy built up from a vertical series of transverse
axial tomograms.
● Each tomogram represents a horizontal slice through
the patient’s head.
TECHN
IQUE
• Patient is placed on the CT
table in a supine position and
the tube rotates around the
patient in the gantry.

• To prevent unnecessary
irradiation of the orbits,
Cranial CTs are performed at
an angle parallel to the base
of the skull.
TECHN
IQUE
• Slice thickness may vary, but
in general, it is between 5 and
10 mm for a routine Cranial
CTs
Types of head CT’s
A. Non-contrast
B. Contrast
● IV contrast is given to better evaluate:

○ Vascular structures

○ Tumors

○ Sites of infection

○ Relative contraindications:

■ Allergy, renal failure

Intravenous Contrast Is Not Routinely Used

AXIAL VERSUS HELICAL SCAN MODE

The decision as to whether to use axial or helical scan should be influenced by the specific
patient indication, scanner capabilities, and image quality requirements.
BASICS…
X-RAYS ARE ABSORBED TO DIFFERENT DEGREES
BY
DIFFERENT TISSUES
● Always describe CT findings as densities:
isodense/ hypodense/hyperdense
● Higher the density = whiter is the appearance
● Lower the density = darker the appearance
● Brain is the reference density
● Anything of the same density as brain= ISODENSE
● Higher density than brain= HYPERDENSE
o skull is the best example
● Anything darker (lower density) than brain=HYPODENSE
o CSF and air are classical examples
Hounsfield Unit
● It is the mean attenuation of x-rays by different tissues

○ Darker shades correspond to lesser attenuation

● Named after the inventor of CT: Godfrey Hounsfield

● Related to composition & nature of tissue

● Represent the density of tissue

● Also called as CT NUMBER

 Hounsfield Unit
DESCRIPTIO APPROX. HU DENSITY
N OF TISSUE
AIR ---1000 HYPODENSE
FAT ---70 HYPODENSE
PURE WATER 0 ISODENSE
CSF +8 ISODENSE
WHITE MATTER +30 HYPERDENSE
GRAY MATTER +45 HYPERDENSE
BLOOD +70 HYPERDENSE
BONE or +1000 HYPERDENSE
CALCIFICATION
NOTE:
 CSF has a density close to water
Grey Matter is denser than White Matter
 WINDOWING
● Also known as grey-level
mapping, contrast stretching,
histogram modification or
contrast enhancement
● The process in which the CT
image greyscale component of
an image is manipulated via the
CT numbers; doing this will
change the appearance of the
picture to highlight particular
structures.
● Eg. Bone window in cases of
craniofacial trauma
PLANE
Systemic Approach to Head CT scan
Interpretation
● Symmetry – Compare left and right side of the cranium
● Midline – Look for midline shift
● Cross-sectional anatomy – Review anatomical landmark
for each section.
o Brain tissue : gray matter, white matter , intracerebral
lesions
o CSF space : ventricle (dilated or not)
o Skull and soft tissue : scalp swelling, fractures, sinuses,
orbit
● Subdural windows : Look for blood collection adjacent to
the skull
● Bone windows : Skull, orbit and sinuses, intracranial air
Systemic Approach to Head CT scan
Interpretation

● The normal head contains air-filled spaces: the frontal, maxillary, ethmoid, and
sphenoid sinuses and the mastoid air cells

● Opacification of an air space may occur because of fluids such as pus, mucus, or
blood; mucosal edema; or because of tumor invasion of the space.
 NORMAL
PLAIN AXIAL
CRANIAL CT
SCAN
AXIAL SECTIONS OF CT HEAD
POSTERIOR FOSSA CUTS
● Above The Foramen Magnum Level
● Above the level Of The Fourth Ventricle
● Above The Fourth Ventricular Level
● Tentorial Cuts

SUPRATENTORIAL SECTIONS :
● Third Ventricular Level
● Lateral Ventricular Level
● Above Ventricular Level
Above the Foramen Magnum Level
Level of the Fourth Ventricle
Above the Fourth Ventricular Level
Third ventricular level
Lateral ventricular level
Above ventricular level
 Upper cortex
A=FALX CEREBRI B=SULCUS C=GYRUS D=SUPERIOR SAGGITAL SINUS
References
● Benjamin Trevias, MD Pocket Guide for Emergent Head CT Interpretation
● Murphy, A. (2021). Windowing (CT) | Radiology Reference Article | Radiopaedia.org. Retrieved
17 January 2021, from https://radiopaedia.org/articles/windowing-ct#:~:text=Windowing%2C
%20also%20known%20as%20grey,picture%20to%20highlight%20particular%20structures.
● http://www.med-ed.virginia.edu/courses/rad/headct/index.html
● FERNE / EMRA 2009 Mid-Atlantic Emergency Medicine Medical Student Symposium: ABCs of
Head CT Interpretation; Heather M. Prendergast MD,
MPH.http://www.ferne.org/Lectures/emra_midatl_2009/pdf/
● Dr. Piyush Ojha, Radiological Anatomy Of Normal Ct Brain.Department Of Neurology.Govt
Medical College, Kota