CT Brain – Acute Pathology

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CTBBleed
A system of reviewing the structures can also be found here
Initially comment on:
  • View – Axial vs Coronal vs Sagittal
  • Type of study – Non-contrast vs Contrast (look at the Circle of Willis and Dural sinus)
  • Movement artefacts (everything looks blurry)
  • Streak artifacts – metal and fillings
Systematically go through structures
Distribution or Location of abnormalities
Comment on how many lobes are effected, how many slices seen. Give dimension in at maximum width or radius. Dimensions in 3 planes easier when there are reconstructs.
Some important shapes to identify
Remember
  • Very white = bone/calcification (can be confused with new blood without checking Hounsfield units)
  • White = new blood (but gets greyer as it gets older e.g. chronic subdurals may be difficult to pick)
  • Light Grey = White matter
  • Dark grey = Neurons (or oedema)
  • Black = CSF (which also replaces old infarcted liquified brain)
Hot tips
  • Compare left and right hemisphere (but watch out for bilateral pathologies)
  • Look carefully that sulci is abutting inner table of skull (might miss old extra-axial blood)
  • Look carefully at the last few slices near the vertex (might be the only area of pathology)
  • Check bone windows carefully for fractures and especially base of skull
  • Look for places where fluid shouldn’t be e.g. sinus including sphenoid, mastoid air cells – could be blood or infection
  • Look at facial skeleton not just the brain especially in trauma
  • Compare with old! It might be stable pre-existing pathology or progressed since.

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