CT Interpretation

What is a CT

A computed tomography (CT) scan is an imaging

method that uses x-rays to createpictures of
cross-sectionsof the body.

With plain X-ray, you get a single shot of X-ray

beams and you get a single image. With CT, you
get a couple of hundred X-rays and the computer
puts them all together to give you a set of
images.

Risk

As with any medical procedure, there are risks and benefits. The
main risk is radiation. This predisposes to cancer.

If you have a 4-month old child, you would have to have a very
good reason to do a CT scan. As they are growing, there's lots of
mitosis going on and a much higher chance that you do damage
to a gene and pre-dispose somebody towards cancer.

An 80 year-old female with a background of MI, severe COPD

and end-stage lung cancer is very amenable to CT. Even if she
develops a neoplasm, it is unlikely to kill her.

Interpretation
Black is air
White is bone, contrast or metal
Grey is everything else
Essentially, if they have given contrast, it will appear as bright white on
the scan. Metal, like hip replacements, appear white as well. Soft tissues
tend to appear grey, empyema appears grey, fat appears grey, colon
appears grey etc

Note: YOU ARE LOOKING FROM THE BOTTOM! When you see a CT scan,
imagine you are at the end of the bed. The front is at the top, the back is
at the bottom, the patient's left is on the right and the patient's right is on
the left. Got it?

Contrast

CT scans may be done with or without contrast."

Contrast refers to a substance taken by mouth

or injected into an intravenous (IV) line that
causes the particular organ or tissue under study
to be seen more clearly.

This is contraindicated in renal failure (acute or

chronic) - if you have an eGFR <20-30 you
cannot have contrast.

Where do we CT and why?

CT head
Stroke

and intracranial haemorrhage are the main

reasons to do an urgent CT head. Fractures can
be seen in trauma. CT angiography is often used
to look at the structure of the neurovasculature.

CT

head and neck can be used to rule out

fractures (skull, cervical spine, facial, orbital),
cord compression or to look for tumours or
abscesses.

CT chest

The main reason chest CT is used for is

pulmonary embolism and cancer. PE can be
diagnosed with CT pulmonary angiography
(CTPA) as is highly specific and sensitive.
Bronchiectasis is often diagnosed using highresolution CT.

CT abdomen/pelvis

These can be ordered separately or together but

are commonly ordered together.

Surgeons often use this to diagnose diverticulitis,

bowel obstruction, appendicitis (if the diagnosis is
unclear), bowel cancer, bowel ischaemia (with
contrast) and many more conditions.

Ovarian tumours, fibroids and other

gynaecological pathology can be seen using this
modality but this is largely done using
transabdominal and transvaginal ultrasound.

CT chest/abdo/pelvis

Patient with possible diagnosis of cancer should

get a staging CT to look for metastases.

Results for histology take some time. Therefore,

if you highly suspect a malignant cancer with
metastasis, proceed with the imaging studies.

References
Dr.

Chris, Lowry. N.p.. Web. 4 Dec 2013.

<http://www.medrevise.co.uk/wiki/Computed_tomography>.

Shaw

AS, Dixon AK. Multidetector computed tomography. In: Adam A, Dixon

AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical
Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 4.

Etminan

M, Takkouche B, Isorna FC, Samii A. Risk of ischaemic stroke in

people with migraine: systematic review and meta-analysis of observational
studies. BMJ 2005; 330 (7482): 63.

Kanne

JP, Lalani TA. Role of computed tomography and magnetic resonance

imaging for deep venous thrombosis and pulmonary embolism. Circulation.
2004; 109:I15-21.