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CT
Blood
Cisterns
Brain
Ventricles
Bone 5
Blood Can Be Very Bad
Blood
Cisterns
Brain
Ventricles
Bone 6
Blood Can Be Very Bad
Blood
Cisterns
Brain
Ventricles
Bone 7
Blood Can Be Very Bad
Blood
Cisterns
Brain
Ventricles
Bone 8
Blood Can Be Very Bad
Blood
Cisterns
Brain
Ventricles
Bone 9
CT Scan Basics
A CT image is a computer-generated
picture based on multiple x-ray
exposures taken around the
periphery of the subject.
X-rays are passed through the
subject, and a scanning device
measures the transmitted radiation.
The denser the object, the more the
beam is attenuated, and hence fewer 10
x-rays make it to the sensor.
CT Scan Basics
The denser the object, the whiter it is on CT
Bone is most dense = + 1000 Hounsfield U.
Air is the least dense = - 1000H Hounsfield
U.
11
CT Scan Basics: Windowing
15
CT Scan
2 nd 2 nd
Key Level
Key Level Sagittal View
Circummesencephalic Cistern
17
Cisterns at Cerebral
Peduncles Level
18
CT Scan
19
CT Scan
20
3rd Key Level Sagittal View
Circummesencephalic Cistern
21
Cisterns at High Mid-Brain Level
22
CT Scan
CSF Production
Produced in choroid plexus in the
lateral ventricles Foramen of
Monroe IIIrd Ventricle Acqueduct
of Sylvius IVth Ventricle
Lushka/Magendie
0.5-1 cc/min
Adult CSF volume is approx. 150 ccs.
Adult CSF production is approx. 500- 24
26
B is for Blood
Acute blood is bright white
on CT (once it clots).
Blood becomes 27
hypodense at
approximately 2 weeks.
B is for Blood
Acute blood is bright white
on CT (once it clots).
Blood becomes 28
hypodense at
approximately 2 weeks.
B is for Blood
Acute blood is bright white
on CT (once it clots).
Blood becomes 29
hypodense at
approximately 2 weeks.
CT Scans
30
Subdural Hematoma
Typically falx or sickle-
shaped.
Crosses sutures, but
does not cross midline.
Acute subdural is a
marker for severe head
injury. (Mortality
approaches 80%)
Chronic subdural usually
slow venous bleed and 31
well tolerated.
Subarachnoid Hemorrhage
32
Subarachnoid Hemorrhage
Blood in the cisterns/cortical gyral surface
Aneurysms responsible for 75-80% of SAH
AVMs responsible for 4-5%
Vasculitis accounts for small proportion (<1%)
No cause is found in 10-15%
20% will have associated acute hydrocephalus
33
CT Scan
34
CT Scan
35
Intraventricular/
Intraparenchymal
Hemorrhage
CT Scan
37
C is for CISTERNS
(Blood Can Be Very Bad)
4 key cisterns
Circummesencephalic
Suprasellar
Quadrigeminal
Sylvian
Circummesencephalic
38
Cisterns
2 Key questions to answer regarding cisterns:
Is there blood?
Are the cisterns open?
39
40
41 Andrew D. Perron, MD, FACEP
B is for BRAIN
(Blood Can Be Very Bad)
42
43
Tumor
44
Atrophy
45
Abscess
46
Hemorrhagic Contusion
47
Mass Effect
48
Intracranial Air
49
Intracranial Air
50
51
52
53
54
55 Andrew D. Perron, MD, FACEP
Blood Can Be Very Bad
If no blood is seen, all cisterns
are present and open, the brain
is symmetric with normal gray-
white differentiation, the
ventricles are symmetric without
dilation, and there is no fracture,
then there is no emergent
diagnosis from the CT scan. 56
Text Book
David Suttons Radiology
Clarks Radiographic positioning and techniques
Assignment
Two students will be selected for assignment.
Question
Define differences between subdural and epidural
hematoma?
Thank You