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Head CT Basics : Trauma

Head CT Basics : Trauma. Micelle Haydel, MD LSU-New Orleans. First, a little test…. 1. 2. 3. 4. 5. 6. 7. 8. 9. Head CT Interpretation the basics. A Little History. In the early 1970s, Hounsfield developed a way of computerizing Xrays to select certain densities for viewing.

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Head CT Basics : Trauma

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  1. Head CT Basics : Trauma Micelle Haydel, MD LSU-New Orleans

  2. First, a little test…

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  12. Head CT Interpretationthe basics

  13. A Little History... • In the early 1970s, Hounsfield developed a way of computerizing Xrays to select certain densities for viewing. • Plain films: black, white or a few shades of grey • CT: thousands of shades of grey based on the density of the tissue (Hounsfield Units)

  14. What We Need to Know • Air is very black (less than -300 HU) • Water/CSF is black (near 0 HU) • Bone is very dense/white (500-3000 HU) • Blood is white (60-80 HU) • Brain is gray 35-50 HU

  15. Before we look at abnormal, A little normal geography: Supra 3rd 4th Quad • Use the Cisterns& Ventricles as landmarks

  16. 4th Ventricle

  17. Suprasellar Cistern

  18. Sella turcica Suprasellar Suprasellar Cistern

  19. 3rd Ventricle Quadrigeminal Cistern

  20. Temporal Horn of Lateral Ventricle

  21. 3rd Ventricle &Quadrigeminal Cistern

  22. Lateral Ventricles Frontal Occipital

  23. Lateral Ventricles

  24. Review: Temp Horn Suprasellar 3rd Quad 4th

  25. Normal Head

  26. ABNORMAL CTs

  27. On each brain slice look for: • Symmetry, symmetry, symmetry • sulci • cisterns and ventricles • grey-white differentiation

  28. Identify What Doesn’t Belong • Hyperdensities (whiter) • extra-axial hematomas (SDH, EDH) • ICB or contusion • SAH in sulci, cisterns or ventricles • Hypodensities (darker) • pneumocephaly (air is darker than CSF) • infarction

  29. Identify What Doesn’t Belong • Localized or diffuse edema • effacement of sulci or cisterns • distortion of gray-white matter interface • enlarged ventricles, temporal horn • Fractures • soft tissue swelling • fluid (blood) in sinuses or mastoid air cells • in children, look for widened sutures • Always look at bone windows

  30. Blood: Acute blood is white (60-80 HU) on CT, due to the density of hemoglobin. As hgb breaks down, the HU decrease (i.e. subacute and isodense hematomas)

  31. Dura tightly adhered to skull, but loosely to brain. Dura mater Pia mater Arachnoid

  32. Epidural Hematoma • Lens shaped (dura tightly adhered to skull • Can cross midline • Frequently assoc. with fracture

  33. Small Epidural Hematoma

  34. Very Small Epidural Hematoma

  35. Epidural with fracture

  36. Very Small Epidural Hematoma with fracture

  37. Epidural with Pneumocephaly

  38. Subdural Hematoma Follows the contour of the brain & doesn’t cross the midline

  39. Small SDH tracking down midline

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