PATHOLOGIES

CT OF THE HEAD PATHOLOGIES AND

PROTOCOLS

SINUSITIS

Sinusitis is the name given when the lining of one or more of these sinuses is red, swollen, and tender, the opening is blocked, and the sinus is at least partially filled with fluid (mucus and/or pus).

SINUS POLYP

ORBITAL FRACTURE

Demonstrates a superior orbital fracture on the left with fragments of bone extending toward the frontal lobe. There was no evidence of an optic canal fracture.

ORBITAL ROOF FRACTURE

TRIPOD FRACTURE

The tripod fracture, also called the zygomaticomaxillary

complex, is composed of a set of fractures including the lateral

orbital wall, inferior orbital floor, and the zygomatic arch.

Blowout fracture

MANDIBULAR FRACTURE

SKULL FRACTURES

• OPEN

• CLOSED

Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include: Simple: a break in the bone without damage to the skinLinear or hairline: a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of boneDepressed: a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brainCompound: a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur.

OPEN FRACTURE-COMPOUND

CLOSED FRACTURE

HEMORRHAGE

• INTRACEREBRAL

• SUBDURAL

• EPIDURAL

• SUBARACHNOID

INTRACEREBRAL

SUBDURAL

SDH

• form of traumatic brain injury in which blood gathers between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges).

EPIDURAL

EDH

• buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull.

SUBARACHNOID

SAH

• is bleeding into the subarachnoid space surrounding the brain, the area between the arachnoid membrane and the pia mater.

Rupture of an intracranial aneurysm is the most common cause of nontraumatic subarachnoid hemorrhage.90-95% of all intracranial aneurysms are located in the carotid system. The anterior communicating artery is the most common site (30%), followed by the posterior communicating artery (25%) and the middle cerebral artery (20%).

CEREBRAL INFARCT

BRAIN CYST

HYDROCEPHALUS

ARTERIO-VENOUS MALFORMATION

What is a brain AVM?Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins

                                                                                                                                        

BRAIN METS

CVA

This is a CAT scan of a patient with a bleeding stroke caused by CAA. The two bright areas represent recent areas of bleeding into the brain. Both areas are in the outer part of the brain that is characteristic for CAA-related strokes.

BRAIN INFECTIONS

• MENINGITIS

• ENCEPHALITIS

• ABSCESS

MENINGITIS

Subdural empyema and diffuse cerebral edema in a patient with bacterial meningitis (same patient as in Image 18). Obtained 1 week after Image 18, this contrast-enhanced CT scan shows diffuse cerebral edema and lacunar infarcts in the thalamus.

ENCEPHALITIS

Encephalitis  

Encephalitis is an inflammation (irritation and swelling with presence of extra immune cells) of the brain, usually caused by infections.

BRAIN ABSCESS

BRAIN TUMORS

• ASTROCYTOMAS

• GLIOMAS

• PINEAL REGION TUMORS

• LIPOMA

• ACOUSTIC NEUROMA

• MENINGIOMA

•astrocytomasAstrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor.

•Brain stem gliomas

are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination

•optic nerve gliomas

Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in persons who have neurofibromatosis, a condition a child is born with that makes him/her more likely to develop tumors in the brain. Persons usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures.

•medulloblastomas

Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually needed to control these tumors

•pineal region tumors

Many different tumors can arise near the pineal gland, a gland which helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas (PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Tumors in this region are more common in children than adults, and make up 3 to 8 percent of pediatric brain tumors. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. Persons with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size.

GLIOMA

ACOUSTIC NEUROMA

ACOUSTIC NEUROMA

PITUITARY GLAND TUMOR

CT PROTOCOLS

• HEAD• HEAD VASCULAR CTA CTV• PITUITARY & SELLA TURCICA• INTERNAL AUDITORY CANAL• ORBITS• PARANASAL SINUSES• TMJ• FACIAL BONES• DENTAL• STEREOTACTIC

OMLCML

IOML

HEAD/BRAIN (ADULT)SCOUT: LATERAL

FOV -240

LANDMARK: OML – 15 DEG ABOVE OML

SLICE PLANE: AXIAL

I.V. CONTRAST: 100-140 ML 1-1.5 ML/SEC, TUMOR, METS - 5 MIN DELAY

SLICE THICKNESS: 5 x 5 mm

START LOCATION: FORAMEN MAGNUMEND LOCATION: VERTEX

FILMING: BONE & SOFT TISSUE DFOV 25

15 DEG AND 20 DEG ABOVE OML

CT HEAD – LOSS OF BALANCESCOUT: LATERAL

FOV -240

LANDMARK: OML – 15 DEG ABOVE OML

SLICE PLANE: AXIAL

I.V. CONTRAST: 100-140 ML 1-1.5 ML/SEC, TUMOR, METS - 5 MIN DELAY

SLICE THICKNESS: 2 x 2 mm POSTERIOR FOSSA5 x 5 mm THE REST

START LOCATION: FORAMEN MAGNUMEND LOCATION: VERTEX

FILMING: BONE & SOFT TISSUE

DFOV 25

CT HEAD – SEIZURES -20 DEG TO OML

BRAIN ANGIO CTA

SCOUT: LATERAL

LANDMARK: OML

SLICE PLANE: AXIAL

I.V. CONTRAST: 100-140 ML- 3-5 ml /sec -

15 - 20 SEC DELAY CTA30 SEC DELAY CTV

BREATH HOLD: NONE

SLICE THICKNESS: 1-2 MM

START LOCATION: BELOW SELLAR FLOOREND LOCATION: 4-5 CM ABOVE SELLA

RECON: 50% OVERLAP

FILMING: 3 D RECON

DFOV 18

PITUITARY AND SELLA TURCICA

SCOUT: LATERAL

LANDMARK: OML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML

BREATH HOLD: NONE

SLICE THICKNESS: 1-1.5 mm

FILMING: BONE & SOFT TISSUE

DFOV 12

IAC

SCOUT: LATERAL

LANDMARK: IOML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML FOR ACOUSTIC NEUROMA OR HEARING LOSS65 SEC DELAY

BREATH HOLD: NONE

SLICE THICKNESS: 1-2 MM, 1MM THROUGH CANAL, 2 MM PETROUS BONE

START LOCATION: CORONAL: P. SEMI-CIRC. CANAL, AXIAL: F. MAGNUMEND LOCATION: CORONAL: THROUGH PETROUS BONE AXIAL THROUGH PETROUS BONE

FILMING: BONE & SOFT TISSUE

SCANNED

DFOV20 CM

RECON: R & L SIDE

DFOV10 CM

ORBITS

SCOUT: LATERAL

LANDMARK: IOML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML MASS OR VISUAL DISTURBANCE 2 CC/SEC65 SEC DELAY

BREATH HOLD: NONE

SLICE THICKNESS: 2-3 MM

START LOCATION: CORONAL: SPH. SINUS, AXIAL: TOP OF MAX. SINUSEND LOCATION: CORONAL: ANTERIOR GLOBE AXIAL:UPPER ORBITAL RIM

FILMING: BONE & SOFT TISSUE

DFOV 15CM

OPTIC NERVE PROTOCOL

PATIENT CAN’T ASSUME PRONE POSITION

SUPINE-CORONAL

DENTAL ARTIFACT OMISSION- MULTIANGULATION

FACIAL BONES

SCOUT: LATERAL

LANDMARK: IOML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML MASS 2 cc/sec65 SEC DELAY

SLICE THICKNESS: 2-3 MM

START LOCATION: CORONAL: EAM AXIAL: S. MENTI

END LOCATION: CORONAL: ANTERIOR GLOBE AXIAL: SUPERIOR ORBITAL MARGIN

FILMING: BONE & SOFT TISSUE

DFOV 20 CM

FACIAL BONES

INCLUDE MANDIBLE!!!!!!

PNS

SCOUT: LATERAL

LANDMARK: OML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML MASS 2 cc/sec65 SEC DELAY

BREATH HOLD: NONE

SLICE THICKNESS: 3 - 5 MM

START LOCATION: CORONAL: BEHIND SPHENOID SINUS AXIAL: BOTTOM OF MAX. SINUS

END LOCATION: CORONAL: THROUGH FRONTAL SINUS AXIAL: THROUGH FRONTAL SINUSFILMING: BONE & SOFT TISSUE

DFOV 15 CM

TMJ

SCOUT: LATERAL

LANDMARK: OML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: NONE

BREATH HOLD: NONE

SLICE THICKNESS: 1 - 2 MM

START LOCATION: CORONAL: POSTERIOR TO JOINT AXIAL: POSTERIOR TO JOINT

END LOCATION: CORONAL: THROUGH THE ENTIRE JOINT AXIAL: THROUGH THE ENTIRE JOINT

FILMING: BONE & SOFT TISSUE

SCANNED

DFOV20 CM

RECON: R & L SIDE

DFOV10 CM

DENTAL

STEREOTACTIC

Stereotactic system use

• Biopsy of intracranial lesions

• Aspiration of cysts

• Laser microsurgery

• Aspiration of brain abcess