JURNAL READING
HOW TO INTERPRET
AN UNENHANCED CT
BRAIN SCAN
NURUL ADZKIA - 2307501010196
PEMBIMBING:
DR. FENNY HARRIKA, SP. RAD
BAGIAN RADIOLOGI RUMAH SAKIT DAERAH DR. ZAINOEL
ABIDIN BANDA ACEH FAKULTAS KEDOKTERAN UNIVERSITAS
SYIAH KUALA 2024
SOUTH SUDAN MEDICAL JOURNAL
THOMAS OSBORNEA , CHRISTINE TANGA , KIVRAJ
SABARWALB AND VINEET PRAKASH www.reallygreatsite.com
HOW TO INTERPRET AN
UN ENHANCED CT BRAIN SCAN
PART 1:
BASIC PRINCIPLES OF
COMPUTED TOMOGRAPHY
AND
RELEVANT NEUROANATOMY
Basic Principles Of CT Imaging
A CT image is produced by firing x-rays. X-
rays are fired at the body and detected by
rotating detectors.
The detected rays are converted into
computerized signals to create cross-
sectional images.
Images can be reconstructed in different
planes (axial, sagittal, coronal).
Right side of the image represents the left
side of the patient’s anatomy and vice
versa.
Interpreting CT Images
Ingoude Company
CT images display varying shades of grey, representing different
tissue densities.
Hounsfield Unit (HU) scale: Used to measure tissue density
ranging from -1000 to +1000.
Higher HU values indicate denser tissues, appearing brighter on
the scan: air (black) and bone (white).
T
The ventricular system
CSF is produced by the choroid plexus and flows
through the ventricular system
Neuroanatomy
The importance of windowing:
Window settings are used to help detect
pathology involving the brain substance
(e.g. infarction), skull vault (e.g. fracture)
or soft tissue (e.g. hematoma).
Defined by Window Width (WW) and
Window Level (WL).
HOW TO INTERPRET AN
UN ENHANCED CT BRAIN SCAN
PART 2:
CLINICAL CASES
Case 1
A 70-year old patient presented following a fall and was found on the floor by carers. The patient had no
recollection of the event
Case 1
On CT, acute blood appears hyperdense (high HU),
making it bright on the scan.
In trauma cases, reviewing the bone window is
crucial to rule out skull fractures.
Case 2
A 65-year old male patient presented with
acute onset dysarthria and right sided
weakness
In the hyperacute phase of stroke (<3
hours from symptom onset), a normal
CT head does not rule out stroke.
In the hyperacute phase of stroke,
although changes in the brain
parenchyma may occur at the cellular
level, the patient may have been
scanned at an early stage so these
changes may not have been identified
on CT.
Case 2
Early signs of tissue infarction
that need to be considered:
‘’Loss of the insular ribbon
sign’’.
Hypoattenuation (reduced
density/darker) of the
caudate nucleus on the
affected side.
Acute hyperdense
thrombus within one of the
major cerebral arterial
vessels of the circle of Willis
Case 3
65-year old male presented with acute onset left sided weakness
Case 3
Arterial infarcts involve both grey and
white matter, typically forming a
wedge shape.
In this case, watershed infarcts occur
between cerebral vascular territories
with no or little anastomoses.
Stroke-specific window settings help
visualize subtle changes in grey-white
matter differentiation.
Case 4
A 70-year old female with
hypertension presented with
confusion.
Case 4
Hyperdense material on CT could be For example, hypertensive bleeds
acute blood, calcification, or typically affect the basal ganglia. The
intravenous contrast. other common locations for
The location of the hemorrhage and hypertensive bleeds include:
clinical context help identify the 80% lenticulostriate.
underlying cause 10% pons.
Things to consider as underlying causes 10% cerebellum
of nontraumatic hemorrhage:
Hypertensive bleed.
Haemorrhagic transformation of an
infarct.
Haemorrhagic mass (primary or
secondary lesion).
Case 5
A 35-year old male
presented with a sudden
onset occipital headache
(severity 10/10) and
vomiting
Case 5
Accumulation of blood in the
subarachnoid space can lead to the
development of hydrocephalus
The common causes of a subarachnoid
haemorrhage include rupture of an
intracerebral aneurysm and trauma.
As in this case, there is an early sign of
hydrocephalus development, namely
widening of the temporal horns of the
lateral ventricles.
CT has a >95% sensitivity for
identifying a subarachnoid
haemorrhage within the first 12 hours.
Case 6
A 60-year old alcoholic male
presented with worsening
confusion over the past
month following a fall
Subdural hematoma appears
as a crescent-shaped
collection on CT.
Acute blood is hyperdense
on CT, and it becomes
hypodense over time.
It is important to check for
skull base fractures in
trauma cases.
Case 7
A 70-year old female presented following a fall. A non- ST elevation myocardial infarction
was demonstrated on her electrocardiogram. She underwent an urgent CT head to exclude
an intracranial bleed prior to commencing antiplatelet therapy
Case 7
Although there is no intracranial
hemorrhage, there is free gas at the
base of the skull.
In trauma cases, the presence of
intracranial air increases the
presence of a skull base fracture,
includinga fluid level within the
sphenoid sinuses and clinical signs
i.e. CSF rhinorrhea and otorrhea,
mastoid ecchymosis (Battle sign)
and periorbital ecchymosis (Raccoon
eyes)
Case 8
A 45-year old presented with tonic-clonic seizures following a fall
Case 8
Case 8
Increased ICP can cause a 'mass effect', where the size
or position of normal brain structures is disrupted by
the presence of an abnormal mass, such as a
hemorrhage or intracerebral mass.
CT features of raised intracranial pressure include:
Displacement of midline structures towards the
opposite side of the primary intracranial
pathology.
Loss of sulci and gyri.
Various forms of parenchymal herniation including
subfalcine, transtentorial and tonsillar herniation
(Figure 14).
A CT study can be used to look for a possible structural
cause for the patient’s signs and symptoms, however a
CT study should not be used to exclude raised ICP
CONCLUSION
"Accurate interpretation of brain CT scans requires a
deep understanding of imaging technology and the
patient's clinical condition. By carefully analyzing
window settings and looking for specific pathological
signs, so clinicians can make precise diagnoses and
enable more effective and timely interventions."
Thank You ;)
