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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 l.jpg

Head CT Basics : Trauma

Micelle Haydel, MD

LSU-New Orleans













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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)


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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


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Before we look at abnormal, A little normal geography:

Supra

3rd

4th

Quad

  • Use the Cisterns& Ventricles as landmarks




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Sella turcica

Suprasellar

Suprasellar Cistern


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3rd Ventricle

Quadrigeminal

Cistern



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3rd Ventricle &Quadrigeminal Cistern


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Lateral Ventricles

Frontal

Occipital



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Review:

Temp Horn

Suprasellar

3rd

Quad

4th




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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


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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


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    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)


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    Dura tightly adhered density of hemoglobin.

    to skull, but loosely to brain.

    Dura mater

    Pia mater

    Arachnoid


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    • Epidural Hematoma density of hemoglobin.

    • Lens shaped (dura tightly adhered to skull

    • Can cross midline

    • Frequently assoc. with fracture


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    Small Epidural Hematoma density of hemoglobin.


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    Very Small Epidural Hematoma density of hemoglobin.


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    Epidural with fracture density of hemoglobin.



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    Epidural with Pneumocephaly density of hemoglobin.


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    Subdural Hematoma density of hemoglobin.

    Follows the contour of the brain & doesn’t cross the midline


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    Small SDH tracking down midline density of hemoglobin.


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    Small Subdural Hematoma density of hemoglobin.


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    Very Small Subdural Hematoma density of hemoglobin.


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    Large Subdural Hematoma with shift density of hemoglobin.


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    Isodense Subdural Hematoma density of hemoglobin.


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    Hygroma with shift s/p SDH density of hemoglobin.


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    Acute on Chronic Subdural Hematoma density of hemoglobin.


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    Intraparenchymal Bleed density of hemoglobin.



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    Intraparenchymal Bleed & Contusions density of hemoglobin.


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    Contusion density of hemoglobin.


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    Pneumocephaly and contusion density of hemoglobin.


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    Subarachnoid hemorrhage- density of hemoglobin.

    Blood in the 4th Ventricle




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    Intra density of hemoglobin. -Ventricular Blood throughout


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    Temporal Horn enlargement density of hemoglobin.

    Subdural hematoma


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    Epidural density of hemoglobin.

    Enlarged Temporal Horn





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    Diffuse Edema s/p SAH density of hemoglobin.


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    Soft-tissue swelling density of hemoglobin.

    Fracture


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    ….the results density of hemoglobin.


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    1. density of hemoglobin.

    Epidural Hematoma


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    2. density of hemoglobin.

    Skull Fracture

    SAH


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    3. density of hemoglobin.

    Cerebral Contusion


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    4. density of hemoglobin.

    SAH


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    5. density of hemoglobin.

    Subdural Hematoma

    Subfalcean Herniation


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    6. density of hemoglobin.

    Epidural Hematoma


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    7. density of hemoglobin.

    Diffuse Edema


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    8. density of hemoglobin.

    Isodense Subdural


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    9. density of hemoglobin.

    Subdural Hematoma


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    ? density of hemoglobin.


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