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PATHOLOGIES. CT OF THE HEAD PATHOLOGIES AND PROTOCOLS. 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). SINUSITIS. SINUS POLYP.

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PATHOLOGIES


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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).

SINUSITIS
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 FRACTURE
slide8

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.

skull fractures
SKULL FRACTURES
  • OPEN
  • CLOSED
slide12

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.

hemorrhage
HEMORRHAGE
  • INTRACEREBRAL
  • SUBDURAL
  • EPIDURAL
  • SUBARACHNOID
slide18
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).
slide20
EDH
  • buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull.
slide22
SAH
  • is bleeding into the subarachnoid space surrounding the brain, the area between the arachnoid membrane and the pia mater.
slide23

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%).

slide28

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

slide32

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
BRAIN INFECTIONS
  • MENINGITIS
  • ENCEPHALITIS
  • ABSCESS
meningitis
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

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

brain tumors
BRAIN TUMORS
  • ASTROCYTOMAS
  • GLIOMAS
  • PINEAL REGION TUMORS
  • LIPOMA
  • ACOUSTIC NEUROMA
  • MENINGIOMA
slide38

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.

slide39

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
slide40

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.
slide41

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
slide42

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.
ct protocols
CT PROTOCOLS
  • HEAD
  • HEAD VASCULAR CTA CTV
  • PITUITARY & SELLA TURCICA
  • INTERNAL AUDITORY CANAL
  • ORBITS
  • PARANASAL SINUSES
  • TMJ
  • FACIAL BONES
  • DENTAL
  • STEREOTACTIC
slide48

OML

CML

IOML

head brain adult
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 MAGNUM

END LOCATION: VERTEX

FILMING: BONE & SOFT TISSUE

DFOV

25

ct head loss of balance
CT HEAD – LOSS OF BALANCE

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: 2 x 2 mm POSTERIOR FOSSA

5 x 5 mm THE REST

START LOCATION: FORAMEN MAGNUM

END LOCATION: VERTEX

FILMING: BONE & SOFT TISSUE

DFOV

25

brain angio cta
BRAIN ANGIO CTA

SCOUT: LATERAL

LANDMARK: OML

SLICE PLANE: AXIAL

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

15 - 20 SEC DELAY CTA

30 SEC DELAY CTV

BREATH HOLD: NONE

SLICE THICKNESS: 1-2 MM

START LOCATION: BELOW SELLAR FLOOR

END LOCATION: 4-5 CM ABOVE SELLA

RECON: 50% OVERLAP

FILMING: 3 D RECON

DFOV

18

pituitary and sella turcica
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

slide64
IAC

SCOUT: LATERAL

LANDMARK: IOML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML FOR ACOUSTIC NEUROMA OR HEARING LOSS

65 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. MAGNUM

END LOCATION: CORONAL: THROUGH PETROUS BONE

AXIAL THROUGH PETROUS BONE

FILMING: BONE & SOFT TISSUE

slide67

SCANNED

DFOV

20 CM

RECON:

R & L SIDE

DFOV

10 CM

orbits
ORBITS

SCOUT: LATERAL

LANDMARK: IOML

SLICE PLANE: CORONAL & AXIAL

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

65 SEC DELAY

BREATH HOLD: NONE

SLICE THICKNESS: 2-3 MM

START LOCATION: CORONAL: SPH. SINUS, AXIAL: TOP OF MAX. SINUS

END LOCATION: CORONAL: ANTERIOR GLOBE

AXIAL:UPPER ORBITAL RIM

FILMING: BONE & SOFT TISSUE

DFOV

15CM

facial bones
FACIAL BONES

SCOUT: LATERAL

LANDMARK: IOML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML MASS 2 cc/sec

65 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 bones74
FACIAL BONES

INCLUDE MANDIBLE!!!!!!

slide75
PNS

SCOUT: LATERAL

LANDMARK: OML

SLICE PLANE: CORONAL & AXIAL

I.V. CONTRAST: 100-140 ML MASS 2 cc/sec

65 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 SINUS

FILMING: BONE & SOFT TISSUE

DFOV

15 CM

slide76
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

slide77

SCANNED

DFOV

20 CM

RECON:

R & L SIDE

DFOV

10 CM

stereotactic system use
Stereotactic system use
  • Biopsy of intracranial lesions
  • Aspiration of cysts
  • Laser microsurgery
  • Aspiration of brain abcess