Easy CT brain

PIYAWAN CHIEWTHANAKUL

Brain window

Bone window

Noncontrast CT

contrast CT

Normal structures on nenhanced CT (section through basal ganglia):

1, Falx cerebri; 1 2, margin between cortex and subcortical white matter; 2 3, internal capsule (anterior limb); 4, external capsule; 3 5, calcification of inner pallidum; 4 6, internal capsule (posterior limb); 5 7, straight sinus; 6 8, frontal cortex; 9, frontal subcortical white matter; 10, head of the caudate nucleus; 11, insular cortex; 7 12, putamen; 13, thalamus; 14 trigone 15, occipital cortex.

8 9

10 11 12
13 14 15

Systemic analysis of CT brain

Anatomical landmarks
Symmetry

Brain structures, CSF space, calcifications

Midline structures: falx, 3&4 ventricles

Brain tissue Density: gray matter = cortex + BG white matter = subcortical Gray-white interface: = cytotoxic edema (ischemia) = vasogenic edema (tumors, abscess) Lesions: intraaxial or extraaxial density - edema (cytotoxic, vasogenic) density blood, calcification (BG) distortion of brain tissue (mass effect or volume loss) contrast CSF spaces Enhancing lesions tumor, abscess, granulomatous lesion Ventricles, cisterns, cortical sulci & fissures Ventricular enlargement atrophy, hydrocephalus density - blood, calcification (choroids plexus) density air (open skull fracture)

Systemic analysis of CT brain

Subdural window Epidural window Bone window Extraaxial blood collection adjacent to skull Crescent shape Not cross dural attachment (falx cerebri) Lentiform usually combine skull fracture Skull fractures, orbits, sinus, mastoid air sinus

Scalp swelling, sinus, orbits, fractures Skull& soft tissues

SDH & EDH SAH ICH

EDH

Multi-stage SDH

Chronic SDH

Subacute SDH

QUIZ

Isodense subdural

SAH
High density fluid collection in sulci, cistern Look for fracture , combine brain injury Aneurysm

CT brain

Hypertensive ICH

Cerebral infarction

CT brain

CT brain

ACA infarction

ICA infarction

CT brain

CT brain

Normal lateral ventricle

Compressed lateral ventricle (mass effect)

CT brain

CT brain

Lacunar infarction

Encephalomalacia

Cerebral venous infarction

right transverse sinus thrombosis

Non-enhanced axial CT increased density within the right transverse sinus (arrow), consistent with thrombus

Empty delta sign

Venous hemorrhage

Venous sinus thrombosis

Infections

 Tuberculous meningitis A postcontrast CT study shows marked enhancement of the basal cisterns with ventricular dilatation indicative of communicating hydrocephalus. areas of low density in the right thalamus, right internal capsule, and left lentiform nuclei (B), representing lacunar infarcts from the vascular compromise in this meningovascular disease process.

Cerebritis

ring-enhancing lesion

a thin, well-defined, ring-enhancing lesion adjacent to the left trigone with surrounding vasogenic edema, producing mass effect and ventricular compression.

Cysticercosis with lesions in multiple stages unenhanced CT : multiple, well-defined lesions of very low density, having central high-density foci.= vesicular stage and scolices. Other nodular lesions have high density= nodular stage, and are undergoing mineralization. A few punctuate lesions of very high density = involuted calcific stage. A number of the low-density ring lesions enhance (B), representing the inflammatory reaction to the dying parasites in the colloidal stage, and the enhancement of those in the nodular stage. Note the enhancing lesion in the right occipital soft tissues.

Brain abscess

CNS TUBERCULOMA

CNS TUBERCULOMA

TUBERCULOSIS BRAIN ABSCESS

Brain abscess

Cerebral toxoplasmosis

CNS lymphoma

Encephalomalacia

 Brain metastasis Multiple , at corticomedullary junction Hypo or hyperdense Hypodense : kidney, lung, breast, H&N Hyperdense : GI, choriocarcinoma,melanoma, hematologic malignancy Surrounding vasogenic brain edema CECT : nodular or thick& irregular ring enhancement

 Meningeal lymphoma bilateral nodular meningeal enhancement in the occipital regions.

Hydrocephalus

Communicating hydrocephalus

Obstructive hydrocephalus

Obstructive hydrocephalus

Brain atrophy

Brain edema

Vasogenic edema

Ischemic edema

Cytotoxic edema

Interstitial edema

QUIZ

Cerebral calcification

Physiological cerebral calcification

Pathological cerebral calcification

QUIZ

Lupus vasculitis

Brain herniation

Subfalcine herniation

Uncal herniation

tonsillar herniation

Reversible posterior leukoencephalopathy

non-contrast CT

contrast CT