Introduction to Head CT

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Technique routine Head CT

Supine position on CT table
Tube rotates around patient in the
gantry
Prevent irradiation of orbits (lenses)
Head CT performed at angle
parallel base of the skull
Slide thickness between 5 and 10 mm
IV contrast is not routinely used
tumors, cerebral infections & in some
cases for evaluation of stroke

 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)

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)

On each brain slice look for:

Symmetry, symmetry, symmetry
sulci
cisterns and ventricles
grey-white differentiation

Identify What Doesnt 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

Identify What Doesnt 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

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)

Dura tightly
adhered
to skull, but
loosely to
brain.

Dura mater

Arachnoid

Pia mater

Epidural Hematoma
-Lens shaped (dura tightly
adhered to skull)
-Can cross midline
-Frequently assoc. with fracture

Small Epidural Hematoma

Very Small Epidural Hematoma

Epidural with fracture

Epidural with Pneumocephaly

Subdural
Hematoma
Follows the contour of
the
brain &falx
doesnt
cross
Typically
or sicklethe
midline
shaped.

Crosses sutures, but does

not cross midline.
Acute subdural is a marker
for severe head injury.
(Mortality approaches 80%)
Chronic subdural usually
slow venous bleed and well

Large Subdural Hematoma

with shift

Isodense Subdural Hematoma

Acute on Chronic Subdural Hematoma

Intraparenchymal Bleed

Intraparenchymal Bleed & Skull Fracture

Intraparenchymal Bleed & Contusions

Contusion

Pneumocephaly and
contusion

Intraventrikel hemorrhagein the 4th Ventricle

Subarachnoid
blood in the
suprasellar
cistern

Blood in the cisterns/cortical

gyral surface
Aneurysms responsible for 7580% of SAH
AVMs responsible for 4-5%

Subarachn
oid blood
tracking
along the
sulci

Intra-Ventricular Blood

Subdural hematoma

Temporal Horn
enlargement

Epidural

Enlarged
Temporal Horn

Diffuse Edema, SAH tracking across tentorium

Subfalcean herniation
(midline shift) due to SDH

Soft-tissue swelling

Fracture

http://www.med-ed.virginia.edu/courses/rad/headct/index.html
https://
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hapter%2069.pdf
ferne_emra_2009_midatl_medstud_ctinterp_prendergasthandout_1229
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1.
Epidural Hematoma

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Skull Fracture
SAH

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Cerebral Contusion

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SAH

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Subdural Hematoma
Subfalcean Herniation

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Epidural Hematoma

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Diffuse Edema
SAH

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Isodense Subdural

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Subdural Hematoma

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Sharply circumscribed hypodense edema (arrowheads)

in the right middle cerebral artery territory.