CT SCAN

Radio/ 2-12-10/Doc Catedral

- All infarcts are hypodense

Cerebral abscess
- Check before contrast administration
a. For renal function disorders
o It adds more insult to injury on kidney, increase damage
o Prepared
o Not dehydrated, so that it will not pool to kidney
b. Not allergic to contrast
o IV testing

Contrast media
- Water soluble
- Iodinated contrast

# obstructive hydrocephalus
# level of obstruction is outside
# dorsal sella is discontinuous

Media
Bronchiectasis
- Normal abdominal CT let the patient drink the contrast
- IV contrast: to assess enhancement of the contrast

Extra-axial Bleed (Outside)

- E.g. Epidural bleed biconvex
Subarachnoid scattered in the cistern
Intraventricular
Subdural bleed crescent shape

Trauma
- Soft tissue window
- Bone windows

Infarcts
- Hyperdense
- Margins not well-defined
- Do not enhance in contrast

Indication for CT
- Head/Spine:
o Trauma
o Stroke
o Tumors
o Hydrocephalus (congenital anomalies)
o Metabolic (white matter/basal ganglia disease)
o Infections
o Sellar/Juxtasellar pathology
o Degenerative disease of the spine
o EENT tumors, trauma, infection, foreign bodies
- Body:
 o Tumors
o Vascular anomalies
o Inflammatory
o Trauma
o Bronchiectasis
o Biliary tract disease

Guided procedures

Limitations:
- Artifacts
- Isodensity of a pathologic lesion to the brain
- Nonspecificity

Advantages:
- A CT image is not degraded by bone, gas or excessive fat
- Spatial resolution of CT is uniform throughout the entire image
- Permanently records all information of the plane image enabling retrospective review
- Can be used ______

Contraindications
- No absolute contraindications
- Relative contraindications are related to the use of contrast material hypersensitivity
reaction, renal function derangement

Additional CT capabilities with multi slice features

Sagittal
Coronal
- Angiographies

CONVENTIONAL ANGIOGRAM
- GOLD STANDARD for:
o Aneurysm
o AV malformation

Colonography
- Rapid evaluations of colon polyps and lesions

MRI
- Best imaging modality for the brain and spine, constrained only by availability, patient
acceptability and safety of patient handling in emergency situations.
- Best tool for CNS and musculoskeletal system & also mediastinum
- Indication
o Almost all cases suspected with pathology
- Contraindications
o In patients with ferromagnetic objects
Implants:
Cardiac pacemakers
Metallic clips
Orthopedic implants
Foreign bodies
o Contraindications related to the use of contrast media
 o Contraindications are relative

- Potential Hazards associated with MRI

o Magnetic force
o Auditory effects of noise
o Inert gas quench
o Claustrophobia
o IV contrast agents

Contrast MRI
o Gadolinium Chelates
Gd Diethelene TriaminePentaAcetic Acid (DTPA), Dimeglumine
gadopentetate (Magnevist)
Gd butrol

o Indications
Tumors
CNS demyelinating diseases differentiate acute from chronic plagues
Differentiate tumor recurrence from post therapy fibrosis, particularly

o Contraindications
No absolute contraindications are known
In similar situations

MRI Signals
T1 T2
Fat
Air
Calcification
Fluid
White Hyperintense (Hypodense)
Black Hypointense (Hyperdense)

T1 longitudinal
T2 reverse

- CT: intensity
- MR: density

?
CSF
- T1: hyperintensity
- T2: hypointensity

FLAIR image you can see blood

#axial
#coronal
#sagittal

Infarct
 - # T2 hyperintense
o Tumor
o Edema white area

** MRI
- When we give contrast, then we give T1
- Black: CSF, blood vessels
- Gray: parenchyma

MR Angiography

CT scan
- for trauma patients, scan fast, especially restless
- BEST CHOICE
- Cheaper

MR
- Pedia patients with development problems

# History & PE first and make a diagnosis before CT/ MRI