Computed Tomography Scan

(CT Scan)
DR. IFEANYI UKACHUKWU
CONSULTANT DIAGNOSTIC AND
INTERVENTIONAL RADIOLOGIST
 OUTLINE
• Definition
• Brief overview
• CT scans in Neuroimaging, Urology, and
abdomen
• A CT scan,[1] also known as computed tomography scan, and formerly known as a computerized
axial tomography scan or CAT scan,[3] makes use of computer-processed combinations of many X-
ray measurements taken from different angles to produce cross-sectional (tomographic) images
(virtual "slices") of specific areas of a scanned object, allowing the user to see inside the object
without cutting.
• The X-ray beam. Although, historically, the images generated were in the axial or transverse plane,
perpendicular to the long axis of the body, modern scanners allow this volume of data to be
reformatted in various planes or even as volumetric (3D) representations of structures. Although
• Digital geometry processing is used to further generate a three-dimensional volume of the inside of
the object from a large series of two-dimensional radiographic images taken around a single axis of
rotation.[4] Medical imaging is the most common application of X-ray CT.

• Its cross-sectional images are used for diagnostic and therapeutic purposes in various medical
disciplines.

• CT produces data that can be manipulated in order to demonstrate various bodily structures based
on their ability to absorb x rays.

• Use of CT has increased dramatically over the last two decades in many countries.[9] An estimated
72 million scans were performed in the United States in 2007 and more than 80 million a year in
2015.
 Brief Overview
• CT Scan is used for diagnostics
• CT required to make accurate diagnosis
• CT scan use radiation to take X-Rays (slices)
of the body
• CT scans take slices and turn into 3D images
 History
• (early 1900’s) Alessandro Vallebona (Italy) had
the idea of taking slices of the body for
imaging (Tomography)
• (1971) First CT Scan performed
• (1974) CT Scanners installed
• The inventors of the CT scan are credited as
Godfrey Hounsfield (Britain) and Allan
Comrack (South Africa).
 State of the Art
• Widely
prevalent
• Over the past
20 years
their use has
increased
greatly
• 3D imaging,
and better
clarity
 CT vs MRI
• CT Scans are usually cheaper
• CT Scans are typically better at showing bones
than MRI, but less effective at showing the soft
tissue
• CT scans take around 5 minutes, MRI’s usually
take 30 minutes
• CT scans can be harmful to the patient, while
MRI’s have no known biohazards
• Both used for for detecting diseases and cancer
 CRANIAL CT
• CT scanning of the head is typically used to
detect
• Stroke CVA
• infections
• Tumors
• calcifications,
• Trauma
• Haemorrhage
 CRANIAL CT

• A. Small hemorrhagic contusion in the right

frontal lobe (arrow)
• B increased mean transit time (MTT)
• C decreased regional cerebral blood flow
SUBDURAL HEMATOMA
• Epidural hematoma. Axial image demonstrates a biconvex shaped extra-
axial fluid collection superficial to the left occipital lobe with hyperdense
and hypodense components.
• Bilateral Subdural Haematomas - demonstrates bilateral crescentic shaped
fluid collections, which were found to cross the coronal sutures.
• C . Massive subarachnoid hemorrhage. 97yr-old man on anticoagulation fell while
walking. Axial image demonstrates a subarachnoid hemorrhage within the basal
cisterns.
• D Subdural hematoma with developing subfalcine herniation. 69 yrs old man on
anticoagulation fell and struck his head. Coronal image demonstrates subdural
hematoma along the right cerebral convexity with mass effect on adjacent lateral
ventricle, midline shift, and subfalcine herniation
 Brain CT scan

• A. Axial image
shows focal area
of hemorrhagic
contusion
(hyperdense) with
surrounding low
density due
oedema
• B. 3D
Reconstruction
• 3 D images
of CT
angiography
 CT UROGRAPHY
• Has replaced IVU as gold standard for imaging the
urinary tract
• MDCTU has been shown to be more accurate in the
diagnosis of upper urinary tract disease a sensitivity of
96% and a specificity of 100% compared to IVU with a
sensitivity of 75% and a specificity of 86% [1]
• Contrast enhanced CT is firmly established as the
overall most sensitive modality for determining the
cause of haematuria [2].
• It is the gold standard in the detection of renal
parenchymal masses, calculi, upper tract urothelial
tumors and extrinsic lesions [3].
 CT UROGRAPHY
• Haematuria
• Renal parenchymal masses
• Calculi,
• Upper tract urothelial tumors and extrinsic
lesions
• (a) Excretory axial CT image
shows that the abdominal
organs are almost entirely
covered even with a small
detector (arrows) measuring
32 cm in diameter.
• (b) Unenhanced axial CT image
(left) shows a left calyx stone
(arrow) of 2.5 mm. However,
this stone measures 2 mm on
nephro-graphic virtual
unenhanced axial CT image
(right).
• DUPLEX KIDNEY
• A large polypoid mass
arising from the
bladder wall

• CT of kidneys (coronal
nephrographic phase
image) demonstrates
an enhancing mass
lesion arising from the
lower pole of the let
kidney consistentwith a
histologically conirmed
renal cell carcinoma.
• CT urogram (coronal
urographic phase
image) demonstrates a
illing defect in the
upper moiety of a
duplex right kidney.
• Histologically
conirmed to be
urothelialcellcarcinoma
following ureteroscopy
and biopsy.
CT abdominal trauma- Renal Injury
• Grade II renal
injury with
subcapsular and
perinephric
hematoma
• CT cystogram of
urinary bladder
trauma in a 28-year-
old man following
MVA. There is
extravasation of
contrast (arrow) in
the perivesical fat
indicating an
extraperitoneal
bladder rupture
• CT demonstrating soft tissue
injury associated with pelvic
fracture.
• A coronal MPR CT image in
soft tissue window of the
same patient showed the
fractured fragment (short
arrow) compressing at the
base of the urinary bladder.
• Note the mal-positioned
Foley’s catheter balloon
within the urethra (long
arrow).
• Urethrogram demonstrated
a membranous urethral
injury.
Advantages CTU clearly outperforms conventional
radiography, ultrasound, and IVU in the detection
of renal parenchymal masses and urinary tract
calculi.
• Fast, Higher resolution, less operator dependent
Disadvantages
• unavailability in some centers,
• the risk of allergic reaction
• Nephrotoxicity with contrast administration,
• cost compared to IVU and ultrasound
 CT ABDOMEN
• CT is an accurate technique for diagnosis of
abdominal diseases.
• Its uses include diagnosis and staging of
cancer, as well as follow up after cancer
treatment to assess response.
• It is commonly used to investigate acute
abdominal pain.
• LYMPHOMA
• SMALL BOWEL
MECHANICAL
OBSTRUCTION
 Post op paralytic ileus
• Axial CT scan
through the lower
abdomen shows
multiple fluid-filled
and dilated loops
of small bowel and
collapsed right
colon consistent
with mechanical
small bowel
obstruction
• Umblical hernia with
proximal obstruction
• -CT scan can define the
level of obstruction, the
degree of obstruction
• The cause of obstruction-
hernia, volvulus, luminal
and mural causes
• Free fluid and gas
• Abnormality within the
bowel wall, mesentery,
mesenteric vessels and
peritoneum
• HEPATOCELLULAR CA
• Wilms
Tumour
• CT scan
performed 2 days
after the incident
showed a total
transection of the
body of pancreas
(arrow)
 CT abdominal trauma
• CT scan showing
haemoperitoneum
from liver injury
• The ‘sentinel clot’ sign
is seen as a high-
attenuation collection
adjacent to the liver
surface (arrow).
• Liver injury was
confirmed surgically
with estimated blood
loss of 3 litres.
 CT abdominal trauma

• Subcapsular haematoma (star) appears as a region

of low attenuation that compresses the normal
splenic parenchyma.
• Multiple lacerations of the spleen.
• Splenectomy was performed in this patient.
 Liver Trauma

• Multiple hypodense areas that connect to the visceral surfaces are

shown.
• This patient had failed conservative treatment and splenectomy
was performed 2 days following the trauma which confirmed the
CT findings of shattered spleen.
 LUNG TRAUMA
• A Revealed fracture
of right posterior rib
(arrow) with
associated pleural
effusion, possibly a
haemothorax.
• B Evaluation of the
lung bases reveals
bilateral lung
contusions with a left
lung laceration
(arrow)
 CT MUSCULOSKELETAL
• For the axial skeleton and extremities, CT is
often used to image complex fractures,
especially ones around joints, because of its
ability to reconstruct the area of interest in
multiple planes.
• Fractures, ligamentous injuries and
dislocations can easily be recognised with a
0.2 mm resolution
 CT MUSCULOSKETAL

• A. The plain radiograph shows a bicondylar fracture with a detached tibial

eminence (insertion of anterior cruciate ligament [ACL]).
• B A three-dimensional (3D) reconstructed model of computed tomography (CT)
scans shows a severely comminuted tibial eminence avulsion fracture ( arrow )
and a depression of the bicondylar articular surface.
• C The 3D model shows huge subchondral and metaphyseal bony defects
• 3D VR images
• This volume-rendered
CT coronal MPR image
clearly depicts fracture
of the right public rami
with displacement of
the fractured fragment
 Bibliography
• [1] L. J. Wang, Y. C. Wong, C. C. Huang, C. Wu, S. Hung, and H.Chen,
“Multidetector computerized tomography urography ismore accurate than
excretory urography for diagnosing transitional cell carcinoma of the upper
urinary tract in adults with hematuria,”The Journal of
Urology,vol.183,no.1,pp.48–55
• [3] J. Richenberg, “Haematuria,”Imaging,vol.20,no.1,pp.57–72, 2008.
• [2] S. A. Joffe, S. Servaes, S. Okon, and M. Horowitz, “Multidetector row CT
urography in the evaluation of hematuria,”
Radiographics,vol.23,no.6,pp.1441–1455,2003.
• "CT Scan vs MRI." - Difference and Comparison. N.p., n.d. Web. 18
Sept. 2012. <http://www.diffen.com/difference/ CT_Scan_vs_MRI>.
• "X-ray Computed Tomography." Wikipedia. Wikimedia
Foundation, 17 Sept. 2012. Web. 17 Sept. 2012.
<http://en.wikipedia.org/wiki/X- ray_computed_tomography>.
• "Read What Your Physician Is Reading on Medscape."
EMedicineHealth. N.p., n.d. Web. 17 Sept. 2012.
<http://www.emedicinehealth.com/ct_scan/ article_em.htm>.
• Healthcare News, GE. "World’s First High Definition CT Scanner Sets
New CT Image Clarity Standard." GE, Apr.- May 2009. Web
 COME PARTNER WITH HEALTHPOINT
DIAGNOSTIC CENTER
• Thank you for listening
• Patronize Healthpoint CT scan services with
reliable reporting