头颅损伤CT片阅读技巧.docx

头颅损伤CT片阅读技巧.docx

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头颅损伤CT片阅读技巧

HowtoreadaheadCT

ThemnemonicusedbyDr.AndrewPerronwholecturesonthistopicfrequentlyis:

BloodCanBeVeryBad.Contentandimagesbelowaretakenfromhislecture（withhispermission）.

Thisstandsfor

B-blood

C-cisterns

B-brain

V-ventricles

B-bones

Step:

1blood

LookforanyevidenceofbleedingthroughoutallslicesoftheheadCT.

Bloodwillappearbrightwhiteandistypicallyintherangeof50-100Houndsfieldunits.

Basiccategoriesofbloodinthebrainareepidural,subdural,intraparenchymal/intracerebral,intraventricular,andsubarachnoid.

Epidural（lensshaped,doesnotcrosssuturelines）

Subdural（crescentshaped,doescrosssuturelines）

Intraparenchymal/intracerbralhemorrhage（highdensitybleedsmostofteninthebasalgangliaareaifduetoHTN）

Intraventricularhemorrhage

Subarachnoidhemorrhage（duemostoftentoaneurysms,CTsensitivitydecreasessharplywithtime）

Step:

2cisterns

2Keyquestionstoanswerregardingthe4keycisterns（Circummesencephalic,Suprasellar,QuadrigeminalandSylvian）

-Isthereblood?

-Arethecisternsopen?

Circummesencephaliccistern

Suprasellarcistern

Quadrigeminalcistern

Sylviancistern

Step:

3brain

Examinethebrainfor

Symmetry-makesuresulciandgyriappearthesameonbothsides.（easiestwhenpatientnotrotatedinthescanner）

Grey-whitedifferentiation-theearliestsignofaCVAonCTscanisthelossofthegrey-whiteinterfaceonCTscan.Comparesidetoside.

Shift-thefalxshouldbeinthemidlinewithventriclesthesameonbothsides.Checkforeffacementofsulci（unilateralorbilateral）.

Hyper/hypodenisty-blood,calcificationandIVcontrastarehyperdense（appearlighter）andair,fatandareasoftumorischemiaarehypodense（appeardarker）.

Step:

4ventricles

ExamineforIIIrd,IVthandlateralventriclesfordilationorcompression/shift.

Pathologicprocessescausedilation（hydrocephalus）orcompression/shift.Communicatingvs.Non-communicating.Communicatinghydrocephalusisfirstevidentindilationofthetemporalhorns（normallysmall,slit-like）.Thelateral,IIIrd,andIVthventriclesneedtobeexaminedforeffacement,shift,andblood.

Step:

5bone

BonehasthehighestdensityonCTscan（whitestinappearance.）Evaluateforfracture.