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CT brain in emergencies ... for ER doctors
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Ct brain by prof. Wael samir

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Ct brain by prof. Wael samir

  1. 1. Intending Learning Objectives (ILOs) Discuss the radiation hazards of CT Demonstrate the usage of different contrast agents safely Identify normal anatomical landmarks on CT brain Interpretation of CT perfusion in cerebral ischemia Interpretation of CT angiogram of cranial and cervicalvasculature.
  2. 2. Radiation Dose Considerations Single Radiographs Effective Dose, mrem (mSv)Skull (PA or AP)1 3 (0.03)Skull (lateral)1 1 (0.01)Chest (PA)1 2 (0.02)Chest (lateral)1 4 (0.04)Chest (PA and lateral)5 6 (0.06)Thoracic spine (AP)1 40 (0.4)Thoracic spine (lateral)1 30 (0.3)Lumbar spine (AP)1 70 (0.7)Lumbar spine (lateral)1 30 (0.3) CT study Effective Dose, mrem (mSv)CT head1 200 (2.0)Lumbar spine series6 180 (1.8)Thoracic spine series6 140 (1.4)Cervical spine series6 27 (0.27)
  3. 3. Contrast Facts Serum Creatinine Levels (in mg/dL) Indicating an Estimated Glomerular Filtration Types: Rate of less than 60 mL/min/1.73 m2  Ionic:Age (years) 20 30 40 50 60 70 80  Nonionic: Dimer or monomerMen (not African American) 1.57 1.47 1.39 1.34 1.30 1.26 1.23 Dose: Contrast African Name Molecula Iodine Osmolalit Viscosity 0.97 0.95Women (notissues:American) safety Trade Medium 1.21 1.13 1.08 1.03 1.00 Viscosity r Weight Conc y at 20 C at 37 CMen  Idiosyncratic (nondose dependent), allergylike reactions: (African American) 1.86 1.73 1.65 1.58 1.53 1.49 (cP) (Dalton) (mgI/mL) (mOsm/kg (cP) 1.46 Acute water) Late: Ionic CM, monomer (High osmolar CM)Women (African American) 1.44 1.34 1.27 1.22 1.18 1.15 1.12 Iothalamate3  Dose-dependent 809 Conray 60% 282 1,400 6.02 (nonidiosyncratic) Reactions: 4.0  CVS: Nonionic CM, monomer (Low osmolar CM) Iohexol  CIN: Omnipaqu 821 300-&350 672 11.8 6.3  Thyroid function e 844 20.4 10.4  Drug interactions: Iopromide Ultravist 791 300& 370 607 9.2 4.9 774 22.0 10.0
  4. 4. Preventive Measures for CMEN
  5. 5. Superior frontal sulcus Superior frontal gyrus Precentral sulcus Precentral gyrus Postcentral Central sulcus gyrus
  6. 6. Corpus callosum (genu)Lateral ventricle (anterior horn) Caudate nucleus (head) Foramen of Monro Lentiform Third ventricle nucleus Internal Pineal gland capsule Lateral ventricle Thalamus (trigone with choroid plexus)
  7. 7. External capsule insular cisternQuadrigeminal plate (colliculus) Insula Quadrigeminal and ambient cisterns
  8. 8. Interhemispheric cistern Sylvian fissure insular cistern Hypothalamus 3rd ventricle Cerebral peduncle Interpeduncular Aqueduct cistern Ambient cistern MidbrainQuadrigeminal cistern Vermis of cerebellum
  9. 9. Sphenoid ridge Optic chiasmLateral ventricle(temporal horn) Pons Fourth ventricle Petrous ridge
  10. 10. Frontal air sinus Frontal lobe Orbital roof Pituitary fossa Greater wing of sphenoid Cavernous carotid Ant. clinoid Basilar artery Dorsum sella PonsPrepontine cistern 4th ventricleCerebello pontine Cerebellar cistern hemisphere
  11. 11. Straight gyrus and olfactory bulb Ethmoid sinus Optic nerve OrbitSphenoid sinus Temporal lobe SOFMastoid air cells EAC VII / VIII complex Vermis
  12. 12. Crista galle Optic foramen SOFAuditory canalCerebello medullary fissure Medulla
  13. 13. SOF Optic foramen
  14. 14. OrbitParanasal sinuses Petrous bone
  15. 15. Skull Base
  16. 16. Principles of CT perfusion (CTP) CBF50-80 ml/100 gm/min normal15-20 ” Neurological dysfunction<10 ” infarction
  17. 17. CT Brain with Stroke window
  18. 18. Infarct signs on NCCT B C
  19. 19. CTP 1) Mean Transition Time (MTT) or time to peak (TTP) 2) Cerebral Blood flow (CBF) , 3) Cerebral Blood Volume (CBV),A B C
  20. 20. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke Cutoff morphology:
  21. 21. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute StrokeTram track (nonocclusive or recanalized clot):
  22. 22. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke The tandem morphology:
  23. 23. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute StrokeTapered morphology :
  24. 24. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Strokemeniscus or flattened shape to clot (recent) versusreverse meniscus (older) :
  25. 25. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke Delayed (antegrade) flow :
  26. 26. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke Retrograde collateral flow :
  27. 27. Initial Angiographic Appearance of Intracranial Vascular Occlusions in Acute Stroke Aneurysms: CTA:sagittal MPR CTA:3D color VR
  28. 28. References
  29. 29. Sits (Information adapted from www.radiologyinfo.org
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