Head CT Basics : Trauma

Micelle Haydel, MD
LSU-New Orleans
First, a little test
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Head CT Interpretation
the basics
 A Little History...
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)
 What We Need to Know
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
 Before we look at abnormal,
A little normal geography:

Use the Cisterns& Ventricles as landmarks

Supra
3rd

Quad
4th
4th Ventricle
Suprasellar Cistern
 Sella turcica

Suprasellar

Suprasellar Cistern
3rd Ventricle

Quadrigeminal
Cistern
Temporal Horn of Lateral Ventricle
3rd Ventricle &
Quadrigeminal
Cistern
Lateral Ventricles

Frontal

Occipital
Lateral Ventricles
 Review:

Temp Horn
Suprasellar 3rd

4th Quad
Normal Head
ABNORMAL CTs
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
Very Small Epidural Hematoma
with fracture
Epidural with Pneumocephaly
Subdural
Hematoma
Follows the
contour of the
brain & doesnt
cross the
midline
Small SDH tracking down midline
Small Subdural Hematoma
Very Small Subdural Hematoma
Large Subdural Hematoma with shift
Isodense Subdural Hematoma
Hygroma with shift s/p SDH
Acute on Chronic Subdural Hematoma
Intraparenchymal Bleed
Intraparenchymal Bleed & Skull Fracture
Intraparenchymal Bleed & Contusions
Contusion
Pneumocephaly
and contusion
Subarachnoid hemorrhage-
Blood in the 4th Ventricle
Subarachnoid blood in the suprasellar cistern
Subarachnoid blood tracking along the sulci
Intra-Ventricular Blood throughout
 Temporal
Subdural hematoma Horn
enlargement
Epidural

Enlarged
Temporal
Horn
Diffuse Edema, SAH tracking across tentorium
Subfalcean herniation
(midline shift) due to SDH
Uncal herniation (EDH & subfalcean
herniation)
Diffuse Edema s/p SAH
Soft-tissue
swelling

Fracture
.the results
1.

Epidural Hematoma
 2.

Skull Fracture
SAH
3.

Cerebral Contusion
4.

SAH
 5.
Subdural Hematoma
Subfalcean Herniation
 6.

Epidural Hematoma
 7.

Diffuse Edema
 8.

Isodense Subdural
 9.

Subdural Hematoma