CT SCAN BRAIN

Dr Asim Rehmani
MBBS, FCPS (Neurosurgery)
Fellowship in Spinal Surgery (Turkey)
Fellowship in Skull Base Neurosurgery (Germany)

Assistant Professor
Department of Neurosurgery
Dow University of Health sciences &
Civil Hospital Karachi, Karachi
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 Principles of CT Scanning
• Developed in 1970s
• Non invasive

• Multiple rotating pencil beams of x-ray traverses the

patient and diametrically opposed detectors measures
the extent of its absorption.
• The absorption values for multiple small blocks of tissues
(voxels) are then sent to computer.

• Computer processor reconstruct these areas on a two-

dimensional display (pixels) that form a CT scan
appearance.
• A pixel within the CT image represents the ability of the
atoms within the voxel to attenuate (decrease) an x-ray
beam.

• The brighter the pixel the greater the ability of the tissue
to attenuate x-rays

• Attenuation of x-ray beam on a CT scan is defined in

Hounsfield units.
 Substance/Region Hounsfield Units
Bone +1000
Calcification 100 – 300
Enhanced vessels 90 – 100
Blood clot 75 – 80
Brain 20 – 40
Cerebral edema 10 – 14
CSF +5
Fat –35 to –40
Air -1000
Normal CT Scan of Brain
Soft Tissue Windows
Normal CT Scan of Brain
Bone Windows
CT-Plain CT-Contrast
 Mass Effects

1. Midline shift
2. Effacement of Sulci
3. Compression of ventricles
4. Obliteration of cisterns
5. Peri-focal edema

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 Effects of Contrast
Pre-contrast Post-contrast
Hydrocephalus
Hydrocephalus
EDH
EDH
Acute SDH
Chronic SDH
Contusions
Contusions
Diffuse Axonal Injury
Linear Skull Fractures
Linear Skull Fractures
Depressed Skull Fractures
Depressed Skull Fractures
Firearm Injury
Firearm Injury
IC Bleed
IC Bleed
SAH
SAH
Infarct
Infarct
Cerebral Abscess
Cerebellar Abscess
Meningioma
Acoustic Neuroma
Pituitary Tumor
Low Grade Glioma
Low Grade Glioma
High Grade Glioma
Cerebellar Tumor
Pilocytic Astrocytoma
Cerebellar Tumor
Medulloblastoma
Cerebellar Tumor
Ependymoma
Cerebral Metastasis
Cerebral Metastasis
MRI SCAN
MRI scanner
Open MRI Scanner
 Principles of MRI Scanning
• When protons are placed in a magnetic field they become
capable of receiving and transmitting radiofrequency (rf)
electro-magnetic waves.

• After receiving rf energy the protons retransmit rf energy

proportional to the density of protons.
• The strength of the signal is also dependent upon the
electromagnetic microenvironment of the individual protons
and their movement within this environment.

• A pixel within an MRI image represents the amplitude of the

radio frequency signal coming from the hydrogen nuclei
(protons) in the water and fat within the voxel.
• This amplitude is determined by a sequence of
radiofrequency pulses and applied magnetic gradients as
well as the density of protons and their electromagnetic
micro-environment.

• The timing of the rf pulses and gradients are altered in

different sequences to change the relative weighting between
the proton density and factors in the microenvironment.
Standard Sequences
 Proton Density - the pixel intensity is primarily dependent on the
density of protons within the voxel.

 T1 weighting - pixel brightness dependent on proton density and

weighted towards those protons that quickly retransmit rf energy
decaying to their baseline unexcited state.

 T2 weighting - pixel brightness dependent on proton density and the

behavior of neighboring protons.
 Region /
T1 Weighting T2 Weighting
Substance

Dense Bone Dark Dark

Air Dark Dark

Fat Brighter Bright

Water / CSF Dark Bright

Grey Mater Grey Grey

Darker than
White Mater Whiter
grey
Normal MRI Brain
Normal MRI Spine
 Effects of Contrast
Pre-contrast Post-contrast
 Effects of Contrast
Pre-contrast Post-contrast
Cervical PIVD
Cervical PIVD
OPLL
Cervical Trauma
CVJ Compression
Chiari Malformation
Syringomyelia
Neurofibroma
Neurofibroma
 Ependymoma
Pre-contrast Post-contrast
Myxopapillary Ependymoma
T1 T2 Gad
 Cervical GBM
T1 T2 Gad
Cervical Cord Mets
T1 T2 Gad
Dorsal Meningioma
T1 T2 Gad
Dorsal Meningioma
T1 Gad
 TB Spine
T1 T2 Gad
Lumbar PIVD
Lumbar PIVD
Lumbar PIVD
Spinal Stenosis
Spinal Trauma
Spinal Trauma
MR Enhancement Patterns
Dural Tail
MR Enhancement Patterns
Mural Nodule
MR Enhancement Patterns
Ring Like
MR Enhancement Patterns
Ring Like
MR Enhancement Patterns
Nodular
 Acoustic Neuroma
T1 T2 Gad
 Meningioma
T1 T2 Gad
 Medulloblastoma
T1 T2 Gad
 Ependymoma
T1 T2 Gad
Pilocytic Astrocytoma

T1 T2 Gad
Pleomorphic Xantho-Astrocytoma
T1 T2 Gad
 Oligodendroglioma
T1 T2 Gad
 Anaplastic Astrocytoma
T1 T2 Gad
GBM
Gad
Pontine Glioma