CT OF THE HEAD PATHOLOGIES AND PROTOCOLS
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
www.indiandentalacademy.com
PATHOLOGIES
www.indiandentalacademy.com
SINUSITIS Sinusitis is the name given when the lining of one or more of these sinuses is red, swollen, and tender, the opening is blocked, and the sinus is at least partially filled with fluid (mucus and/or pus). www.indiandentalacademy.com
SINUS POLYP
www.indiandentalacademy.com
ORBITAL FRACTURE Demonstrates a superior orbital fracture on the left with fragments of bone extending toward the frontal lobe. There was no evidence of an optic canal fracture. www.indiandentalacademy.com
ORBITAL ROOF FRACTURE
www.indiandentalacademy.com
TRIPOD FRACTURE
www.indiandentalacademy.com
The tripod fracture, also called the zygomaticomaxillary complex, is composed of a set of fractures including the lateral orbital wall, inferior orbital floor, and the zygomatic arch.
www.indiandentalacademy.com
Blowout fracture
www.indiandentalacademy.com
MANDIBULAR FRACTURE
www.indiandentalacademy.com
SKULL FRACTURES • OPEN • CLOSED
www.indiandentalacademy.com
Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include: Simple: a break in the bone without damage to the skinLinear or hairline: a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of boneDepressed: a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brainCompound: a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur. www.indiandentalacademy.com
OPEN FRACTURECOMPOUND
www.indiandentalacademy.com
CLOSED FRACTURE
www.indiandentalacademy.com
HEMORRHAGE • • • •
INTRACEREBRAL SUBDURAL EPIDURAL SUBARACHNOID
www.indiandentalacademy.com
INTRACEREBRAL
www.indiandentalacademy.com
SUBDURAL
www.indiandentalacademy.com
SDH • form of traumatic brain injury in which blood gathers between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges).
www.indiandentalacademy.com
EPIDURAL
www.indiandentalacademy.com
EDH • buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull.
www.indiandentalacademy.com
SUBARACHNOID
www.indiandentalacademy.com
SAH • is bleeding into the subarachnoid space surrounding the brain, the area between the arachnoid membrane and the pia mater.
www.indiandentalacademy.com
Rupture of an intracranial aneurysm is the most common cause of nontraumatic subarachnoid hemorrhage. 90-95% of all intracranial aneurysms are located in the carotid system. The anterior communicating artery is the most common site (30%), followed by the posterior communicating artery (25%) and the middle cerebral artery (20%).
www.indiandentalacademy.com
CEREBRAL INFARCT
www.indiandentalacademy.com
BRAIN CYST
www.indiandentalacademy.com
HYDROCEPHALUS
www.indiandentalacademy.com
ARTERIO-VENOUS MALFORMATION
www.indiandentalacademy.com
What is a brain AVM? Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins www.indiandentalacademy.com
BRAIN METS
www.indiandentalacademy.com
CVA
www.indiandentalacademy.com
www.indiandentalacademy.com
This is a CAT scan of a patient with a bleeding stroke caused by CAA. The two bright areas represent recent areas of bleeding into the brain. Both areas are in the outer part of the brain that is characteristic for CAAwww.indiandentalacademy.com related strokes.
BRAIN INFECTIONS • MENINGITIS • ENCEPHALITIS • ABSCESS
www.indiandentalacademy.com
MENINGITIS
Subdural empyema and diffuse cerebral edema in a patient with bacterial meningitis (same patient as in Image 18). Obtained 1 week after Image 18, this contrast-enhanced CT scan shows www.indiandentalacademy.com diffuse cerebral edema and lacunar infarcts in the thalamus.
ENCEPHALITIS
Encephalitis Encephalitis is an inflammation (irritation and swelling with presence of www.indiandentalacademy.com extra immune cells) of the brain, usually caused by infections.
BRAIN ABSCESS
www.indiandentalacademy.com
BRAIN TUMORS • • • • • •
ASTROCYTOMAS GLIOMAS PINEAL REGION TUMORS LIPOMA ACOUSTIC NEUROMA MENINGIOMA www.indiandentalacademy.com
•astrocytomas Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor.
www.indiandentalacademy.com
•Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination
www.indiandentalacademy.com
•optic nerve gliomas Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in persons who have neurofibromatosis, a condition a child is born with that makes him/her more likely to develop tumors in the brain. Persons usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures. www.indiandentalacademy.com
•medulloblastomas Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually needed to control these tumors www.indiandentalacademy.com
•pineal region tumors Many different tumors can arise near the pineal gland, a gland which helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas (PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Tumors in this region are more common in children than adults, and make up 3 to 8 percent of pediatric brain tumors. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. Persons with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size. www.indiandentalacademy.com
GLIOMA
www.indiandentalacademy.com
ACOUSTIC NEUROMA
www.indiandentalacademy.com
ACOUSTIC NEUROMA
www.indiandentalacademy.com
PITUITARY GLAND TUMOR
www.indiandentalacademy.com
CT PROTOCOLS • • • • • • • • • •
HEAD HEAD VASCULAR CTA CTV PITUITARY & SELLA TURCICA INTERNAL AUDITORY CANAL ORBITS PARANASAL SINUSES TMJ FACIAL BONES DENTAL STEREOTACTIC www.indiandentalacademy.com
OML CML
IOML
www.indiandentalacademy.com
HEAD/BRAIN (ADULT) SCOUT: LATERAL FOV -240 LANDMARK: OML – 15 DEG ABOVE OML SLICE PLANE: AXIAL I.V. CONTRAST: 100-140 ML 1-1.5 ML/SEC, TUMOR, METS - 5 MIN DELAY
SLICE THICKNESS: 5 x 5 mm START LOCATION: FORAMEN MAGNUM END LOCATION: VERTEX FILMING: BONE & SOFT TISSUE
www.indiandentalacademy.com
DFOV 25
15 DEG AND 20 DEG ABOVE OML
www.indiandentalacademy.com
CT HEAD – LOSS OF BALANCE SCOUT: LATERAL FOV -240 LANDMARK: OML – 15 DEG ABOVE OML SLICE PLANE: AXIAL I.V. CONTRAST: 100-140 ML 1-1.5 ML/SEC, TUMOR, METS - 5 MIN DELAY
SLICE THICKNESS: 2 x 2 mm POSTERIOR FOSSA 5 x 5 mm THE REST START LOCATION: FORAMEN MAGNUM END LOCATION: VERTEX FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com
DFOV 25
CT HEAD – SEIZURES -20 DEG TO OML
www.indiandentalacademy.com
www.indiandentalacademy.com
BRAIN ANGIO CTA SCOUT: LATERAL LANDMARK: OML SLICE PLANE: AXIAL I.V. CONTRAST: 100-140 ML- 3-5 ml /sec -
15 - 20 SEC DELAY CTA 30 SEC DELAY CTV BREATH HOLD: NONE SLICE THICKNESS: 1-2 MM START LOCATION: BELOW SELLAR FLOOR END LOCATION: 4-5 CM ABOVE SELLA RECON: 50% OVERLAP FILMING: 3 D RECON www.indiandentalacademy.com
DFOV 18
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
PITUITARY AND SELLA TURCICA SCOUT: LATERAL LANDMARK: OML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML BREATH HOLD: NONE SLICE THICKNESS: 1-1.5 mm FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com
DFOV 12
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
IAC SCOUT: LATERAL LANDMARK: IOML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML FOR ACOUSTIC NEUROMA OR HEARING LOSS
65 SEC DELAY BREATH HOLD: NONE SLICE THICKNESS: 1-2 MM, 1MM THROUGH CANAL, 2 MM PETROUS BONE START LOCATION: CORONAL: P. SEMI-CIRC. CANAL, AXIAL: F. MAGNUM END LOCATION: CORONAL: THROUGH PETROUS BONE AXIAL THROUGH PETROUS BONE FILMING: BONE & SOFT TISSUE
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
SCANNED DFOV 20 CM
RECON: R & L SIDE DFOV 10 CM www.indiandentalacademy.com
ORBITS SCOUT: LATERAL LANDMARK: IOML
DFOV 15CM
SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML MASS OR VISUAL DISTURBANCE 2 CC/SEC
65 SEC DELAY BREATH HOLD: NONE SLICE THICKNESS: 2-3 MM START LOCATION: CORONAL: SPH. SINUS, AXIAL: TOP OF MAX. SINUS END LOCATION: CORONAL: ANTERIOR GLOBE AXIAL:UPPER ORBITAL RIM FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com
OPTIC NERVE PROTOCOL
www.indiandentalacademy.com
PATIENT CAN’T ASSUME PRONE POSITION
SUPINE-CORONAL
www.indiandentalacademy.com
DENTAL ARTIFACT OMISSIONMULTIANGULATION
www.indiandentalacademy.com
www.indiandentalacademy.com
FACIAL BONES SCOUT: LATERAL LANDMARK: IOML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML MASS 2 cc/sec
65 SEC DELAY SLICE THICKNESS: 2-3 MM START LOCATION: CORONAL: EAM AXIAL: S. MENTI END LOCATION: CORONAL: ANTERIOR GLOBE AXIAL: SUPERIOR ORBITAL MARGIN FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com
DFOV 20 CM
FACIAL BONES
INCLUDE MANDIBLE!!!!!!
www.indiandentalacademy.com
PNS SCOUT: LATERAL LANDMARK: OML
DFOV 15 CM
SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML MASS 2 cc/sec
65 SEC DELAY BREATH HOLD: NONE SLICE THICKNESS: 3 - 5 MM START LOCATION: CORONAL: BEHIND SPHENOID SINUS AXIAL: BOTTOM OF MAX. SINUS END LOCATION: CORONAL: THROUGH FRONTAL SINUS AXIAL: THROUGH FRONTAL SINUS FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com
TMJ SCOUT: LATERAL LANDMARK: OML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: NONE BREATH HOLD: NONE SLICE THICKNESS: 1 - 2 MM START LOCATION: CORONAL: POSTERIOR TO JOINT AXIAL: POSTERIOR TO JOINT END LOCATION: CORONAL: THROUGH THE ENTIRE JOINT AXIAL: THROUGH THE ENTIRE JOINT FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com
SCANNED DFOV 20 CM
RECON: R & L SIDE DFOV 10 CM
www.indiandentalacademy.com
DENTAL
www.indiandentalacademy.com
STEREOTACTIC
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Stereotactic system use • • • •
Biopsy of intracranial lesions Aspiration of cysts Laser microsurgery Aspiration of brain abcess
www.indiandentalacademy.com
Thank you www.indiandentalacademy.com Leader in continuing dental education
www.indiandentalacademy.com