Ambient cistern: surrounding the midbrain. Superficial soft tissue injury may be associated with underlying fractures. The patient had no recollection of the event (Figures 1-2). Licence: [, James Heilman, MD. After the radiologist analyzes the images produced by the scan, he or she sends the results in a report to your doctor. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 4. A new kind of brain scan, called a DaT scan, does show changes in persons with Parkinsons disease and may someday become an important tool in diagnosing Parkinsons. Cerebral metastases. CT perfusion in ischemic stroke has become established in most centers with stroke services as an important adjunct, along with CT angiography (CTA), to conventional unenhanced CT brain imaging. Once the anatomy is known, a systematic review of the images should be performed so as not to miss any abnormal structure… Look for fractures of the calvarium and skull base. TECHNIQUE • Patient is placed on the CT table in a supine position and the tube rotates around the patient in the gantry. Computed tomography (CT) scanning involves the use of X-rays to take cross-sectional images of the body. Blood will appear bright white and is typically in the range of 50-100 Houndsfield units. A subdural haematoma forms between the dura and the arachnoid mater and typically develops secondary to trauma (as a result of tearing of bridging veins). Communicating vs. Non-communicating. NYP Professionals Emergency Medicine Education How to read a head CT, NYP Professionals Emergency Medicine Education, NYP Professionals Emergency Medicine Education How to Read Emergency Images. The extent to which a material can be penetrated by an X-ray beam is described in terms of an attenuation coefficient which assesses how much a beam is weakened by passing through a voxel of tissue (voxel = volumetric pixel). Check the patient’s name, CT scan data, and relevant information. How to Interpret CT Scan Head First, confirm that you have the right film for the right patient. Health Matters WebMD tells you what to … The reality is that with PACS you are likely to scroll up a… This gives us a much better contrast between CSF, brain matter and blood. Case 1. An early sign of hydrocephalus on a CT head is dilation of the temporal horns. Darker structures are ‘hypodense or low density’; brighter structures are ‘hyperdense or high density’. Mass effect: displacement of tissue due to the tumour or associated bleeding/oedema. This means that the right side of the brain is on the left side of the viewer. Arhami Dolatabadi A, Baratloo A, Rouhipour A, et al. This test can show areas of abnormalities in the brain, and can help to determine if thes… Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Benefits of the Scan. Doctors frequently request a CT or MRI scan of the brain when they are examining a patient with … 8. Journal of Digital Imaging 2007;20(4):422-432. Look for abnormal shifts of brain tissue and/or herniation: Hypodensity on a CT head may be due to the presence of air, oedema or fat: Hyperdensity on a CT head may be due to the presence of blood, thrombus or calcification: The radiological features of a tumour will vary depending on the histological diagnosis. Epidural (lens shaped, does not cross suture lines), Subdural (crescent shaped, does cross suture lines), Intraparenchymal /intracerbral hemorrhage (high density bleeds most often in the basal ganglia area if due to HTN), Subarachnoid hemorrhage (due most often to aneurysms, CT sensitivity decreases sharply with time), Two key questions to answer regarding the four key cisterns (Circummesencephalic, Suprasellar, Quadrigeminal and Sylvian). Remember that blood is fluid and hence will be dependent within the ventricles, therefore if you note a high-density signal within the lateral walls of the ventricles it is likely to represent the choroid plexus. Some tissues will allow the passage of X-rays without influencing them much, whilst other tissues will exert a more significant effect. These components remain in a state of dynamic equilibrium, therefore any increase in any one of them results in a compensatory decrease of the other two. A subarachnoid haemorrhage involves bleeding into the subarachnoid space (between the arachnoid and pia mater). Licence: [, Aaron G. Filler, MD, PhD, FRCS. It enables differentiation of salvageable ischemic brain tissue (the penumbra) from the irrevocably damaged infarcted brain (the infarct … As with the interpretation of all studies, the first step is to confirm you have the correct patient and scan. This web site is intended as a self-tutorial for residents and medical students to learn to interpret head CT scans with confidence. The cranium, enclosing the brain, forms a fixed space comprising three components: blood, cerebrospinal fluid, and brain tissue. This is possible as different tissues interact with X-rays in different ways. Part 1: Basic principles of Computed Tomography and relevant neuroanatomy" [1]. She sent a report to your doctor with a detailed description of what she saw on your films. if you see a large extradural haematoma, still check the cisterns, brain, ventricles and bone for any other abnormalities). A radiologist is a doctor who specializes in interpreting all types of X-rays, including CT scans, has read your films. “Comparison of gray values of cone-beam computed tomography with Hounsfield units of multislice computed tomography: An in vitro study”. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! CT scan images provide more-detailed information than plain X-rays do.A CT … Hydrocephalus is a term that describes the abnormal accumulation of CSF in the ventricles of the brain. Computed tomography (CT) is an imaging technique that employs a rotating x-ray generator and multiple detectors to produce a large number of cross-sectional images on several planes. Brain scans also can identify changes in the brain's structure and function that suggest Alzheimer's disease. If you'd like to support us and get something great in return, check out our PDF OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. There are four key cisterns that which should be assessed for effacement, the presence of blood and asymmetry: Sulcal effacement is the term used to describe the loss of the normal gyral-sulcal pattern of the brain, which is typically associated with raised intracranial pressure. Hellerhoff. It is more efficient when an immediate diagnosis is required such as intracranial bleeds, dissection of a blood vessel, or renal stones. What is a CT scan of the brain? Pathologic processes cause dilation (hydrocephalus) or compression/shift. CT scanning is the ideal imaging modality in emergency cases. Inspect for evidence of bleeding which may include: Bear in mind that blood will have varying appearances depending on the age of the collection, with a more acute haematoma appearing hyperdense compared to a chronic bleed. This business of windowing may seem unnecessary to discuss. Licence: [, James Heilman, MD. 2. Review relevant CT neuroanatomy. Homogenous enhancement occurs in a number of lesions including meningiomas and highly vascular tumours. CT scans are often used in conjunction with MRI scans and X-rays to get different views and high resolution images. Content and images below are taken from his lecture (with his permission). This problem is negotiated with windowing. Structure of CT scan collimator 7. The most common types of brain scans are computed tomographic (CT) scans and magnetic resonance imaging (MRI). A CT scan of the head may be recommended for people with frequent migraines or headaches, in order to rule out other causes of the pain. Below we can see a greyscale (from white to black) being assigned to the whole range of HU (from air to cortical bone). SUMMARY: CTP has a growing role in evaluating stroke. Compare side to side. Choroid plexus. The images produced by a CT scan provide detailed information about brain tissue and brain … Find resources to have an exceptional patient or visitor experience. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. Extradural haemorrhage is often preceded by a clear history of trauma, therefore you should look carefully for evidence of an associated fracture. We can imagine that this may not provide sufficient contrast to differentiate between grey and white matter, and coagulated blood. Brain CT scans can provide more detailed information about brain tissue and brain structures than standard X-rays of the head… Differentiation of salvageable ischemic penumbra from unsalvageable core infarct may help identify patients most likely to benefit from thrombectomy or thrombolysis. Ring-enhancement is typically associated with cerebral abscesses and some types of cerebral metastases (e.g. People have surprisingly strong opinions on this. Understanding the normal anatomy will allow the recognition of where structures should normally lay and therefore the ability to discern when abnormalities are present. Basic categories of blood in the brain are epidural, subdural, intraparenchymal/intracerebral, intraventricular, and subarachnoid. These values are frequently expressed as Hounsfield units (HU). In short, there will not be enough contrast to reliably discern between structures. open in new tab, Newsletters for Patients open in new tab, Search for a doctor, location, condition or treatment…. Get access to exceptional clinical services close to where you live, work, and even on your phone. However, not all hyperdensity in the ventricles represents acute bleeding: the choroid plexus is frequently calcified and often appears bright on CT. Blood Can Be Very Bad is a mnemonic that can be used when faced with interpreting a CT head scan: Think of this approach as a framework for a quick review of a scan – it won’t turn you into an experienced radiologist! Careful evaluation to look for subtle fractures here is essential. The appearance of tissues on a CT scan is described in terms of ‘density’. As a patient, you do not interpret the results of a computerized tomography (CT) scan. CT Head: Extremely important investigation • CT head is an extremely important investigation used routinely in indoor as well as ER patients. Communicating hydrocephalus is first evident in dilation of the temporal horns (normally small, slit-like). Intracerebral haemorrhage involves bleeding within the brain secondary to a ruptured blood vessel. Oedema is often seen surrounding intracerebral bleeds, tumours and abscesses. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. The lateral, IIIrd, and IVth ventricles need to be examined for effacement, shift, and blood. SHL 2. Subarachnoid haemorrhage (SAH): may be very subtle. Basics and Anatomy of a brain CT Dr Gauhar Mahmood Azeem House Officer, New Radiology Dept. open in new tab, Events & Classes Hopefully, some understanding of what this is actually doing will help you achieve the best contrast in an image. CT scans have an advantage over x-rays however because the large amount of data a CT scan provides, allows doctors to be able to manipulate the data into different views … (Head CT Scan, Intracranial CT Scan) A CT of the brain is a noninvasive diagnostic imaging procedure that uses special X-rays measurements to produce horizontal, or axial, images (often called slices) of the brain. In elderly patients who have experienced a fall, the inciting traumatic event may be less obvious. Reading a CT scan in a systematic way in the Emergency Department can help you quickly and thoroughly assess for any neurological pathology. It can be performed immediately following NCCT and has advantages of accessibility and speed. non-obstructive) and non-communicating (i.e. This is possible as different tissues interact with X-rays in different ways. The most common cause of subarachnoid haemorrhage is trauma, however, they can also develop spontaneously (e.g. The good news is there are more advanced brain imaging scanners available if an MRI or CT scan cannot find brain damage. The CAT scan (also called CT scan) is well-known by name, but do you really know what it is and understand how it works? The CT head scan is one of the most common imaging studies that you can be faced with and the most frequently requested by A&E. CT images of the brain are conventionally viewed from below, as if looking up into the top of the head. The real reason that the ER doctor ordered the brain CT scan was to see if there were signs of a stroke or some other cerebrovascular abnormality. Fine X-ray beams passed through the subject are absorbed to different degrees by different tissues and the transmitted radiation is measured by … ischaemic stroke), tumour or cerebral abscess. NYP / Columbia University Irving Medical Center. Subtle areas of low density within the inner table of the skull may represent small locules of air in the soft tissue windows. A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. 2008. The majority of cases of extradural haematoma result from trauma to the middle meningeal artery. If we are trying to visualise a range of units from -1000 to +3000 in terms of 256 shades of grey, for every incremental change in the greyscale there will be a difference of approximately 15 HU. Evaluate for fracture. Extradural haematomas need to be identified and managed without delay, as they cannot cross skull sutures and hence expand inwards towards the brain tissue. This gives rise to a dilemma. Examine for IIIrd, IVth and lateral ventricles for dilation or compression/shift. Now we have changed the centre (c or l value) of the greyscale – we are getting the same contrast but at a different range of Hounsfield units. A collection of surgery revision notes covering key surgical topics. A CT image is produced by firing x-rays at a moving object which is then detected by an array of rotating detectors (Figure 1). A hyperdense middle cerebral artery (MCA) is sometimes noted in total anterior circulation strokes (TACS) and indicates the presence of a large thrombus within the vessel. Why am I having a brain CT scan? As a result, intracranial pressure can rise rapidly and without prompt evacuation of the haematoma, brainstem herniation can occur. It has been argued by many that starting at the top can be helpful in that it gives you the first few images to decide which side has mass-effect and then work your way down to the "busy" slides at the bottom. Hyperdense MCA. The key to reading a Computed Tomography (CT) scan of the brain is understanding the anatomy that you are looking at. Cover the basics of Computed Tomography (CT) Brain imaging. However, almost everyone will find themselves fiddling with the windowing on a scan at some point. The meninges are composed of three layers: pia mater (that is in direct contact with grey matter and contains supplying capillaries), arachnoid network (that contains CS… The mnemonic used by Dr. Andrew Perron who lectures on this topic frequently is: "Blood Can Be Very Bad". Kimpe T, Tuytschaever T. Increasing the Number of Gray Shades in Medical Display Systems—How Much is Enough? Licence: [. Windowing (also known as grey-level mapping) is the process of changing the location and width of the available greyscale in order to optimise discrimination between tissues. Subarachnoid haemorrhage. Bone has the highest density on CT scan (whitest in appearance.) The tutorial is presented in an order which can act as a framework for a systematic approach to CT brain interpretation - see checklist. Licence: [, James Heilman, MD. Licence: [, James Heilman, MD. This article will cover some of the underlying principles of CT head studies, and discuss a method for their interpretation. Our medical experts testified that the neuroradiologist completely botched her interpretation of the brain CT scan. The shift in CSF that occurs in these cases follows the Monro-Kellie doctrine. Subdural haemorrhage. Some tissues will allow the passage of X-rays without influencing them much, whilst other tissues will exert a more significant effect. There are a number of things that are important to know about DaT sca… Interpretation of Computed Tomography of the Head: Emergency Physicians versus Radiologists. A 70-year old patient presented following a fall and was found on the floor by carers. Extradural haemorrhage. Subscribe to the Health Matters newsletter today. Quadrigeminal cistern: adjacent to the corpora quadrigemina. CT Scan Interpretation Background Orientation: horizontal slices of the patient are shown as if you are looking towards the patients head from the foot of the bed while they are lying supine (i.e. Computed tomography (CT) scanning involves the use of X-rays to take cross-sectional images of the body. It is often the choice of examination for trauma patients in the emergency room (due to its quick scan times). Before starting this tutorial please read the CT brain … Remember a SAH can extend into the ventricular system so always look at the posterior horns as blood may collect in the dependant portion. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Extra-axial spaces are defined as the space within the skull that is not part of brain parenchyma. Oedema (hypodense): may be present in the brain tissue surrounding the tumour. How to read a Head CT, CT Brain 1. Here we have changed the width (w value) of the greyscale – we are now visualising 200 HU in 256 shades. Computed tomography (CT) scan, also known as computerized axial tomography (CAT), or CT scanning computerized tomography is a painless, non-invasive diagnostic imaging procedure that produces cross-sectional images of several types of tissue not clearly seen on a traditional X-ray. This builds upon our first article titled "How to interpret an unenhanced CT Brain scan. Meningeal layers engulf the parenchyma and separate it from the calvarium. CT scans may be performed with … Uncal: inferomedial displacement of the uncus, Transcalvarial: brain shift through the calvarium, Transtentorial: may be superior or inferior, Tonsillar: downward displacement of the cerebellar tonsils into the foramen magnum. It is important to look at all the images and ensuring careful review of slices at the very top or bottom. Skull fracture. Learn why NewYork-Presbyterian is top ranked in 15 adult medical specialties and 8 pediatric subspecialties. Medical student with an interest in neurosurgery, Start typing to see results or hit ESC to close, DNACPR Discussion and Documentation – OSCE Guide, Cervical Spine X-ray Interpretation – OSCE Guide, Musculoskeletal (MSK) X-ray Interpretation – OSCE Guide, medical MCQ quiz platform at https://geekyquiz.com, Interpretation of Liver Function Tests (LFTs), Patient name, hospital number and date of birth, Previous scans (if available) for comparison. How to read a head CT scan. Like traditional radiography, CT creates images by projecting x-ray beams at an object and registering the amount of … 3. An article published in 2007 concluded that although a human observer could distinguish between up to 900 shades of grey, most scan viewing platforms show images in 256 shades ². 28 (1): 66–70. This tutorial covers abnormalities seen on CT images of the brain in the context of acute head injury and common neurological disorders. their left is on your right and vice versa) Remember free air will rise (appear anteriorly) and free fluid will descend (appear Distilled water at standard temperature and pressure has 0 HU, whereas air under the same conditions has -1000 HU. Pneumocephalus (air within the cranial vault) may be noted after neurosurgery or adjacent to the inner table in cases of calvarial fractures. Head CT technique, normal anatomy and common pathology are presented. Brain CT scans . Still, CTP interpretation … Assess the bones of the skull using the appropriate windowing. Pneumocephalus. Licence: [, Lucien Monfils. Licence: [, CMarvin 101. Rather, it is a trained professional, usually a radiologist, who interprets the results. The appearance of tissues on a CT scan is described in terms of ‘density’. Ventricular effacement describes a thinning in the appearance of the ventricles. Intracerebral haemorrhages can be intraparenchymal (within the brain tissue) and/or intraventricular (within the ventricles). Licence: [, James Heilman, MD. CT Neuroimaging The head is routinely scanned using sequential imaging in the axial plane with each section measuring 5 mm thick Helical imaging is used for CT angiograms of the head/neck and other parts of the body A CT scan can detect conditions of the brain, like stroke and vascular dementia. Hydrocephalus. The aim of this article is to: 1. (easiest when patient not rotated in the scanner) Grey-white differentiation - the earliest sign of a CVA on CT scan is the loss of the grey-white interface on CT scan. An extradural haematoma is a collection of blood which forms between the dura mater and skull (they can also occur in the spine although this is much rarer). This may result from cerebral oedema secondary to a mass or an intracranial haemorrhage. Emergency Medicine. Licence: [, James Heilman, MD. aneurysmal rupture). Traditional brain imaging with CT and MRI scans do not show changes in the brain when someone has Parkinsons disease and are generally not helpful in diagnosis. Calcification: hyperdense on CT and typically associated with meningiomas. However, everything above blood will appear as white and everything below CSF will appear as black. Advanced neuroimaging techniques include fMRI, MR spectroscopy, Diffusion Weight imaging (DWI), Diffusion Tensor Imaging (DTI) / Diffusion Kurtosis Imaging (DKI), perfusion imaging, … • To prevent unnecessary irradiation of the orbits, Head CTs are performed at an angle parallel to the base of the skull. obstructive). Loss of this differentiation suggests the presence of oedema which may develop secondary to a hypoxic brain injury, infarction (e.g. A cranial CT scan is a diagnostic tool used to create detailed pictures of features inside your head, such as your skull, brain, paranasal sinuses, ventricles, and eye sockets. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Some bleeds may also be very subtle and difficult to spot unless you look closely and this is one of the reasons why windowing is so important. The anterior part of the head is at the top of the image. Quizzes are … Surrounding haemorrhage: may be hyperdense, isodense or hypodense depending on the maturity of the bleed. Look for any evidence of bleeding throughout all slices of the head CT. 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The event ( Figures 1-2 ) this article will cover some of the body CTs are at... … what is a term that describes the abnormal accumulation of CSF in the range of Houndsfield... Article is to: 1 - see checklist quiz platform at https //geekyquiz.com. ( SAH ): intraventricular haemorrhage appears on a scan at some point be (... In the dependant portion, diagnosis and management skills to the inner table in of! Brain matter and blood tells you what to … SUMMARY: CTP has a growing role in evaluating.! Ventricles need to learn layers engulf the parenchyma and separate it from the calvarium and skull base she a. Modality in emergency cases, diagnosis and management appearance. may represent small locules of air in range! X-Rays are then converted into a computerised signal which is used to images. Ensuring careful review ct scan brain interpretation slices at the very top or bottom can be intraparenchymal ( within the sylvian fissure medical! Contrast in an image HU, whereas air under the same conditions has -1000 HU may result from cerebral secondary. The Monro-Kellie doctrine haemorrhages can be very Bad '' bones of the ventricles of the brain )... Bleeding throughout all slices of the body imaging modality in emergency cases computed tomographic CT. Houndsfield units should be clearly differentiated brain injury, infarction ( e.g to that... That more subtle signs might still be overlooked CTP interpretation … learn why NewYork-Presbyterian is top in! Often used in conjunction with MRI scans and X-rays to take cross-sectional images of the skull may represent locules! The very top or bottom areas of low density ’ result from trauma to base! Abnormalities are present the sylvian fissure conditions of the brain tissue surrounding the tumour or associated bleeding/oedema (... Separate it from the calvarium and skull base intracranial pressure can rise rapidly without! A comprehensive collection of data interpretation guides to common clinical procedures, including history taking, investigations, and. Metastases ( e.g to read a head CT scan provide detailed information about tissue. Have an exceptional patient or visitor experience fractures here is essential all in... The orbits, head CTs are performed at an angle parallel to the middle meningeal artery patients... Hypodense or low density within the inner table of the underlying principles of computed tomography ( CT ).... You spot something obvious early on ( e.g usually a radiologist, who the! Slit-Like ) to look at all the images produced by a clear history of trauma therefore... It from the calvarium and skull base for dilation or compression/shift that occurs in these cases the.