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INDICATIONS

INDICATIONS (1-8)

  • If MRI is contraindicated

  • Mental status change with known CNS infection, intracranial disease, or mass (MRI preferred)

  • Lesions shown by alternative neurological investigations. 

  • Abnormality identified on plain scan 

  • Suspected posterior fossa lesion

  • Suspected suprasellar lesions

  • Abnormalities within cranial cortex

  • Further clarification on cerebral mass (MRI preferred)

  • Fluid collection, abscess, cavitating lesion characterisation (MRI preferred)

  • Brain metastases: varied enhancement of lesion

  • Meningioma: Solid well enhanced lesion

  • Suspected Neoplasm (e.g. glioblastoma)

  • Meningitis and Meningoencephalitis

  • Multiple Scelrosis 

  • Lymphoma 

  • Ventriculitis

  • Seizures, headache or mental state change with hx of malignancy

PATHOLOGY DEMONSTRATED (9)

Pathology Demonstrated

  • MRI more sensitive for delineating most cerebral lesions

  • Cerebral metastases: variable enhancement of the lesion post-contrast

  • Meningioma: solid enhancement of the lesion post-contrast   

  • Brain abscesses:

    • early encapsulation - ​​a discrete lesion with a thin enhancing rim

    • late encapsulation - progressive central necrosis, cavity shrinks, decreasing surrounding oedema

  • fluid/pus: hypoattenuating centre

  • necrotic neoplasm (e.g. glioblastoma) or abscess: outer enhancing ring surrounding a necrotic centre

  • meningitis and meningoencephalitis: Leptomeningeal enhancement

  • multiple sclerosis: contrast enhancement of plaques

  • lymphoma: enhancement of lesion post-contrast

  • ependymitis and ventriculitis: thin linear enhancement of the margins of the ventricles

PATIENT PREPARATION

Patient Preparation

  • Patient able to lie still for ten minutes

  • Not claustrophobic (sedation may be given)

  • Cognitively capable of following basic instructions

  • Metal artefacts removed from the region of interest

  • No respiratory distress when lying supine

  • Not allergic to Iodine based Contrast

  • No known kidney disease (eGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function

  • No hyperthyroidism, may induce thyroid storm

  • Patient to have 20G cannula in anterior cubital fossa.

  • Preferably patient fasted for 4 hours

ANATOMY INCLUDED

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CT Brain - Non Contrast (Axial)
axial.gif
CT Brain - Post Contrast (Axial)
coronal.gif
CT Brain - Non Contrast (Coronal)
coronal.gif
CT Brain - Post Contrast (Coronal)
sagittal.gif
CT Brain - Non Contrast (Sagittal)
 
sagittal.gif
CT Brain - Post Contrast (Sagittal)

REFERENCES

ANATOMY INCLUDED

  1. Radiopaedia. CT Head. [Internet]. 2010 [updated 01 Dec 2021, cited 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-head

  2. Radiopaedia. Brain Abscesses. [Internet]. 2009. [updated 20 Nov 21, accessed 3 Jan 22]. Available from https://radiopaedia.org/articles/brain-abscess-1?lang=us 

  3. Radiopaedia. Cerebritis. [Internet]. 2018 [updated 14 Dec 2018, accessed 3 Jan 22]. Available from https://radiopaedia.org/articles/cerebritis?lang=us

  4. Radiopaedia. Brain tumours. [Internet]. 2008. [updated 18 Dec 2019, accessed 23 Nov 21]. Available from https://radiopaedia.org/articles/brain-tumours

  5. American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 23 Nov 2021]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria

  6. Barrington NA, Lewtas NA. Indications for contrast medium enhancement in computed tomography of the brain. Clinical Radiology. 1977. 28 )5), 535-537. 

  7. Demaerel P, Buelens C, Wilms G, Baert AL. Cranial CT revisited: Do we really need contrast enhancement? European Radiology.1998. 8 (8). 1447-1451. 

  8. Cedars-Sinai. CT Brain with or without contrast. [Internet]. 2022. [updated 2021, accessed 3 Jan 22]. Available from https://www.cedars-sinai.org/programs/imaging-center/exams/neuroradiology/ct-brain-contrast.html

  9. Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012.

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