Multidetector computed tomography (MDCT) offers new and exciting opportunities for imaging patients suspected of afflictions of the nervous system. Achievement of this benefit requires an understanding of its full potential in displaying the features of the spectrum of relevant diseases. It also depends upon employing an approach that ensures that it is applied to best effect by tailoring the technique of examination to the patient's clinical problem.
This book will provide practical guidance to radiologists, whether general or specialist, and their team of radiographers/technicians that will enable them to take full advantage of the opportunities offered by MDCT in brain and spine imaging. This will enrich their practice and expand the benefits they can bring to their patients.
The advantages of MDCT include its ability for routine sub-millimetre scanning of large areas at acceptable radiation doses. The enhanced postprocessing techniques and the rapidity and ease with which they can be obtained mean that they can be applied with no limitation on throughput or reporting times. Although magnetic resonance imaging (MRI), with its ability to differentiate soft tissues has many applications, computed tomography (CT) remains the appropriate first-line investigation for most patients with an acute cerebral event and for those who still cannot undergo MR for one reason or another (approximately 1 patient in 5).
MDCT has many technical benefits over single-slice CT but when a small area is to be covered, e.g. the orbit and the cavernous sinus, a single slice scanner is acceptable and a 4-slice MDCT can be almost as effective as a 64-slice CT. In contrast, when a large area is to be covered, a scanner with 16 or more detectors is optimal and single slice imaging precluded by technical limitations and the radiation dose it would give. MDCT provides new opportunities to improve the standard of routine brain examinations and to expand CT techniques into new areas. The techniques we describe can be adapted to any MDCT system for any similar clinical situation
In most radiology textbooks a systematic approach is followed. The appearances of specific pathologies, e.g tumours, trauma, and degenerative disease, are classified, described and inclusively illustrated. In practice, most patients present with a combination of symptoms and signs which must be investigated in order that pathology can be either excluded or identified and managed. This book adopts such a problem-based approach and is intended to be a supplement to the standard disease-based texts. Our approach is based on the concept that the information from the clinical referral can be used to define a tailored MDCT technique which will optimize the likelihood of correctly identifying or excluding causative pathology. The commonly held belief that a single CT brain protocol is appropriate in all situations is no longer realistic, appropriate, or tenable.
The illustrations are intended to convey how the CT techniques applied affected diagnosis or management in a range of common clinical scenarios. They show how MDCT can be used in a routine service role in a way that maximizes its potential, and how knowledge of that potential enables its use to be extended to unexpected applications. The illustrations are not inteded to be a comprehensive catalogue of abnormalities, but to convey why such images should be obtained and how to get the most from them. Protocols are given in detail so that radiographers or technicians, with the guidance of the radiologist, can apply them in any specialist or nonspecialist department.
Detailed imaging of a patient suspected of disease of the brain or other parts of the nervous system need no longer be the prerogative of a specialist neuroradiology unit. Using the approaches we describe, detailed, highly focussed, highly informative and clinically influential investigation can be practised in any radiology department where there is a need and desire to provide quality brain and spinal CT imaging.
This book will appeal to many kinds of reader and at different stages of their careers. It will be an invaluable companion to trainee and trained radiologists in their daily study and work. Radiographers/technicians will find the reasons that a specific protocol is chosen will enhance their knowledge and understanding and make their work more interesting and fulfilling. Clinicians will gain insight into the radiologists mind: how and why they make decisions and why specific techniques are chosen. Most of the common neurological and neurosurgical conditions are covered so that a review of the images will be a valuable exercise in preparation for the ordeals of post-graduate examinations!
Contents
1 Routine noncontrast brain imaging
2 Contrast enhanced brain imaging
3 Orbital pathology
4 Visual failure
5 Pituitary imaging
6 Cranial nerve palsies 3–6
7 Intracranial imaging in stroke: ischaemic
8 Vascular imaging in ischaemic stroke and TIA
9 Acute haemorrhagic stroke
10 Variations in arterial anatomy
11 Venous pathology and variations in venous anatomy
12 Cranial nerve palsies 7–12
13 Spinal imaging
Concluding comments
Index
This book will provide practical guidance to radiologists, whether general or specialist, and their team of radiographers/technicians that will enable them to take full advantage of the opportunities offered by MDCT in brain and spine imaging. This will enrich their practice and expand the benefits they can bring to their patients.
The advantages of MDCT include its ability for routine sub-millimetre scanning of large areas at acceptable radiation doses. The enhanced postprocessing techniques and the rapidity and ease with which they can be obtained mean that they can be applied with no limitation on throughput or reporting times. Although magnetic resonance imaging (MRI), with its ability to differentiate soft tissues has many applications, computed tomography (CT) remains the appropriate first-line investigation for most patients with an acute cerebral event and for those who still cannot undergo MR for one reason or another (approximately 1 patient in 5).
MDCT has many technical benefits over single-slice CT but when a small area is to be covered, e.g. the orbit and the cavernous sinus, a single slice scanner is acceptable and a 4-slice MDCT can be almost as effective as a 64-slice CT. In contrast, when a large area is to be covered, a scanner with 16 or more detectors is optimal and single slice imaging precluded by technical limitations and the radiation dose it would give. MDCT provides new opportunities to improve the standard of routine brain examinations and to expand CT techniques into new areas. The techniques we describe can be adapted to any MDCT system for any similar clinical situation
In most radiology textbooks a systematic approach is followed. The appearances of specific pathologies, e.g tumours, trauma, and degenerative disease, are classified, described and inclusively illustrated. In practice, most patients present with a combination of symptoms and signs which must be investigated in order that pathology can be either excluded or identified and managed. This book adopts such a problem-based approach and is intended to be a supplement to the standard disease-based texts. Our approach is based on the concept that the information from the clinical referral can be used to define a tailored MDCT technique which will optimize the likelihood of correctly identifying or excluding causative pathology. The commonly held belief that a single CT brain protocol is appropriate in all situations is no longer realistic, appropriate, or tenable.
The illustrations are intended to convey how the CT techniques applied affected diagnosis or management in a range of common clinical scenarios. They show how MDCT can be used in a routine service role in a way that maximizes its potential, and how knowledge of that potential enables its use to be extended to unexpected applications. The illustrations are not inteded to be a comprehensive catalogue of abnormalities, but to convey why such images should be obtained and how to get the most from them. Protocols are given in detail so that radiographers or technicians, with the guidance of the radiologist, can apply them in any specialist or nonspecialist department.
Detailed imaging of a patient suspected of disease of the brain or other parts of the nervous system need no longer be the prerogative of a specialist neuroradiology unit. Using the approaches we describe, detailed, highly focussed, highly informative and clinically influential investigation can be practised in any radiology department where there is a need and desire to provide quality brain and spinal CT imaging.
This book will appeal to many kinds of reader and at different stages of their careers. It will be an invaluable companion to trainee and trained radiologists in their daily study and work. Radiographers/technicians will find the reasons that a specific protocol is chosen will enhance their knowledge and understanding and make their work more interesting and fulfilling. Clinicians will gain insight into the radiologists mind: how and why they make decisions and why specific techniques are chosen. Most of the common neurological and neurosurgical conditions are covered so that a review of the images will be a valuable exercise in preparation for the ordeals of post-graduate examinations!
Contents
1 Routine noncontrast brain imaging
2 Contrast enhanced brain imaging
3 Orbital pathology
4 Visual failure
5 Pituitary imaging
6 Cranial nerve palsies 3–6
7 Intracranial imaging in stroke: ischaemic
8 Vascular imaging in ischaemic stroke and TIA
9 Acute haemorrhagic stroke
10 Variations in arterial anatomy
11 Venous pathology and variations in venous anatomy
12 Cranial nerve palsies 7–12
13 Spinal imaging
Concluding comments
Index