Computed tomography of the head
Computed tomography of the head | |
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ICD-9-CM | 87.03 |
OPS-301 code | 3-200, 3-220 |
Computed tomography of the head uses a series of
Uses
Computed tomography (CT) has become the diagnostic modality of choice for head trauma due to its accuracy, reliability, safety, and wide availability. The changes in microcirculation, impaired auto-regulation, cerebral edema, and axonal injury start as soon as head injury occurs and manifest as clinical, biochemical, and radiological changes. Proper therapeutic management of brain injury is based on correct diagnosis and appreciation of the temporal course of the disease process. CT scan detects and precisely localizes the intracranial hematomas, cerebral contusions, edema and foreign bodies.[2]
Even in emergency situations, when a head injury is minor as determined by a physician's evaluation and based on established guidelines, CT of the head should be avoided for adults and delayed pending clinical observation in the emergency department for children.[3] Many people visit emergency departments for minor head injuries. CT scans of the head can confirm a diagnosis of skull fracture or brain bleeding, but even in the emergency department, such things are uncommon and not minor injuries, so CT of the head is usually not necessary.[3] Clinical trials have shown the efficacy and safety of using CT of the head in emergency settings only when indicated, which would be at the indication of evidence-based guidelines following the physical examination and a review of the person's history.[3]
Concussion is not a routine indication for having brain CT or brain MRI and can be diagnosed by a healthcare provider trained to manage concussions.[4] People with concussions usually do not have relevant abnormalities about which brain imaging could give insight, so brain imaging should not routinely be ordered for people with concussions.[4] If there is concern about a skull fracture, focal neurological symptoms present or worsening symptoms, then CT imaging may be useful.[4] MRI may be useful for people whose symptoms worsen over time or when structural pathology is suspected.[4]
CT of the head is sometimes used for people who have sudden hearing loss.[5] However when there are not other neurological findings, a history of trauma, or a history of ear disease, CT scans are not useful and should not be used in response to sudden hearing loss.[5]
CT of the head is also used in CT-
Special views focusing on the
Comparison with MRI
Magnetic resonance imaging (MRI) of the head provides superior information as compared to CT scans when seeking information about headache to confirm a diagnosis of neoplasm, vascular disease, posterior cranial fossa lesions, cervicomedullary lesions, or intracranial pressure disorders.[9] It also does not carry the risks of exposing the person to ionizing radiation.[9] CT scans may be used to diagnose headaches when neuroimaging is indicated and MRI is not available, or in emergency settings when hemorrhage, stroke, or traumatic brain injury is suspected.[9]
MRI (magnetic resonance imaging) provides more sensitivity in the evaluation of the cavernous sinus and the orbital apex.[8]
One advantage over a
Cautions
Several different views of the head are available, including
CT scans of the head increase the risk of
See also
References
- ^ "Computed Tomography (CT)". National Institute of Biomedical Imaging and Bioengineering. 15 May 2013. Retrieved 21 November 2018.
- ^ a b c "Head CT (Computed Tomography, CAT scan)". Radiological Society of North America (RSNA) and American College of Radiology. June 22, 2018.
- ^ ABIM Foundation, American College of Emergency Physicians, retrieved January 24, 2014, which cites
- Jagoda, Andy S.; et al. (2008). "Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting". Annals of Emergency Medicine. 52 (6): 714–748. PMID 19027497.
- Haydel, Micelle J.; Preston, Charles A.; Mills, Trevor J.; Luber, Samuel; Blaudeau, Erick; DeBlieux, Peter M.C. (2000). "Indications for Computed Tomography in Patients with Minor Head Injury". New England Journal of Medicine. 343 (2): 100–105. S2CID 25844133.
- Jagoda, Andy S.; et al. (2008). "Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting". Annals of Emergency Medicine. 52 (6): 714–748.
- ^ ABIM Foundation, American Medical Society for Sports Medicine, 24 April 2014, retrieved 29 July 2014, which cites
- McCrory P, et al. (Apr 2013). "Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012". British Journal of Sports Medicine. 47 (5): 250–258. PMID 23479479.
- McCrory P, et al. (Apr 2013). "Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012". British Journal of Sports Medicine. 47 (5): 250–258.
- ^ a b "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology – Head and Neck Surgery, retrieved August 1, 2013, which cites
- Stachler RJ, et al. (2012). "Clinical Practice Guideline: Sudden Hearing Loss". Otolaryngology–Head and Neck Surgery. 146 (3 Suppl): S1–35. PMID 22383545.
- Stachler RJ, et al. (2012). "Clinical Practice Guideline: Sudden Hearing Loss". Otolaryngology–Head and Neck Surgery. 146 (3 Suppl): S1–35.
- ISBN 978-1-4614-8363-2.
- ISBN 978-0-444-53497-2.
- ^ ISBN 978-0781742078.
- ^ American Headache Society, September 2013, archived from the originalon 3 December 2013, retrieved 10 December 2013, which cites
- Health Quality, O. (2010). "Neuroimaging for the evaluation of chronic headaches: An evidence-based analysis". Ontario Health Technology Assessment Series. 10 (26): 1–57. PMID 23074404.
- Evans, R. W. (2009). "Diagnostic Testing for Migraine and Other Primary Headaches". Neurologic Clinics. 27 (2): 393–415. PMID 19289222.
- Semelka, R. C.; Armao, D. M.; Elias Jr, J.; Huda, W. (2007). "Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI". Journal of Magnetic Resonance Imaging. 25 (5): 900–909. S2CID 5788891.
- Brenner, D. J.; Hall, E. J. (2007). "Computed Tomography — an Increasing Source of Radiation Exposure". New England Journal of Medicine. 357 (22): 2277–2284. S2CID 2760372.
- Health Quality, O. (2010). "Neuroimaging for the evaluation of chronic headaches: An evidence-based analysis". Ontario Health Technology Assessment Series. 10 (26): 1–57.
- ISBN 978-3-13-108131-5. Retrieved 18 July 2011.
- PMID 29717567.