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new) hemorrhages
appear dense (i.e. white) on computed tomography (CT). The primary imaging features that
help Radiologists determine the presence, type of hemorrhage are the location, shape and
proximity to other structures.
Challenge: Determine the presence, type of hemorrhage
Intracranial Hemorrhage:
If no blood is seen
All cisterns are present and open
The brain is symmetric with normal grey white differentiation
Ventricles are symmetric without dilation
No bone fractures
Then there is no emergent diagnosis from CT scan
Unit of Tissue density for CT images is known as Hounsfield Unit.
Tissue window is the combination of Window (Range of HU) and Level (where is the
window centred).
If tissue density < L-W/2 then that tissue is displayed as black.
If tissue density>L+W/2 then that tissue is displayed as white.
W= 90, L=68.
W=70, L=40.
Dence Blood has Density approx. 80 and Bone
Dence Blood has Density approx. 80 and
has density 400. Therefore, bone will be
Bone has density 400. Therefore, both
displayed whiter whereas blood will be not that
will be displayed white. Therefore, we
much white. Therefore, we can distinguish
cannot distinguish between Bone and
between Bone and Subdural Hemorrhage.
Subdural Hemorrhage.
There are at least 5 windows that a radiologist goes through for each scan
1) Brain Matter window: W:80 L:40
2) Blood/subdural window: W:130-300 L:50-100
3) Soft tissue window: W:350–400 L:20–60
4) Bone window: W:2800 L:600
5) Grey-white differentiation window: W:8 L:32 or W:40 L:40