ARRS 2022 Abstracts

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E1970. Cracking Hyperattenuating Intracranial Lesions in the Non-Contrast Head CT
Authors
  1. Lin Gu; St. Louis University Hospital
  2. Shamseldeen Mahmoud; St. Louis University Hospital
  3. Yihua Zhou; University of Pittsburgh Medical Center
Background
Since the debut, CT has witnessed staggering increase of utilization. For example, statistics from 2010 showed a 6-fold increase of CT examinations in the emergency room from 1995 to 2007, from 2.7 million to 16.2 million examinations. Noncontrast CT for the head is one of the most frequently ordered CT scans. Identification of hyperdense acute intracranial bleeding is the most important task of head noncontrast CT. Knowing that not all hyperdensities are bleeding, accurate recognition of acute bleeding from various mimics remains challenging, especially for junior radiology residents.

Educational Goals / Teaching Points
The goals of this education exhibit include reviewing common components/etiologies of hyperdensities on the non-contrast CT head scan. Multiple relevant examples will be used to demonstrate the appearance of various hyperattenuating lesions/structures, differentiating points, and clinical significances.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Intra- and extra-axial physiologic and pathologic hyperdensities on the noncontrast CT head scan with correlating MRI will be demonstrated. Common causes of hyperdensities such as minerals, contrast, protein, hypercellularity, and foreign bodies including surgical/interventional materials and etiologies frequently mistaken for acute bleeding, including physiologic structures (cortical vein, dehydration), tumors with proteinaceous contents or calcifications, vascular abnormalities (cavernous malformation, developmental venous anomaly), infections (tuberculosis, toxoplasmosis), genetic disorders (Wilson disease), metabolic disease (diabetic striatopathy), and post-procedural changes (contrast contamination, hemostatic materials, dural thickening) will be discussed. Finally, the differentiating imaging characteristics and clinical significances will be summarized.

Conclusion
With the increasing use of CT head, more and more hyperdensities are incidentally identified aside from acute bleeding which often requires observation, admission, or immediate intervention. Due to the divergent treatment algorithm, it is meaningful to be familiar with radiographic appearance of physiologic and pathologic intracranial hyperdensities other than acute hemorrhage on the non-contrast CT head.