Neuro Protocols

Neuro CT Protocols:

  1. CT Head/brain without contrast: Acute trauma, acute stroke, ER presentation headache
  2. CT brain without and with contrast:  Neurologic symptoms with known primary, neurologic symptoms not MRI compatible, older patients unable to tolerate MRI. Contrast is primarily useful for metastatic disease, tumors and vascular anomalies so it is only occasionally useful.
  3. CT Sinus: Chronic sinus disease. Primarily evaluates sinus drainage.
  4. CT temporal bone: Best for evaluating ossicles or for temporal bone fracture.
  5. CT orbits with contrast: 1st line for infection/abscess. Inferior to MRI orbit for optic nerve evaluation.
  6. CT Facial bones: Facial trauma
  7. CT Mandible/Panorex: Replaces mandible films
  8. CT angiogram head: Usually the best study to evaluate arterial occlusion and aneurysms

Neuro MRI

  1. Routine MRI brain with and without contrast (History: Headache, stroke, AVM concern, dementia, metastatic disease concern) Contrast can be very useful on MRI as many things on MRI are better evaluted or only seen with contrast. Most centers routinely scan brains with contrast.
  2. MRI Brain without contrast: Neurologic symptoms and GFR < 30 or studies with low likelyhood of findings.
  3. Seizure protocol with contrast:  Contrasted protocol with special sequences for Temporal lobe
  4. Multiple Sclerosis protocol with contrast:  Special sequences for MS affected regions.
  5. MRI orbits with contrast (Blurred vision, vision loss, papilledema, optic nerve atrophy/abnormality) Contrasted study with dedicated orbit sequences without and with contrast.
  6. Pituitary MRI protocol with contrast: Hyper/hypogonadism, Pituitary tumor, abnormal FSH/TSH, acromegaly, cushings) Includes dynamic thin section enhancement images of pituitary.
  7. IAC/skull base protocol with contrast: Vertigo/dizziness, acoustic neuroma, sensory neural hearing loss, facial paralysis, mastitis, temporal bone tumor, pulsitile tinnitis.
  8. MR angiogram head: Can be performed without or with contrast. With contrast is superior.
  9. MR Angiogram Neck: Can be performed without or with contrast or both. Use contrast if high risk of disease as non-contrast is prone to artifacts.

Neck Imaging:

  1. CT angiogram neck: Evaulate carotid arteries. Superior to ultrasound
  2. CT neck with contrast: Masses, adenopathy, abscess, epiglotitis.
  3. CT neck without contrast: Contrast allergy.
  4. Limited CT neck for parotid mass with contrast:

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