Friday, June 25, 2010

Is CT head relevant in current scenario?

This is what i read as a comment in yahoo news by my friend Dr Philip Chao who has worked in Delaware to produce the best MRIs possible since 1990. He has monitored hundreds of thousands of MRIs over his career at the University of Pennsylvania and working for the people of Delaware. He is a board certified neuroradiologist and recently passed his maintenance of certification examination in 2006. He is also trained in body MRI and was the body MRI fellow at the University of Pensylvania from 1988 through 1990.

This what he says
 "CT of the head is almost useless. This is a fact I tried to teach residents for years. Usually they do a CT scan of the head non contrast - this is woefully inadequate to pick up stroke, tumor or meningitis. In fact it misses bleeding in the brain if it is older than 24 hours old. The funny thing is that if the CT is negative you get an MRI because a negative CT does not rule out significant intracranial pathology. If the CT is positive you STILL get an MRI because you see the lesion margins better and additional lesions with MRI. So... in both cases a negative and a positive CT does not prevent you from getting further testing. "



Sounds like soon we will not see the plain CT anymore. Thinking of it now, how may times we have actually recommended MRI after CT, kind of makes sense. Other than head injury this logiq seems quite valid, what are your views?

All comments and discussions are welcome.

5 comments:

Anonymous said...

Definitely still useful in acute stroke for ruling out bleeding before initiating thrombolysis.

Wafa.. said...

What I have learned in neurology..

CT is faster, Cheaper and more sensitive in differentiating Hemorrhagic from ischemic strokes and is still the first choice.

Faster "thrombolytic therapy"
Cheaper "I live in Egypt"
More sensitive "hgc and ischemic strokes have dramatically different management as you know..


I want to read your openion

Dr. Pankaj Nagori said...

Ya Sir,
I also think that plain CT might not be useful but for emergencies its the best as its very fast.
Also as far as india is concerned....cost is a big factor here....not every1 can afford an mri....so ct will still hold its place for quite some time....

Pankaj

drmgkmurthy said...

It is fine foir developed economy with institutionalised practice
but for the rest of the world which is 6 billion plus , CT in the near time irreplaceble for the head and is infact proving more useful in far reaching areas with headinjuries. remote access reporting by competent people is only making better
i perosnally agree with your views . but hte world has to wait for a while to be able to afford
drmgkmurthy

dr sb nayak said...

I do differ.
We r aware of the clinical history.We can fit CT in to radiological decission making algorithm and while intrpreting we understand limitations and advantages of the modality,what ever ,in question.

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