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Mutlidetector CT: new horizons in neurological imaging

Department of Clinical Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK

• The acceptance that MR is the only useful examination in neuroimaging is seriously challenged by the advent of multidetector CT (MDCT)
  
• MDCT has changed neurological investigations beyond predicted expectations
  
• Radiation issues are not a relevant concern for any patient in whom the investigation is clinically required
  
• MDCT angiography can and has replaced all routine diagnostic catheter arterial and venous angiography for the brain and spine.
  
• Clinically driven protocols are illustrated to enable any department to optimize the use of MDCT in neuroimaging
  
• The routine use of volume-rendered maximum intensity projections (MIPs) and multiplanar reconstructions (MPRs) is necessary, and many examples are offered to illustrate this point
  
• Exploring the applications of MDCT in spinal and skull base pathology will improve imaging opportunities for patients.
  
• MDCT offers an excellent alternative for imaging structural pathology at any site in patients who are MR intolerant
  
• MDCT in many situations, e.g. orbit and skull base, is superior to MR, and its use should be exploited in those areas
  

MR has for some time been accepted as the premier imaging modality for disease of the brain and spine. As radiologists, we have a duty to enable equivalent imaging for all patients, including the 20% who are unable to undergo MR for whatever reason. Multidetector CT (MDCT) allows us to do this and more. This article describes and illustrates how clinically determined protocols can optimize the benefits of the improved temporal and spatial resolution offered by MDCT in neurological disorders. The routine use of improved multiple reconstructive algorithms is essential in optimizing the wealth of information available from MDCT. Examples are given of standard brain and orbit examinations, vascular studies and spinal applications, all of which are now growing in acceptance and importance. All or any of these protocols can be adopted for use in any interested and appropriately equipped radiology department.