Diagnostic use

Since its introduction in the 1970s, CT has become an important tool in medical imaging to supplement X-rays and medical ultrasonography. Although it is still quite expensive, it is the gold standard in the diagnosis of a large number of different disease entities.

Cranial CT
Diagnosis of cerebrovascular accidents and intracranial hemorrhage is the most frequent reason for a "head CT" or "CT brain". Scanning is done without intravenous contrast agents (contrast may resemble a bleed). CT generally does not exclude infarct in the acute stage, but is useful to exclude a bleed (so anticoagulant medication can be commenced safely).

For detection of tumors, CT scanning with IV contrast is occasionally used but is less sensitive than magnetic resonance imaging (MRI).

CT can also be used to detect increases in intracranial pressure, e.g. before lumbar puncture or to evaluate the functioning of a ventriculoperitoneal shunt.

CT is also useful in the setting of trauma for evaluating facial and skull fractures.

In the head/neck/mouth area, CT scanning is used for surgical planning for craniofacial and dentofacial deformities, evaluation of cysts and some tumors of the jaws/sinuses/nasal cavity/orbits, and for planning of dental implant reconstruction.

Chest CT
CT is excellent for detecting both acute and chronic changes in the lung parenchyma. For detection of airspace disease (such as pneumonia) or cancer, ordinary non-contrast scans are adequate.

For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections with high spatial frequency reconstructions are used. For evaluation of the mediastinum and hilar regions for lymphadenopathy, IV contrast is administered.

CT angiography of the chest (CTPA) is also becoming the primary method for detecting pulmonary embolism (PE) and aortic dissection, and requires accurately timed rapid injections of contrast and high-speed helical scanners. CT is the standard method of evaluating abnormalities seen on chest X-ray and of following findings of uncertain acute significance.

Cardiac CT
With the advent of subsecond rotation combined with multi-slice CT (up to 64 slices), high resolution and high speed can be obtained at the same time, allowing excellent imaging of the coronary arteries. It is uncertain whether this modality will replace the invasive coronary catheterization.

Abdominal and pelvic CT
Many abdominal disease processes require CT for proper diagnosis. The most common uses include diagnosis of renal/urinary stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction. CT is also the first line for detecting solid organ injury after trauma. Oral and/or rectal contrast is usually administered (more often iodinated contrast than barium due to the tendency of barium to cause imaging artifacts that limit evaluation of abdominal structures).

CT has limited application in the evaluation of the pelvis. For the female pelvis in particular, ultrasound is the imaging modality of choice. Nevertheless, it may be part of abdominal scanning (e.g. for tumors), and has uses in assessing fractures.

Extremities
CT is often used to image complex fractures, especially ones around joints, because of the ability to reconstruct the area of interest in multiple planes.