Maria rauf



Brain imaging techniques provide the ability to non-invasively map the structure and function of the brain. Though CT is the earliest, fastest and convenient first line modality to evaluate the abnormality within the normal looking brain. There are certain blind spots where pathological findings are commonly missed along with the subtle radiological findings which are commonly misinterpreted by the radiologist, especially the one with the limited experience.


METHOD: Aim of our study is to determine such blindspot areas and enlist the cases encountered at Shifa International Hospital which were most commonly missed / misinterpreted by retrospectively reviewing 1200 consecutive CT brain over a period of one year from June 2018 to june 2019.


RESULTS: Out of these, 150 CTs showed nearly missed /misinterpreted findings which are further characterized into; traumatic ( fractures, subdural and subarachnoid hemorrhage) 61/150 scans (40.7%); ischemic (hyperacute infarcts) 44/150 scans (29.3%); vascular (aneurysms and dural sinus thrombosis) 30/150 scans (20.7%); neoplastic (meningioma, glomus tumor, CP angle schwannoma) 14 /150 scans (9.3%) and miscellaneous including infections 1/150 scans (less than 1 %).


CONCLUSION: Knowledge of anatomical features of these blind spots and use of appropriate window width and level settings while evaluating CT images are important for avoiding false negative results in a normal looking brain. Also systematic review of the blind spots using comprehensive check list is key to avoid such errors.


KEYWORDS: blindspot, CT, window width, trauma, vascular.

Full Text:



Hota, Paramita & Chadaga, Harsha & Patwari, Sriram & Surendra, Kanumukul. (2019). Normal looking abnormal brain: Review areas in routine practice. 10.26044/ecr2019/C-2347.

Erly WK , Berger WG , Krupinski E , Seeger JF , Guisto JA . Radiology resident evaluation of head CT scan orders in the emergency department. AJNR Am J Neuroradiol 2002 ; 23 ( 1 ): 103 – 107 .

Malatt C, Zawaideh M, Chao C, Lee RR, Chen JY. Head computed tomography in the emergency department: a collection of easily missed findings that are life-threatening or life-changing. J Emerg Med, 2014 Dec;47(6):646-59. doi: 10.1016/j.jemermed.2014.06.042. Epub 2014 Sep 26.

Bahrami, S., & Yim, C. M. (2009). Quality Initiatives: Blind Spots at Brain Imaging. RadioGraphics, 29(7), 1877–1896

5. Yaniv G, Mozes O, Greenberg G, Bakon M, Hoffman C. Common sites and etiologies of residents’ misinterpretation of head CT scans in the emergency department of a level I trauma center. Isr Med Assoc J 2013;15:221–5.

Funaki B, Szymski G, Rosenblum JD. Significant on-call misses by radiology residents interpreting computed tomographic studies: perception versus cognition. Emerg Radiol 1997;4(5):290–294.

Wysoki MG, Nassar CJ, Koenigsberg RA, et al. Head trauma: CT scan interpretation by radiology residents versus staff radiologists. Radiology 1998;208:125–128.

Committee on Trauma, American College of Surgeons. National Trauma Data Bank annual/pediatric report 2014. Chicago, IL: American College of Surgeons; 2014.

Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery 2006;58(3 Suppl):S16– 24. discussion Si–iv.

Tsui EY, Fai Ma K, Cheung YK, Chan JH, Yuen MK. Rapid spontaneous resolution and redistribution of acute subdural hematoma in a patient with chronic alcoholism: a case report. Eur J Radiol 2000; 36:53–7.

Winegar BA, Murillo H, Tantiwongkosi B. Spectrum of critical imaging findings in complex facial skeletal trauma. Radiographics 2013;33:3–19.

Wei SC, Ulmer S, Lev MH, Pomerantz SR, Gonza´lez RG, Henson JW. Value of coronal reformations in the CT evaluation of acute head trauma. AJNR Am J Neuroradiol 2010;31:334–9.

von Kummer R, Holle R, Gizyska U, et al. Interobserver agreement in assessing early CT signs of middle cerebral artery infarction. AJNR Am J Neuroradiol 1996;17:1743–8. 9. Riedel CH, Zoubie J, Ulmer S, Gierthmuehlen.

Haridy J, Churilov L, Mitchell P, Dowling R, Yan B. Is there association between hyperdense middle cerebral artery sign on CT scan and time from stroke onset within the first 24-hours?. BMC Neurol. 2015;15:101. Published 2015 Jul 3. doi:10.1186/s12883-015-0358-5

Lev MH, Farkas J, Gemmete JJ, et al. Acute stroke: improved nonenhanced CT detection–benefits of soft-copy interpretation by using variable window width and center level settings. Radiology 1999; 213:150–5. 11.

Agid R, Shelef I, Scott JN, Farb RI. Imaging of the intracranial venous system. Neurologist 2008;14(1): 12–22.

C.S. Kidwell, M. Wintermark Imaging of intracranial haemorrhage Lancet Neurol., 7 (3) (2008), pp. 256-267.

Kasliwal MK, Moftakhar R, O’Toole JE, Lopes DK. High cervical spinal subdural hemorrhage as a harbinger of craniocervical arteriovenous fistula: an unusual clinical presentation. Spine J 2015;15(5):e13–17.

Riascos R, Bonfante E, Cotes C, Guirguis M, Hakimelahi R, West C. Imaging of atlanto-occipital and atlantoaxial traumatic injuries: what the radiologist needs to know. RadioGraphics 2015;35(7):2121–2134.

Singh K, Singh MP, Thukral C, Rao K, Singh K, Singh A. Role of magnetic resonance imaging in evaluation of cerebellopontine angle schwannomas. Indian J Otolaryngol Head Neck Surg 2015;67:21–27.

Springborg JB, Poulsgaard L, Thomsen J. Nonvestibular schwannoma tumors in the cerebellopontine angle: a structured approach and management guidelines. Skull Base 2008;18(4):217–227.

H.R. Bello, J.A. Graves, S. Rohatgi, M. Vakil, J. McCarty, R.L. Van Hemert, S. Geppert, R.B. PetersonSkull base–related lesions at routine head CT from the emergency department: pearls, pitfalls, and lessons learned. Radiographics, 39 (2019), pp. 1161-1182, 10.1148/rg.2019180118

Dankbaar JW, van Bemmel AJ, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging 2015;6(5):509–518


  • There are currently no refbacks.

© Copyright PJR 2008-