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Fig. 2.1. Lateral radiograph of the lumbosacral junction. Defect in the pars interarticularis of L5 is clearly shown (arrow).

There have been great improvements since the early machines, with excellent resolution and very fast scanning times, making it possible to scan a head in a few seconds. Although MRI is superior in the investigation of most neurological and spinal diseases, CT scanners are both readily available in virtually all hospitals and very cost effective, so they are widely used as the workhorse of neuroimaging. CT remains the foremost imaging modality in the emergency situation. This applies particularly to trauma, where intracranial hematoma can be rapidly assessed in the unstable patient and where, in the case of polytrauma, other areas such as the cervical spine or abdomen can be scanned. CT is superior to MRI in the visualization of calcification, bone detail and acute hemorrhage.

The CT appearances of hematoma are well recognized in the acute phase, being of higher attenuation than the adjacent brain. In hypera-cute hematoma, areas of low density may be seen consistent with active bleeding before a clot has formed. The appearance of the hematoma changes to become the same density as brain and eventually lower (Table 2.1). This typical evolution of hematoma can be altered by clotting disorder, anticoagulation, low haem-ocrit and anemia, when the acute hematoma can be isodense with brain in 50% of cases [5].

The presence of fluid-fluid levels within an extra-axial hematoma often represents acute hemorrhage with a chronic bleed. Fluid levels within a parenchymal hematoma are not only

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