The vertex scan: an important component of cranial computed tomography.

Physicians who monitor cranial computed tomography occasionally omit the most superior aspects of the brain and calvarium because of time limitations and overloaded scanning schedules. In addition, standardized CT reporting forms as well training literature distributed by some manufacturers support the concept that a complete CT series consists of three scan pairs. Omission of a vertex scan pair results in failure to visualize 10%-15% of the brain volume. We have reviewed the results of 2,000 consecutive CT studies to determine the number and variety of pathologic entities that would have been missed had a vertex scan not been obtained. The most significant or sole abnormality was present on the vertex scan alone in 3% of the cases. Examples are presented. A true vertex levels should be obtained in every routine CT examination.