弥漫性脑肿胀临床分析(附46例报告)

目的　分析弥漫性脑肿胀 (DBS)的机理并探讨其诊断和治疗。方法　按Zimmerman的CT诊断标准对急诊 46例弥漫性脑肿胀 (DBS)患者临床资料进行研究 ,并对其诊断和鉴别诊断、治疗和预后进行分析。结果　DBS多发生于交通肇事 ,后即刻意识障碍 ,呈持续性昏迷 ,CT表现双侧大脑弥漫性肿胀 ,中线附近散在点状高密度灶。结论　DBS损伤机制与病理诊断的弥漫性轴索损伤 (DAI)是一致的 ,其致死、致残率高。     

脑弥漫性轴索损伤62例的临床分析

目的加深对脑弥漫性轴索损伤(DAI)的认识，提高其诊断和治疗效果。方法回顾性分析62例脑弥漫性轴索损伤患者的临床和影像学资料。结果62例DAI患者中，存活30例，死亡32例，19例恢复良好，4例轻残，4例重残，3例植物生存。结论DAI在CT图像上有特征性改变，综合治疗仍然为目前治疗DAI的原则。     

弥漫性轴索损伤的诊断与治疗

目的 探讨脑弥漫性轴索损伤（DAI）的临床诊断及治疗方法。方法 回顾分析32例脑弥温性轴索损伤的临床资料。结果 87.5％的DAI为交通事故伤，伤后立即迷并呈持续状态，CT扫描有异常者占75％，而 MR对DAI的诊断敏感性优于CT，能清楚显示脑干损伤，DAI的治疗以非手术治疗为主，亚低温治疗是处理DAI的关键。结论 临床与影像学的结合有助于DAI的早期诊断，加强监护和治疗是防止DAI引起继发性脑损害的重要环节。     

螺旋CT及三维重建在纵膈气肿诊断价值

目的:探讨螺旋CT及三维重建在纵膈气肿诊断价值,提高纵隔气肿的诊断水平。方法:回顾性分析21例纵隔气肿的CT及三维重建图像,所有患者常规行CT平扫,薄层重建数据应用AW4.3软件进行三维成像。结果:CT显示纵隔气肿呈线条状或片状透亮影,HRCT清晰显示气肿呈气体密度影和被气体勾画出的纵隔结构。结论:X线检查早期纵隔气肿易漏诊,螺旋CT及三维重建检查有利于早期诊断纵隔气肿,方法简便快捷。     

多层螺旋CT在急性胰腺炎诊断中的应用价值

目的 探讨多层螺旋CT对急性胰腺炎的诊断应用价值.方法 对2008年1月～2010年12月住院的急性胰腺炎患者经手术病理证实和CT复查确诊的63例患者的临床资料作回顾性分析,全部病例均做腹部平扫,5例做增强扫描.结果胰腺局部或弥漫性肿大,胰腺边缘模糊及胰周积液是急性胰腺炎常见的CT征象,胰腺密度不均匀,其内见斑片状低密度灶和高密度出血是急性出血坏死性胰腺炎的特征表现.结论 多层螺旋CT检查对急性胰腺炎有较高的诊断价值,不仅能明确诊断,而且有助于临床定量,可发现并发症和判断预后.     

脑弥漫性轴索损伤的CT表现及诊断价值

目的:通过加深对脑弥漫性轴索损伤的CT表现的认识,来探讨正确诊断对临床治疗的价值。方法:对48例脑弥漫性损伤患者的早期CT表现及临床资料进行回顾性分析。结果:48例脑弥漫性轴索损伤早期表现为弥漫性脑肿胀45例,脑实质出血灶3 4例,呈单发或多发斑点状,直径多少于2cm ,主要位于胼胝位,基底节区,皮髓质交界部;蛛网膜下腔或脑室出血3 0例,合并硬膜外血肿5例,硬膜下血肿16例,颅骨骨折10例。结论:CT检查对脑弥漫性轴索损伤有较高诊断价值,对临床早期正确诊断及治疗具有重要参考价值。     

磁敏感加权成像联合弥散加权成像诊断脑弥漫性轴索损伤的应用

目的探讨磁敏感加权成像(SWI)联合弥散加权成像(DWI)诊断脑弥漫性轴索损伤(DAI)的应用价值。方法选取2018年2月至2020年2月本院收治的60例DAI患者,所有患者入院时均行MRI检查,比较MRI检查中T1WI、T2WI、FLAIR、SWI、DWI各序列检出的病灶率,并分析各序列病灶分布特点及信号特征。结果 DAI病灶的分布区域主要是基底节、胼胝体、丘脑、深部白质区、脑干、皮髓质交界区;SWI、DWI对各分布区域病灶的检出率均高于T1WI、T2WI、FLAIR(P0.05);SWI对微出血性病灶的检出数高于DWI、FLAIR(P0.05);DWI对水肿性病灶的检出数高于FLAIR、SWI(P0.05)。结论 SWI、DWI对DAI病灶检测的敏感性均优于T1WI、T2WI、FLAIR,两者联用可进一步提升DAI检出率,但对于特殊病例还需结合常规MRI进行鉴别诊断。     

艾滋病继发弓形体脑炎的CT及MRI表现

目的探讨艾滋病(AIDS)继发弓形体脑炎的CT及MRI表现。方法收集经临床及病理证实的AIDS继发弓形体脑炎患者30例,其中21例接受CT平扫,增强16例;24例接受常规MR检查,增强18例;15例同时接受CT和MR检查。结果本组25例病灶多发,5例单发;病灶部位多位于灰白质交界处(21例),其次为侧脑室周围(16例)、半卵圆中心(6例)、小脑(5例)、脑干(4例)、基底节区(4例)。CT平扫表现为多发斑片状、片状低密度灶,部分夹有混杂密度影;MRI表现为斑片状、块状及结节状长T1长T2信号,FLAIR序列多为高信号;增强后表现为斑片状、环状强化,以环状强化多见(13例)。本组所有病例经抗弓形体治疗后症状均有好转。结论 CT及MRI对AIDS继发弓形体脑炎有重要的诊断价值。根据MRI的特征性表现,结合临床及血清HIV、弓形体IgG及IgM抗体阳性,可对本病进行确诊。     

第三脑室孤立性纤维性肿瘤/血管外皮细胞瘤1例

正患者女,54岁,7个月前无明显诱因出现双下肢无力,偶有头晕,无恶心、呕吐,3个月前发现记忆力下降;发病以来神志清、精神可,睡眠正常。MRI:第三脑室可见不规则斑片状混杂等长T1等T2信号,约36.6mm×41.5mm×49.2mm,病灶内见斑片状囊性长T1长T2信号,瘤周见多发流空血管影,双侧丘脑及中脑受压移位,内见斑片状稍长T2信号(图1A、1B);增强扫描病灶呈明显强化,囊性区无强化(图1C)。MRI诊断:脑     

肝内胆管细胞癌22例的CT诊断分析

目的探讨肝内胆管细胞癌CT表现,加深对其影像特征的认识。方法回顾性分析经手术病理证实的22例肝内胆管细胞癌患者的CT检查资料。结果 22例患者均为单发病灶,其中肝内胆管扩张19例,肝内胆结石13例,肝叶萎缩7例,肝门区、腹主动脉旁淋巴结肿大14例,局部肝轮廓凹陷4例。增强扫描可见病灶内动脉期无或轻度强化,静脉期呈轻度或中度强化,延迟扫描随着时间的延长,病灶逐步呈斑片状、分隔状向心性强化。结论肝内胆管细胞癌CT表现具有一定的特征性,有助于与肝内其他占位性病变相鉴别,CT诊断对肝内胆管细胞癌具有重要意义。     

Magnetic resonance imaging in diffuse brain injury]

Forty cases diagnosed as diffuse brain injury (DBI) were studied by magnetic resonance imaging (MRI) performed within 3 days after injury. These cases were divided into two groups, which were the concussion group and diffuse axonal injury (DAI) group established by Gennarelli. There were no findings on computerized tomography (CT) in the concussion group except for two cases which had a brain edema or subarachnoid hemorrhage. But on MRI, high intensity areas on T2 weighted imaging were demonstrated in the cerebral white matter in this group. Many lesions in this group were thought to be edemas of the cerebral white matter, because of the fact that, on serial MRI, they were isointense. In mild types of DAI, the lesions on MRI were located only in the cerebral white matter, whereas, in the severe types of DAI, lesions were located in the basal ganglia, the corpus callosum, the dorsal part of the brain stem as well as in the cerebral white matter. As for CT findings, parenchymal lesions were not visualized especially in mild DAI. Our results suggested that the lesions in cerebral concussion were edemas in cerebral white matter. In mild DAI they were non-hemorrhagic contusion; and in severe DAI they were hemorrhagic contusions in the cerebral white matter, the basal ganglia, the corpus callosum or the dorsal part of the brain stem.     

Diffuse axonal injury and early intracranial sequelae in severe head injury.

The importance of diffuse axonal injury (DAI) and early intracranial sequelae was studied in 107 patients with diffuse and focal brain injuries. Comprehensive neuropathological study was also undertaken in 24 fatal patients. The mortality rate was clearly the highest in traumatic subarachnoid hemorrhage, followed by acute subdural hematoma, cerebral contusion with delayed hematoma formation, traumatic intracerebral hematoma, diffuse cerebral swelling, DAI with classical features, and finally nearly normal on computed tomographic scans. The mean flow velocities in the middle cerebral artery recorded by transcranial Doppler ultrasound were variable in diffuse brain injury, but commonly decreased on the hematoma side depending on increased intracranial pressure and decreased cerebral perfusion pressure in focal brain injury. Deep-seated hemorrhagic lesions did not expand in diffuse brain injury, but sizable hematoma developed within 24 hours in focal brain injury. The platelet count was significantly lower in patients with poor outcomes in focal brain injury. Histological evidence of classical DAI was found in eight (50%) of 16 cases with focal brain injury. DAI of varying severity is the common subjacent lesion in patients with severe head injury, but the final outcome varies greatly with different lesion types.     

Outcome of patients with diffuse axonal injury: the significance and prognostic value of MRI in the acute phase

BACKGROUND: To compare the magnetic resonance imaging (MRI) findings in the acute phase with outcome in patients with diffuse axonal injury (DAI). METHODS: A group of 33 patients with closed head injury and discrepancy between the apparently normal computed tomographic scan findings and their neurologic statuses were studied with MRI during the first 48 hours. Among them, 24 were found to suffer from DAI-type lesions. According to the Glasgow Coma Scale (GCS), 19 patients suffered from severe head injury (GCS score <8) and 5 patients had moderate head injury (GCS score of 9-12). Four MRI sequences in various planes were applied. Patients were divided into three groups, according to staging described in the literature. RESULTS: In five patients, MRI demonstrated nonhemorrhagic DAI lesions stage 1. In 11 patients, findings were consistent with DAI lesions stage 2, eight nonhemorrhagic and three hemorrhagic. Eight patients showed DAI lesions stage 3, six of which were nonhemorrhagic. CONCLUSIONS: MRI is more sensitive compared with computed tomography in the detection of traumatic brain lesions, especially the nonhemorrhagic DAI. The presence of hemorrhage in DAI-type lesions and the association with traumatic space-occupying lesions is a poor prognostic sign. Isolated nonhemorrhagic DAI-type lesions are not associated with poor clinical outcome.     

Significance of magnetic resonance imaging in diffuse axonal injury

Advantages of magnetic resonance imaging (MRI) to computed tomography (CT) on a diagnosis of diffuse axonal injury (DAI) were discussed. Sixteen patients diagnosed as DAI defined by the criteria of Gennarelli were studied with CT and MRI. Lesions were demonstrated as high intensity areas on MRI of T2 weighted imaging (SE 2000/111) in all of the patients. These lesions were located only in a cerebral white matter in the cases of mild DAI, whereas in the cases of severe DAI located in a basal ganglia, corpus callosum, dorsal part of the brain stem as well as in the cerebral white matter. As for the findings of CT, these parenchymal lesions were not visualized in nine cases including six cases without any pathological findings. Our series suggest that MRI is superior to CT on the diagnosis of DAI and provides some information to evaluate the severity of DAI.     

The neuropsychology of blunt head injury in the early postacute stage: effects of focal lesions and diffuse axonal injury

This investigation evaluated the neuropsychological symptoms in the early posttraumatic period following blunt head injury and their correlation to routine imaging data in a consecutive series of TBI patients (Magdeburg Neurotrauma Databank). Of 135 consecutive patients, 68 could be assessed neuropsychologically 8-21 days after trauma. In 61 patients, routine clinical CT data were sufficient for neuroradiological analysis focusing on the presence or absence of CT signs of diffuse axonal injury (DAI) or focal traumatic injury. In these patients, the initial GCS score was significantly correlated with the presence of DAI but not with focal pathology. The presence of DAI was correlated with behavioral and cognitive symptoms of frontal lobe dysfunction, especially in interference tasks (Go/NoGO and Stroop reaction times) and semantic fluency. The presence of local frontal or temporal traumatic lesions was associated with deficits in concept formation, fluency tasks and behavioral symptoms, but not with increased interference. Patients with frontal contusions were impaired in a task of visuomotor planning and performance (Block design). Our data indicate that both traumatic DAI and focal lesions result in frontal lobe symptoms. We conclude that, even in clinically "mild" TBI, brain imaging should be used to identify patients with substantial brain damage. These should be assessed neuropsychologically for possible posttraumatic cognitive or behavioral impairment. In consideration of its easy accessibility, the refined use of the CT is considered a promising and valid tool for patient stratification. The application of MRI and biochemical markers may further improve prognostic predictions.     

Computed tomography in diagnosis of diffuse axonal injury

Diffuse axonal injury (DAI) has been described in instances of prolonged traumatic coma on the basis of the neuropathological findings, but the same findings are also found in patients with cerebral concussion. Experimental studies confirm that the quality of survivors following trauma is directly proportional to the amount of primarily injured-axon. When the injured axon lies in a widespread area of the brain, outcome for the patient is always poor. In a series of 260 severely head-injured patients, based on their poor outcome, 69 (27%) were diagnosed as DAI. Because of their relatively good outcome, eighty-two patients (32%) were classified into non-DAI group. The predominant CT finding of DAI patients was intraparenchymal deep-seated hemorrhagic lesion. This was observed in 28 patients (41%). Normal CT was also observed in 11 patients (16%). On the other hand, 8 of the non-DAI group (10%) manifested deep-seated lesions. Diffuse cerebral swelling (DCS) appeared in both groups in the same incidence. Subarachnoid hematoma in the perimesencephalic cistern (SAH (PMC] and intraventricular hematoma (IVH) were observed in 64% of the DAI group, and in 23% of the non-DAI group. The available evidence indicates that various types of hematoma seen in the deep-seated structures of the brain do not have an absolute diagnostic value, but the frequency of hematoma is thought to increase in proportion to the amount of injured-axon.     

Utility of fractional anisotropy imaging analyzed by statistical parametric mapping for detecting minute brain lesions in chronic-stage patients who had mild or moderate traumatic brain injury

Diffusion tensor imaging (DTI) has recently evolved as valuable technique to investigate diffuse axonal injury (DAI). This study examined whether fractional anisotropy (FA) images analyzed by statistical parametric mapping (FA-SPM images) are superior to T(2)*-weighted gradient recalled echo (T2*GRE) images or fluid-attenuated inversion recovery (FLAIR) images for detecting minute lesions in traumatic brain injury (TBI) patients. DTI was performed in 25 patients with cognitive impairments in the chronic stage after mild or moderate TBI. The FA maps obtained from the DTI were individually compared with those from age-matched healthy control subjects using voxel-based analysis and FA-SPM images (p < 0.001). Abnormal low-intensity areas on T2*GRE images (T2* lesions) were found in 10 patients (40.0%), abnormal high-intensity areas on FLAIR images in 4 patients (16.0%), and areas with significantly decreased FA on FA-SPM image in 16 patients (64.0%). Nine of 10 patients with T2* lesions had FA-SPM lesions. FA-SPM lesions topographically included most T2* lesions in the white matter and the deep brain structures, but did not include T2* lesions in the cortex/near-cortex or lesions containing substantial hemosiderin regardless of location. All 4 patients with abnormal areas on FLAIR images had FA-SPM lesions. FA-SPM imaging is useful for detecting minute lesions because of DAI in the white matter and the deep brain structures, which may not be visualized on T2*GRE or FLAIR images, and may allow the detection of minute brain lesions in patients with post-traumatic cognitive impairment.     

Influence of lesions detected by computed tomography on outcome and neuropsychological recovery after severe head injury

Outcome at 6 months after severe head injury was determined in 117 patients whose computed tomographic (CT) examinations demonstrated diffuse axonal injury (DAI), diffuse swelling (DS), or focal injuries. Neuropsychological sequelae were ascertained from two examinations in 30 of the conscious survivors within the 1st year after injury. Outcome differences varied with the type of CT lesion. DS and focal injuries resulted in more favorable (good recovery) outcomes. Mortality was higher after DAI. Neuropsychological outcome varied with the type of CT lesion and the function measured. Overall differences in memory and learning were revealed among the three CT lesion categories, whereas differences in intelligence and visuomotor functions were not significant. Levels of memory, learning, and visuomotor speed were higher after DS injuries, but improvement was less. Greater improvement of memory, learning, and visuomotor speed occurred after DAI. After focal injuries, visuomotor speed improved, but not recall and learning. The results suggest that the type of injury incurred differentially influences the outcome and the neuropsychological aftermath of severely head-injured adults.