脑弥漫性轴索损伤的CT诊断

弥漫性轴索损伤（DAI）是头部加速运动引起的脑白质轴索广泛性损伤。我们报告18例脑弥漫性轴索损伤，提出DAI的CT诊断标准；大脑皮髓质交界处、基底地内囊区域、胼胝体、脑干或小脑一个或多个直径≤2cm的出血灶和／或脑室内出血，无明显颅内血肿和挫裂伤；或CT仅提示急性弥漫性脑肿胀，蛛网膜下腔出血，但伤后原发性持久昏迷，无脑缺氧情况。在384例急性脑外伤中，CT诊断DAI18例。对DAI的发病机理、CT表现的病理基础及诊断标准、CT表现与临床的关系进行了讨论。     

脑弥漫性轴索损伤的CT诊断价值（附45例分析）

目的　探讨CT对脑弥漫性轴索损伤的诊断价值。方法　对 45例脑弥漫性轴索损伤患者的早期CT表现进行回顾性分析。结果　 45例脑弥漫性轴索损伤早期CT表现为弥漫性脑肿胀 45例 ,脑白质内单发或多发小出血灶 (大脑半球 1 8例 ,基底节区1 0例 ,脑干 3例 ) ,蛛网膜下腔出血 2 1例 ,脑室内出血 8例 ,硬膜下血肿 7例 ,硬膜外血肿 5例 ,颅骨骨折 9例。结论　CT检查对脑弥漫性轴索损伤具有较高的诊断价值     

脑弥漫性轴索损伤的CT诊断和临床分析

目的：分析脑弥漫性轴索损伤（DAI）的CT表现并和临床症状相结合，评价CT在DAI诊断中的价值。方法：回顾分析临床确诊的56例DAI病例的CT资料，并与临床症状相对照。结果：51例脑质中见到一个或数个点状出血灶，其中大脑半球35例，胼胝体8例，脑干5例，小脑2例，脑室1例，52例出现弥漫性脑肿胀。结论：脑CT扫描是临床诊断DAI的有力依据。     

脑弥漫性轴索损伤的MRI表现

目的　分析脑弥漫性轴索损伤 (DAI)的MRI表现 ,评价MRI对脑弥漫性轴索损伤的诊断价值。　方法　回顾性分析 30例CT检查阴性的脑弥漫性轴索损伤的MRI表现。MRI分别采用自旋回波T1WI、T2WI序列、液体衰减反转恢复序列 (FLAIR)及弥散加权成像 (DWI)。所有扫描在伤后 1周内进行。　结果　轴索积聚区多发的小灶性损伤 ,多数病灶为非出血性 (<2cm) ,除 3例超急性期外 ,所有病灶T2WI均显示为高信号 ,中线结构无明显移位。在超急性期患者 ,仅DWI上显示出高信号病灶。　结论　MRI对脑弥漫性轴索损伤敏感性较高 ,其影像学表现与DAI的严重程度有较好的对应关系。采用MRI检查CT表现阴性的临床疑诊患者 ,对脑弥漫性轴索损伤的临床诊断及治疗具有重要意义     

脑弥漫性轴索损伤的CT诊断（附40例分析）

在急性脑外伤患者的ＣＴ片研究弥漫性轴索损伤的ＣＴ征象，目的是为ＤＡＩ的诊断提供影像学依据。回顾性分析经临床确诊的４０例ＤＡＩ患者的早期ＣＴ表现，结合文献提出ＤＡＩ的ＣＴ诊断标准：脑白质内单发或多发无占位效应的小出血灶，中线结构无移位；蛛网膜下腔出血或脑池内出血；脑室内出血；弥漫性脑肿胀。     

脑弥漫性轴索损伤与弥漫性脑肿胀

脑弥漫性轴索损伤与弥漫性脑肿胀在重型颅脑损伤中的发现率逐渐增加,病死率高。然而,近年来不断发现一些文章将两者混为一谈。为说明两者的关系,综述如下。1　脑弥漫性轴索损伤　　脑弥漫性轴索损伤(diffuseaxonalinjury,DAI)过去只能在尸检时发现。直到CT与MRI应用后,DAI方可能在临床作出诊断。1982年Adams等提出DAI这一术语〔1～3〕。他认为,脑内各种组织的质量不同,因此其运动的加速度及惯性也不同;又由于脑组织的不易屈性,突然的加、减速运动可使各种组织间产生相对位移,形成一种剪切力,造成脑损伤。他指出DAI在外伤时即刻发生,…     

脑弥漫性轴索损伤的CT表现（附68例分析）

目的：分析脑弥漫性轴索损伤（DAI）的CT征象,为DAI的诊断提供影像学依据。方法：回顾性分析68例经临床确诊的DAI的早期CT表现。其中,男52例,女16例,年龄6-72岁,平均32.3岁,51例采用保守治疗,17例行开颅减压术,死亡37例（54.4%),重残21例（30.9%),CT扫描在伤后30分钟至24小时进行,使用岛津SCT-4500TE型全身CT机行非增强扫描。结果：脑白质内单发或多发小出血灶49例（大脑半球37例,基底节区4例,胼胝体6例,脑干2例）,蛛网膜下腔出血17例,脑室出血5例,弥漫性脑肿胀58例。结论：CT是早期诊断DAI的有效方法。并可提示病人的预后。     

脑弥漫性轴索损伤125例临床分析

目的探讨脑弥漫性轴索损伤的发病机制、临床特点、诊断、治疗和预后。方法回顾性分析125例脑弥漫性轴索损伤患者的临床资料。结果伤后6个月根据格拉斯哥预后分级:恢复良好28例(22.4%)、中残32例(25.6%)、重残30例(24%)、植物生存11例(8.8%)、死亡24例(19.2%)。结论脑弥漫性轴索损伤是重型颅脑损伤患者死亡的主要原因,致残率高;意识障碍是其典型临床表现。其诊断MRI检查优于CT;大部分采取非手术治疗。格拉斯哥昏迷评分越低,患者昏迷持续时间越长,预后越差。     

3T磁敏感成像在弥漫性轴索损伤中的应用及与GCS评分的相关性

目的探讨3 T磁敏感加权成像(SWI)及扩散加权成像(DWI)对弥漫性轴索损伤(DAI)的诊断价值及其与格拉斯哥昏迷量表(GCS)评分的相关性。资料与方法对40例DAI患者,均行常规T1WI、T2WI、液体衰减反转恢复(FLAIR)、DWI及SWI,对所得数据在工作站用软件进行图像后处理,并分析、统计。结果在40例DAI患者中,磁共振常规序列共发现36个出血灶,在DWI上共发现44个出血灶,在SWI上共发现376个出血灶,GCS评分13～15分25例,9～12分11例,≤8分4例,GCS评分较低者其出血灶数较多,且出血灶范围较大者其GCS评分亦较低。结论在DAI患者中,SWI能较常规序列及DWI上显示更多脑内微小出血灶,GCS评分高低与出血灶数目多少及大小有明显相关性。SWI可为临床早期诊断DAI和在治疗方案的制定及评估预后中提供很大帮助。     

The Clinical Value of SWI and DWI in Diffuse Axonal Injury on 3 T MR and Correlated with GCS

目的 探讨3T磁敏感加权成像(SWI)及扩散加权成像(DWI)对弥漫性轴索损伤(DAI)的诊断价值及其与格拉斯哥昏迷量表(GCS)评分的相关性.资料与方法 对40例DAI患者,均行常规T1WI、T2WI、液体衰减反转恢复(FLAIR)、DWI及SWI,对所得数据在工作站用软件进行图像后处理,并分析、统计.结果 在40例DAI患者中,磁共振常规序列共发现36个出血灶,在DWI上共发现44个出血灶,在SWI上共发现376个出血灶,GCS评分13～ 15分25例,9～12分11例,≤8分4例,GCS评分较低者其出血灶数较多,且出血灶范围较大者其GCS评分亦较低.结论 在DAI患者中,SWI能较常规序列及DWI上显示更多脑内微小出血灶,GCS评分高低与出血灶数目多少及大小有明显相关性.SWI可为临床早期诊断DAI和在治疗方案的制定及评估预后中提供很大帮助.     

弥漫性轴索损伤影像学分析

目的探讨弥漫性轴索损伤(DAI)影像学表现及诊断价值。方法回顾性分析2010年9月~2015年9月26例DAI患者临床与CT、低场MRI资料,其中男性19例,女性7例;年龄16~65岁,平均34.6岁。患者均有创伤史,道路交通伤22例,高处坠落伤3例,重物打击伤1例。伤后均立即出现昏迷或持续昏迷,入院时格拉斯哥昏迷量化表(GCS)评分,重度(≤8分)4例,中度(9~12分)6例,轻度(13~15分)16例。结果 26例均使用CT及低场MRI诊断,主要表现为颅内不同部位单发或多发点状病变,DAI病灶分为出血灶和非出血灶,主要分布在灰白质交界区、基底节区、丘脑、深部白质、胼胝体等区域。低场MRI敏感性明显高于CT(χ2=14.567,P=0.012),各序列中GRE-T2*WI对出血灶检出数(97.59%)最高,DWI对非出血灶检出数(95.18%)最高。结论 CT及低场MRI对DAI的早期诊断很有价值,低场MRI能弥补CT检查阴性颅脑损伤而症状较重患者,能明显提高颅脑损伤的检出率、诊断率,能有效避免漏诊,提示预后。     

Imaging findings in diffuse axonal injury after closed head trauma

Even in patients with closed head trauma, brain parenchyma can be severely injured due to disruption of axonal fibers by shearing forces during acceleration, deceleration, and rotation of the head. In this article we review the spectrum of imaging findings in patients with diffuse axonal injuries (DAI) after closed head trauma. Knowledge of the location and imaging characteristics of DAI is important to radiologists for detection and diagnosis. Common locations of DAI include: cerebral hemispheric gray-white matter interface and subcortical white matter, body and splenium of corpus callosum, basal ganglia, dorsolateral aspect of brainstem, and cerebellum. In the acute phase, CT may show punctate hemorrhages. The true extent of brain involvement is better appreciated with MR imaging, because both hemorrhagic and non-hemorrhagic lesions (gliotic scars) can be detected. The MR appearance of DAI lesions depends on several factors, including age of injury, presence of hemorrhage or blood-breakdown products (e. g., hemosiderin), and type of sequence used. Technical aspects in MR imaging of these patients are discussed. Non-hemorrhagic lesions can be detected with fluid attenuated inversion recovery (FLAIR), proton-density-, or T2-weighted images, whereas gradient echo sequences with long TE increase the visibility of old hemorrhagic lesions. Received 17 September 1997; Revision received 2 December 1997; Accepted 15 December 1997     

Adult cerebral malaria: prognostic importance of imaging findings and correlation with postmortem findings

PURPOSE: To correlate imaging abnormalities, clinical features, and postmortem findings in patients with proved cerebral malaria. MATERIALS AND METHODS: Twenty-one patients aged 17-50 years with cerebral malaria consented to undergo transverse nonenhanced (10-mm sections) and contrast material-enhanced (8-mm sections in posterior fossa and 10-mm sections in supratentorial region) CT on admission (n = 21) and on day 10 (n = 6), with thin sections (5 mm) obtained in the area of abnormality. All CT scans were evaluated for diffuse cerebral edema, focal parenchymal abnormalities, and hemorrhage. CT findings were categorized as normal, diffuse cerebral edema, and edema with thalamic hypoattenuation without or with cerebellar hypoattenuation. Spearman rank correlation test was performed. RESULTS: Initial scans were normal in seven patients with mild disease (median Acute Physiology and Chronic Health Evaluation [APACHE] II score of 7, median Glasgow Coma Scale [GCS] score of 10), and all survived. Of eight patients with diffuse cerebral edema (GCS > or = 8; median APACHE II, 21), six survived. Cerebral edema with thalamic and cerebellar white matter hypoattenuation was seen in five patients. All had GCS score of 6 or less, median APACHE II score of 26, and multiorgan failure; none survived. One patient (GCS = 6) had thalamic hypoattenuation without cerebellar lesions. He survived with mild residual hemiparesis. Diffuse petechial hemorrhages were seen in the cerebrum and cerebellum at autopsy in all seven patients who died. These petechial hemorrhages were not visualized on CT scans. CT findings did not correlate with degree of parasitemia. CONCLUSION: CT findings correlate well with level of consciousness and severity of disease but underestimate the extent of disease at pathologic examination. A normal CT scan indicates a favorable outcome, whereas cerebellar hypoattenuation portends a poor outcome.     

Indications for CT in patients receiving anticoagulation after head trauma

BACKGROUND AND PURPOSE: Head CT is frequently ordered for trauma patients who are receiving anticoagulation. However, whether patients with a Glasgow Coma Scale (GCS) score of 15 and normal findings on neurologic examination require CT is still debated. The purpose of our study was to assess the use of cranial CT in patients receiving anticoagulants after head trauma and to establish clinical criteria to identify those in this group who do not need emergency CT. METHODS: We retrospectively reviewed patients receiving heparin or coumadin who had head trauma and who subsequently underwent cranial CT at a level I trauma center within a 4-year period. Patients were evaluated for mechanism of injury, clinical signs and symptoms of head injury, and type and reason for anticoagulation. Prothrombin time, international normalized ratio, partial thromboplastin time, GCS score, age, and head CT results were recorded for each patient. RESULTS: A total of 89 patients fulfilled the enrollment criteria. Among them, 82 had no evidence of intracranial injury on CT. Seven patients had evidence of intracranial hemorrhage. Patients without hemorrhage had no significant focal neurologic deficits and presented with an average GCS score of 14.8. Patients with intracranial hemorrhage tended to have focal neurologic deficits and presented with an average GCS score of 12.0. CONCLUSION: Patients with head injury, normal GCS scores, and no focal neurologic deficits and who are receiving the anticoagulants heparin or coumadin may not necessarily require emergency CT.     

CT for acute stage of closed head injury

Brain damage after head injury can be classified by its time course. Primary damage that includes acute subdural hematoma (SDH), acute epidural hematoma (EDH), and intraaxial lesions that include contusions, diffuse axonal injury (DAI), and intracranial hemorrhage (ICH), occurs at the moment of impact and is thought to be irreversible. Secondary damage that includes herniations, diffuse cerebral swelling, and secondary infarction and hemorrhage, evolves hours or days after injury as a consequence of systemic or intracranial complications. The duration and severity of secondary damage influence outcome. Head injury management is focused on preventing, detecting, and correcting such secondary damage. CT has been widely used for the neuromonitoring of head trauma. CT is the gold standard for the detection of intracranial abnormalities and is a safe method for survey. While MRI is more sensitive and accurate in diagnosing cerebral pathology, CT is considered the most critical imaging technique for the management of closed head-injured patients in the acute stage. In this article, we review the imaging findings and literature of various lesions of closed head injury in the acute stage.     

Cerebrotendinous xanthomatosis: cranial CT and MRI studies in eight patients

Summary We report the findings on cranial computed tomography (CT) and magnetic resonance imaging (MRI) and their correlation with the clinical manifestations, disease severity and biochemical abnormalities in eight patients with cerebrotendinous xanthomatosis. CT revealed cerebral atrophy in seven cases, cerebellar atrophy in four and focal low density lesions in the cerebral white matter in two. T2-weighted MRI showed high signal lesions in the cerebral white matter, focal in four cases and diffuse in one, and in the globus pallidus in three patients, two of whom also had lesions in the cerebellar white matter. While severely affected patients showed variable CT and MRI abnormalities, our cases did not show the dramatic findings expected from the neurological manifestations. Diffuse lesions in the cerebral and cerebellar white matter have been emphasized in previous reports, but in our study the focal lesions in the cerebral white matter were also present; the globus pallidus was frequently involved.     

皮质下动脉硬化性脑病的临床表现及CT分析

目的：分析皮质下动脉硬化性脑病（SAE）的CT特征及其与临床表现的关系。方法：回顾性分析经临床确诊的216例SAE患者的临床表现有CT特征。结果：全部患者中214例颅脑CT平扫显示双侧脑室周围自质有稍低密度影，病变模糊边界不清，双侧对称或基本对称；合并腔隙性梗塞210例，合并程度不同脑萎缩187例。渐进性痴呆表现越重，CT异常表现越明显。结论：对有脑动脉硬化表现者行头颅CT平扫可较早期诊断SAE。     

外伤性迟发性脑内血肿的早期CT表现

目的　研究外伤性迟发性脑内血肿的早期CT表现 ,评价这些表现对迟发性脑内血肿的预期诊断意义。方法　搜集CT复查证实的外伤性迟发性脑内血肿 31例 ,对其首次CT检查及复查的CT影像特点进行分析。按时间顺序抽取脑外伤后复查无脑内血肿病人 5 0例作为对照。统计处理2组观察结果。结果　 31例迟发性脑内血肿首次CT检查主要异常表现包括 :(1)限局性脑实质密度减低 ,灰白质分界不清 18例。 (2 )限局性蛛网膜下腔出血 2 4例。 (3)局部脑轻度占位效应 16例。 (4 )硬膜下血肿 9例。统计学显示与无迟发性脑内血肿差异有显著性意义 (χ2 =4 5× 10 -10 ,2 7 98,19 5 7,10 5 4,P值均 <0 0 1)。同时盲法测试结果显示 ,作者与盲法观察结果差异无显著性意义 (χ2 =1 0 3,0 34 ,2 81,P值均 >0 0 5 )。结论　脑外伤后首次行CT检查 ,出现局部脑实质密度减低 ,灰白质分界不清 ;局部蛛网膜下腔出血及脑占位效应 ,提示此部位可能出现迟发性脑内血肿 ,应及时做CT复查