颅脑外伤急诊CT检查"阴性"的病例分析(附51例报告)

目的探讨颅脑外伤病例CT检查阴性的原因及防治办法.方法回顾性分析2002～2004年我院收治的颅脑外伤病例51例,急诊CT检查均为阴性,分析CT检查阴性的原因.结果造成CT检查阴性的原因分为CT操作员与诊断医生经验不足12.8%;损伤早期征象不典型46.8%;迟发性病变16.2%;CT本身的局限性24.2%.结论首先要加强CT操作员技术培训;颅脑外伤的CT诊断应结合临床表现及其它检查结果综合分析;对怀疑有颅内损伤的病例给予复查或MR检查.     

30例颅脑外伤CT检查阴性的病例分析

目的：探讨颅脑外伤CT检查阴性的原因及防治办法。方法：回顾性分析2005年-2007年我院收治的颅脑外伤病例30例，急诊CT检查为阴性，分析CT检查阴性的原因。结果：CT检查阴性原因分为：1．CT检查员及诊断医生水平：2．损伤早期征象不典型；3．迟发性病变；4．CT本身局限性。结论：加强人员培训；颅脑外伤的CT诊断应结合临床表现及其他检查；对怀疑病变的建议作CT薄层扫描。     

外伤迟发性颅内血肿CT检查的应用

颅脑外伤中的迟发性颅内血肿预后一般较差，CT是作为急性颅脑损伤患者首选的检查技术。本文回顾分析了改类血肝100例，以提高临床对本病CT检查的认识，及时的发现和积极的治疗可降低病人的死亡率和伤残率。     

汶川大地震颅脑损伤概况及多层螺旋CT的诊断价值

目的 总结汶川大地震颅脑损伤情况及多层螺旋CT的诊断价值.方法 对收治的汶川地震伤员1557例中因颅脑外伤的292例进行CT检查,其中CT检查阳性者225例.回顾性总结225例颅脑损伤患者的损伤类型及多层螺旋CT表现,分析多平面重组(MPR)及三维(3D)重组成像的应用价值.结果 颅脑损伤225例,主要包括颅骨骨折66例,脑挫裂伤50例,颅内血肿55例,蛛网膜下腔出血16例,硬膜下积液16例,头皮异物20例,外伤性脑梗死2例.其中22例进行了手术治疗.结论 地震住院救治伤员中颅脑损伤占的比例较大,MPR及3D图像可以为神经外科医师术前提供直观可靠的依据.     

小儿颅脑外伤280例CT诊断分析

目的：分析小儿颅脑外伤的临床及CT表现特点。方法：本组男206例，女74例，年龄8个月～14岁，平均6岁。280例均有完整的CT资料，其中35例检查2次，12例检查3次，4例行MRI检查。结果：颅骨骨折52例，占18．6％；硬膜外血肿50例，占18．0％；硬膜下血肿58例，占20．7％；蛛网膜下腔出血19例，占6．8％；脑室出血4例，占1．5％；脑内血肿45例，占16．0％；脑挫裂伤50例，占18．0％；弥漫性轴索损伤6例，占2．1％；脑疝2例，占0．7％；创伤性脑梗塞7例，占2．5％。85．0％的病例有2种以上CT表现。结论：(1)小儿颅脑外伤与成人相比有其相对特殊的临床特点；(2)CT检查快速、准确，是小儿颅脑外伤首选影像检查方法。     

螺旋CT对颅脑外伤后迟发性血肿的诊断价值

颅脑外伤后迟发性血肿较常见，如果不结合临床追踪观察，不及时进行CT复查，极易漏诊。CT扫描是发现颅内损伤出血及血肿最常用的诊断方法，笔者对2004-2006年经我科确诊的12例颅内迟发性血肿的CT诊断进行回顾性分析如下。     

颅脑外伤比较影像学进展

颅脑外伤是外伤性急症的一种常见病,临床诊断主要依椐病史、症状、体征及影像资料。头颅平片简单易行,可以显示颅骨骨折,但不能显示颅内细微改变。随着现代影像学技术的迅速发展,多层螺旋CT（MSCT）已广泛应用于颅脑外伤急症诊断,并取代了最初的头颅平片检查。核磁共振（MRI）检查是急性颅脑外伤检查的重要补充。这些影像学检查在颅脑外伤病情判断、治疗指导及预后判断中相互补充。     

浅析轻型颅脑外伤临床与CT扫描的相关性

目的 :研究轻型颅脑外伤的临床及CT表现,总结与轻型颅脑外伤密切相关的高危因素,探讨CT检查的适应证。方法:采用前瞻性队列研究,对180例受伤24 h以内的轻型颅脑外伤患者进行注册登记,根据CT结果分析,探讨轻型颅脑外伤的CT检查适应征。结果 :能准确评估颅脑损伤程度的有:神经查体阳性、格拉斯哥昏迷评分(GCS)15分及年龄≥60岁者、可疑颅骨骨折及锁骨上损伤体征阳性,可作为轻型颅脑外伤患者CT检查适应证。不具备上述5项临床表现中任意1项者,CT检查阴性率为100%,可暂不行CT检查。结论:通过此项研究,为临床医师诊疗轻型颅脑外伤患者提供更加合理化的指导意见,有助于临床医师对颅脑损伤做出准确评估,有效避免不必要的CT检查。     

重型颅脑损伤术中急性脑膨出38例临床分析

目的探讨重型颅脑损伤术中急性脑膨出的主要原因、早期诊断与应急处治方法 ,以提高治愈率,降低致残率和死亡率。方法对38例重型颅脑损伤术中急性脑膨出的临床资料进行回顾性分析。结果死亡16例,占42.1%;植物生存2例,占5.3%;中残6例,占15.8%;重残4例,占10.5%;良好10例,占26.3%。结论颅内血肿、弥漫性脑肿胀、脑水肿是重型颅脑损伤术中急性脑膨出的主要原因。早期诊断、针对不同的原因迅速采取相应的应急处治措施及综合治疗是治疗脑膨出成功的关键。     

国人轻型颅脑外伤CT检查适应证的初步研究

目的 对轻型颅脑外伤(MHI)患者临床指标和CT异常结果进行相关性及多因素分析,初步探讨适合我国成年MHI的CT检查适应证.方法 对860例符合纳入标准的颅脑外伤后24 h以内、格拉斯哥昏迷评分(GCS)为13～15分的成年MHI患者进行前瞻性观察研究.把患者临床指标作为自变量,CT显示的急性颅脑损伤作为因变量,利用SPSS16.0软件(检验水准α=0.05)进行单因素和多因素分析,初步探讨MHI患者CT检查适应证.结果 与颅脑损伤相关性最强的临床指标是神经查体阳性(OR=35.079,P=0.000);敏感性为100%,能预测颅脑损伤的6项临床指标组合是:意识丧失、可疑颅骨骨折、危险的外伤机制、GCS评分<15分、年龄≥65岁、锁骨上损伤体征.以此作为MHI患者CT检查适应证,可以减少27.8%的CT检查.结论 本研究初步探讨了适合我国成年MHI的CT检查适应证,此临床因素组合可以敏感地预测急性颅脑损伤的发生,减少不必要的CT检查.     

迟发性外伤性颅内病变的CT检查

目的：为了及早诊治外伤性颅内迟发性病变,探索ＣＴ复查的合适时间。材料与方法：搜集颅脑外伤后ＣＴ复查时发现新病变的ＣＴ资料１３１例,统计分析颅内的新病变和发现新病变的时间。结果：发现颅内迟发性病变２０１个,常见的病变有颅内血肿,脑挫裂伤和硬膜下积液等。接近半数的病变在伤后３天内出现,１０天内发现的病变占８４％。结论：颅脑外伤后３、６、１０天是ＣＴ复查的最佳时机,伤后１０天内积极复查ＣＴ能及早发现颅内迟发性病变     

重型颅脑损伤伴发急性多发性颅内血肿的救治

目的：探讨重型颅脑损伤并发急性多发性颅内血肿的救治。方法：对１５３例７～７１岁的病例进行研究。本组主要致伤原因为车祸和跌伤。手术治疗１４４例（９４．１２％）。结果：总死亡率２６．１４％,１９８６年以前为４６．８％,１９８６年以后为２０．６６％。结论：该类创伤的病理损害特殊,因此选择科学的手术方法及防治继发病理损害十分重要。     

Computed tomography of craniocerebral injury in the abused child.

Computed tomography (CT) was performed in 26 infants and children with craniocerebral trauma related to abuse during a 41-month period. The pattern of brain injury differed from that seen in the nonabused traumatized infant or child. Parieto-occipital acute interhemispheric subdural hematoma (AIHSH) with associated parenchymal injury was the most frequent finding (58%). Follow-up by CT in patients with AIHSH demonstrated infarction in half and cerebral atrophy in all.     

Comparison of non-sedated brain MRI and CT for the detection of acute traumatic injury in children 6 years of age or less

CT is considered the first-line study for acute intracranial injury in children because of its availability, detection of acute hemorrhage, and lack of sedation. An MRI study with rapidly acquired sequences can obviate the need for sedation and radiation. We compared the detection rate of rapid non-sedated brain MRI to CT for traumatic head injury in young children. We reviewed a series of children 6 years of age or less who presented to our ED during a 5-year period with head trauma and received a non-sedated brain MRI and CT within 24 h of injury. Most MRI studies were limited to triplane T2 and susceptibility sequences. Two neuroradiologists reviewed the MRIs and CTs and assessed the following findings: fracture, epidural hematoma (EDH)/subdural hematoma (SDH), subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), and parenchymal injury. Thirty of 33 patients had radiologically identified traumatic injuries. There was an overall agreement of 82 % between the two modalities. Skull fracture was the only injury subtype which had a statistically significant difference in detection between CT and MRI (p?=?0.0001), with MRI missing 14 of 21 fractures detected on CT. While not statistically significant, MRI had a higher detection rate of EDH/SDH (p?=?0.34), SAH (p?=?0.07), and parenchymal injuries (p?=?0.50). Non-sedated MRI has similar detection rates to CT for intracranial injury in young children presenting with acute head trauma and may be an alternative to CT in select patients.     

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.     

彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

目的 探讨彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值.方法 回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案.观察记录术中超声诊断脑膨出的病因类别、部位特点(包括...     

颅脑损伤的迟发性CT表现

目的：探讨颅脑损伤的迟发性CT表现，提高颅脑损伤的正确诊断率。方法：搜集颅脑损伤后首次检查阴性复查阳性者7例及首次检查阳性复查病变加重和／或出现新病变者74例，共81例，每例检查2-12次不等。结果：本组颅脑损伤主要迟发性表现有颅脑血肿、脑挫裂伤、蛛网膜下腔出血、脑水肿、硬膜下积液、幕下疝、弥漫性轴索损伤等。结论：颅脑损伤者经保守治疗恢复缓慢或病情进行性加重，应考虑有迟发性病变的可能性，必要时CT复查。     

Diagnostic sensitivity of computerized tomography in closed trauma of the diaphragm. Retrospective study of 35 consecutive cases

PURPOSE: To evaluate the effectiveness and role of CT in blunt diaphragmatic injuries by reviewing our 8-year experience. MATERIAL AND METHODS: We reviewed the preoperative CT findings of 35 patients with surgically confirmed diaphragmatic rupture. Surgical repair was performed in the acute setting (within 12 hours of trauma) in 22 cases, and late (8 months-5 years) in 13 cases. Twenty-eight patients (80%) were examined with conventional CT and 7 (20%) with Helical CT. Scans were initiated at the thoracic inlet to the pubic symphysis, with 8-mm slice thickness, after i.v. contrast agent administration. Four-mm slices were acquired in the region of interest; sagittal and coronal reformations were obtained for Helical CT images. RESULTS: In the acute group, 20 patients had left hemidiaphragmatic and 2 right hemidiaphragmatic rupture; thoracic herniation of the abdominal organs was seen in all cases. Of the 13 patients examined long after trauma, the left hemidiaphragm was ruptured in 12 cases (with visceral herniation in 4), and the right hemidiaphragm in 1, with no herniation. The diaphragmatic rent was found in the dome (15 cases, 43%), musculotendinous junction (11 cases, 31%), muscular portion (8 cases, 23%), and at the muscular attachments on the ribs (1 case, 3%). CT diagnosed diaphragmatic rupture in all the acute cases (22/35 patients, 63%) and in 4 patients with visceral herniation (11%) examined long after trauma. CT findings were questionable in the 9 cases (25%) not presenting visceral herniation. As for the site of diaphragmatic injury, CT never depicted the diaphragmatic rent in the dome and at the musculotendinous junction (74%), not even with thin slices and the multiplanar Helical technique. CT detected indirects signs of injury at the muscular portion (23%), showing the injury site directly in the case with diaphragmatic avulsion (3%). CONCLUSION: CT is a reliable tool in the diagnosis of suspected diaphragmatic injury in the acute trauma setting. Long after trauma, CT performs poorly because it depicts the diaphragmatic rent only in some peripheral traumas. Helical CT has greater diagnostic potentials, but the injury site and type do affect its capabilities.