急性外伤性小脑幕裂孔下疝的CT诊断与临床(附40例分析)

目的：提高对急性外伤性小脑幕裂孔下疝ＣＴ改变的认识。方法：回顾性分析４０例经临床证实的急性小脑幕裂孔下疝的ＣＴ表现。结果：海马钩回移位征１３例（３２．５％）；脑干变形３３例（８２．５％），移位２９例（７２．５％），旋转８例（２０％）；脑干周围池不同程度的变形、闭塞；临床疝晚期患者中，第四脑室严重变形、闭塞者１２例（９２．３％）。结论：ＣＴ为临床判断急性小脑幕裂孔下疝的形成程度提供可靠的影像学依据。第四脑室的变形、闭塞可作为ＣＴ诊断晚期疝的主要依据。     

小脑幕切迹下疝的CT诊断

目的 确定小脑幕切迹下疝的CT表现。方法 回顾性分析经临床证实的68例小脑幕切迹下疝的CT表现。结果 CT显示因脑组织移位及中脑本身受压移位导致单侧或双侧鞍上池改变60例、脚间池改变56例、环池改变52例、四叠体池改变50例。多数为前疝和半环疝。均有脑干的移位、旋转及变形改变，可伴有四脑室的变窄、闭塞及幕上占位病变的一系列改变。结论 参考原发病变的占位程度，脑干与脑干周围脑池两CT改变均存在并结合起来分析，可作出正确诊断。     

小脑幕硬膜下血肿并小脑幕切迹下疝的CT分析

目的：分析小脑幕硬膜下血肿并小脑幕切迹下疝CT表现，探讨其形成机制，提高对该病的早期CT诊断水平。材料和方法：收集资料完整的小脑幕硬膜下血肿并小脑幕切迹下疝27例，并分析CT表现。结果：小脑幕硬膜下血肿主要CT表现为小脑幕区的条片状高密度影边界清楚或模糊；小脑幕切迹下疝主要CT表现为幕上脑组织疝出、脑池变窄或闭塞、脑干受压移位及中线移位。结论：采用适当的CT扫描方法，可准确诊断小脑幕硬膜下血肿并小脑幕切迹下疝。     

小脑幕切迹疝CT诊断及临床价值

目的:探讨小脑切迹疝的CT早期表现及临床应用价值。方法:对临床诊断为小脑切迹疝75例CT表现和临床分型进行分析。结果:小脑切迹疝CT表现鞍上池、脚间池、环池、四叠池缩小变形或闭塞分别占52/75、52/75、47/75、20/75。中脑变形移位33/75,脑室系统扩张(侧、三脑室)7/75,蛛网膜下腔出血占26/75。临床分前疝、后疝、全疝、环疝,各占24/75、31/75、16/75、4/75。行脑定位抽吸术治疗27例,外科手术34例。结论:小脑切迹疝CT表现具有特征性,脑疝早期可无典型脑疝临床表现,而CT检查可早期诊断,且优于其他检查。     

小脑幕切迹下疝的螺旋CT诊断价值

目的:探讨小脑幕切迹下疝的螺旋CT扫描行MPR(多平面重建)像观察的诊断价值。方法:分析37例小脑幕切迹下疝患者的螺旋CT扫描临床资料。结果:与斜坡垂直的冠状MPR图像可直观显示上下关系改变,显示幕上脑组织挤入幕下2~4 mm 7例,4~6 mm 18例,>6 mm 12例;病变位于脑干侧前方3例,侧方25例,侧后方9例。脑干不同程度受压变形、移位。部分可见同侧邻近及以下环池的扩大(22例)。结论:根据螺旋CT扫描横断位提示,结合MPR图像对直接病理改变征象的观察分析,在小脑幕切迹下疝的诊断中具有重要的意义和价值,应作为诊断依据。     

脑室肿瘤的CT定位诊断

目的:评价CT对脑室及脑室旁肿瘤的定位诊断的价值和分析CT定位误诊的原因。材料和方法:回顾分析我院近五年的手术和病理证实的脑室和脑室旁肿瘤50例。术前均经CT检查。本文将病例分为四组分别从脑水肿,脑积水、脑室外压及脑室闭塞等征象加以分析和讨论。第一组:肿瘤起源脑室位于脑室内17例;第二组:肿瘤起源于脑室并突向脑室外13例;第三组:肿瘤起源于脑室外向脑室内生长9例;第四组:肿瘤位于脑室旁12例。结果:第一组脑积水为100％,但无脑水肿和脑室受压;第二组脑积水占84％,脑水肿占60％(轻度脑水肿45％,中度脑水肿15％),脑室受压占23％;第三组脑积水和脑水肿均为100％,脑水肿轻度占67％,中度占33％,脑室受压占56％;第四组脑积水占92％,脑水种为73％(轻度占50％,中度占23％),脑室受压为100％,中线移位67％。CT术前定位诊断误诊率达42％。结论:CT对位于脑室内实质性肿瘤可作出准确定位。对脑室内囊肿不易准确作出判断。对于第二、三组病例的起源的鉴别可根据脑室是否闭塞以及脑水肿的情况得以初步结论。对于脑室外肿瘤可以观察脑室受压加以鉴别。CT定位不准主要对脑水肿的改变,脑室闭塞与否的改变及脑室内囊性病变的认识。     

早期小脑幕疝的CT及MR诊断及临床价值的研究

目的:探讨CT及MR诊断早期小脑幕疝的标准及临床价值。方法:选取79例无瞳孔改变的偏侧占位效应明显的患者与100名无明显颅脑症状及体征的志愿者作为对照,研究诊断早期小脑幕疝的标准及临床价值。结果:对照组100名志愿者经CT及MRI检查未发现小脑幕疝征象。实验组CT发现小脑幕疝49例,MR发现57例。其中平行斜坡垂线CT扫描发现41例,平行于斜坡CT扫描发现19例。结论:平行斜坡垂线CT及MRI均可对早期小脑幕疝做出诊断,对指导制定治疗方案具有重要意义。     

小脑内脊索瘤1例报告

脊索瘤 (chordoma)为先天性肿瘤 ,来源于胚胎脊索残余。原发于小脑内非常罕见 ,我院发现 1例 ,经手术证实 ,报告如下。男 ,2 3岁 ,间断头痛、头晕 2个月 ,无视物旋转及吞咽呛咳。体检 :双侧视乳头水肿 ,无肢体活动障碍及共济失调。CT表现 :右侧小脑半球及蚓部可见一椭圆形低密度影 ,CT值 2 6HU ,其下方呈高密度 ,CT值 5 4.9HU ,二者之间形成液液平面。病灶周边有一均匀的高密度厚壁 ,病灶约 3 .8cm× 4cm大小。增强扫描见病变呈明显环状强化 ,CT值 63 .3HU。病灶内部无增强。肿瘤周边有轻度水肿 ,四脑室受压变形向前方移位。幕上脑室…     

颅脑损伤后小脑幕切迹疝263例CT分析

小脑幕切迹疝是颅脑损伤引起的临床急症。CT在诊断颅脑损伤的同时可显示小脑幕切迹疝的征象。1991年10月～1998年6月,我院诊治颅脑外伤后小脑幕切迹疝263例,均有完整的CT资料,报告如下。1　临床资料1.1　一般情况　本组男186例,女77例;年龄1～86岁,平均40岁。颅脑损伤后1～72h行CT检查,均有不同程度的脑疝征象,如剧烈头痛、呕吐等颅内高压症状和意识障碍、瞳孔改变、偏瘫等。1.2　原发性颅脑损伤　硬膜下血肿35例(51.3%),硬膜外血肿51例(19.4%),脑内血肿43例(16.3%),脑肿胀并脑挫裂伤20例(7.6%),脑挫裂伤并脑室出血6例(2.3%),弥漫性轴索…     

CT诊断早期颞叶型天幕疝的标准及临床价值

目的：探讨CT诊断早期颞叶型天幕疝的标准及临床价值。方法：选择138例偏侧占位效应明显的患者及100例无颅脑症状及体征的志愿者，应用斜坡垂线扫描法进行CT扫描，研究早期颞叶型天幕疝的CT表现及临床价值。结果：斜坡垂线扫描图像上，74例显示天幕疝的直接征象即小脑幕内侧环池内软组织块，与颞叶组织相延续。颞叶疝至幕下3.0mm以内者5例，疝至幕下3.0-6.0mm者28例，疝至幕下6.0mm以上者41例。100例正常人中98例颞叶组织位于小脑膜外侧，仅2例在小脑幕切迹层面上见到颞叶位于小脑幕内介。结论：①早期颞叶型天幕疝的CT诊断标准为：颞叶伸入幕下≥3.0mm可诊断为颞叶下疝；＜3.0mm应视为可疑。以颞叶下移3.0mm为阈值诊断颞叶下疝的敏感度为90.7%，特异度为100%，准确度为90.7%；②早期颞叶型天幕疝的影像诊断对指导临床治疗具有重要意义。     

Diaphragmatic hernia: diagnostic approaches with review of the literature

Because surgical repair is indicated for the treatment of diaphragmatic hernia (DH), preoperative imaging of the diaphragmatic defect, hernia content, and associated complications with other organ's pathologies is important. While various techniques can be used on imaging of DHs, selection of the most effective but the least invasive technique will present the most accurate findings about DH, and will facilitate the management of DH. We reviewed the diaphragmatic hernia types associated with our cases, and we discussed the preferred imaging modalities for different DHs with review of the literature. We evaluated the imaging findings of 21 DH cases. They were Morgagni's hernia (n=4), Bochdalek hernia (n=2), iatrogenic DH (n=4), traumatic DH (n=6), and hiatal hernia (n=5). Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. With high sensitivity for soft tissue, MR imaging may be performed in the selected patients, on the late presenting DH cases or on the cases of the diagnosis still in doubt especially.     

高分辨率64层螺旋CT在鼻骨骨折法医鉴定中的应用价值

目的评价高分辨率64层螺旋CT(HR-MSCT)扫描在鼻骨骨折法医鉴定中的应用价值。方法收集自我院200例(包括外伤性180例和非外伤性20例)鼻骨骨折患者均经颅面部HR-MSCT扫描。其中,180例外伤性鼻骨骨折患者依据其CT表现分为3种类型:Ⅰ型为单侧或双侧鼻骨骨折,断端无明显错位或成角,Ⅱ型为单侧或双侧鼻骨骨折,伴有明显的断端错位(大于1/2)或明显的成角(大于等于45°),Ⅲ型为粉碎性骨折。结果在200例患者中,外伤性与非外伤性鼻骨骨折患者分别见于180例和20例。研究证实,在180例外伤性鼻骨骨折患者中有Ⅰ型41例,Ⅱ型35例以及Ⅲ型104例。结论 HR-MSCT扫描可清晰显示鼻骨骨折的部位、范围、积液,并能对外伤性骨折准确分型,为司法鉴定及临床诊治提供可靠依据。     

后颅窝脑实质出血穿入脑室系统的CT研究

目的：探讨后颅窝出血经脑室系统弥散的CT表现及临床意义。方法：回顾性分析23例后颅窝出血的CT检查资料。结果：后颅窝出血经脑室系统弥散者12例,其中第四脑室积血12例,第三脑室积血9例,侧脑室积血8例。后颅窝出血穿入脑室与血肿体积有明显关系（P＜0．01）,第三脑室扩大在脑室积血与非积血者之间有显著差异（P＜0．01）。结论：后颅窝出血可穿入第四脑室并经脑室系统弥散。CT检查对于发现病因及制定治疗方案具有重要意义。     

成人外伤性脑梗死的CT诊断

目的 探讨成人外伤性脑梗死的影像特点.方法 分析30例成人外伤性脑梗死的临床与CT资料.结果 脑叶梗死17例,基底节-内囊区梗死13例,伴蛛网膜下腔出血15例,硬膜下血肿9例,硬膜外血肿3例,脑内血肿3例,脑疝5例,出血性脑梗死2例.结论 CT发现成人外伤性脑梗死的最佳时间是外伤后24 h～6 d,梗死多伴有颅脑损伤的其他CT表现,临床结合动态CT观察是诊断成人外伤性脑梗死的有效方法.     

膈疝的影像学特征及检查方法评价

目的：分析膈疝的影像学特征,并对检查方法进行比较。材料与方法：本组１６例包括滑动性食管裂孔疝４例,不可复性食管裂孔疝２例,胸腹膜裂孔疝３例,胸骨旁裂孔疝３例,创作性膈疝４例,１４例摄胸片,１２例作钡餐,２便作钡灌肠,４便作胸部ＣＴ,４例作Ｂ超结果：１２便膈疝钡餐清楚显示胃、小肠或结肠疝入胸腔内,２例膈疝钡灌肠清晰显示结肠肝曲疝入胸腔,２例膈疝ＣＴ显示部门胃腔疝入胸腔。结论：当膈疝内容物为消化道腔脏     

Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria

PURPOSE: To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis. MATERIALS AND METHODS: Retrospective review of medical records revealed 17 patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images. RESULTS: CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients. CONCLUSION: Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.     

Value of high-resolution computed tomography in evaluating cervical herniated disks

Previous difficulties in the diagnosis of cervical disk hernia were related to lack of non-invasive imaging techniques, but the gap has now been filled by CT scan imaging. A total of 442 patients with pains in neck, shoulder or arm were referred for a CT scan to exclude a cervical disk hernia. Of the group studied, 2% were found to have a herniated disk, 16% a lateral hernia and 9% combined lateral hernia-narrow cervical canal due to concomitant arthrotic changes. Assessment of correlation between CT scan images and myelographic and surgical findings indicated that CT scan imaging is a very precise, non-invasive method for investigation of cervical disk hernia.     

Chest radiographic findings after bilateral lung transplantation

We reviewed the postoperative chest radiographic and CT findings in the first 13 patients who underwent bilateral lung transplantation at our institution. Portable chest radiography was performed daily for about 10 days, after which upright posteroanterior studies were performed daily for about 10 days, and then as clinically required. CT was performed when a complication was suspected. The reimplantation response (noncardiogenic pulmonary edema due to ischemia, trauma, denervation, and lymphatic interruption) occurred in 12 patients and usually consisted of bilateral perihilar and basal consolidation. Twelve episodes of acute rejection, an imprecise clinical diagnosis, occurred in 10 patients. Radiographic changes consisted of bibasal (n = 2), right mid and lower (n = 2), or left basal consolidation (n = 1); there were no changes in seven episodes. Radiographic resolution occurred in four cases after administration of IV steroids. The radiographic findings associated with the reimplantation response and rejection were nonspecific and were mimicked by fluid overload and infection. Bronchial dehiscence and/or stricture formation occurred in seven patients; generally chest radiography was inaccurate and CT was very accurate in the assessment of these complications. Chest radiography was helpful but not definitive in sorting out the problems occurring in the postoperative period after bilateral lung transplantation. CT was excellent for use in demonstrating airway problems.     

多层螺旋CT诊断肠梗阻的临床应用价值

目的探讨多层螺旋CT诊断肠梗阻性质及病因的临床价值。方法回顾分析经临床手术病理证实为肠梗阻的22例患者的CT平扫和/或强化资料,并与手术病理结果对照,分析肠梗阻的CT表现。结果 22例患者CT均诊断为肠梗阻,20例(91%)病因诊断与手术病理一致,包括肠道肿瘤3例,肠粘连6例,肠套叠2例,斜疝2例,小网膜囊疝1例,肠扭转2例,肠系膜上动脉栓塞1例,粪石3例。结论多层螺旋CT能快速准确的显示肠梗阻的部位及病因,并能清晰显示肠管周围情况,对临床治疗方案及预后评估有重要价值。