儿童外伤性腔隙性脑梗塞的CT诊断

目的　探讨CT对外伤性腔隙性脑梗塞的诊断价值及其特征。方法　对 2 6例颅脑外伤后临床主要表现为不同程度偏瘫患儿行横断CT扫描。结果　外伤性腔隙性脑梗塞好发于基底节内囊区 ,均位于豆状核、尾状核和内囊区 ,呈斑片腔隙性低密度影。结论　CT对外伤性腔隙性脑梗塞的诊断、评估病变的程度及其预后有重要价值     

外伤性腔隙性脑梗塞的CT诊断

探讨ＣＴ在外伤性腔隙性脑梗塞诊断中的价值及其特征。材料与方法对３６例头颈外伤后,临床上主要表现为不同程度的偏瘫患者均行横位ＣＴ扫描。结果外伤性腔隙性脑梗塞好于基底节－内囊区,均位于豆状核、尾状核及内囊区,呈小片腔隙性低密度影响。结论ＣＴ扫描检查对外伤性脑梗塞的准确诊断,估计病变程度,预后及法医学鉴定及肯定价值。     

外伤性脑梗死的CT诊断(附39例分析)

目的：探讨螺旋CT在外伤性脑梗死诊断中的价值及其特征。方法：对39例头颈部外伤后临床主要表现为不同程度的偏瘫患者行横断面螺旋CT扫描，分析外伤性脑梗死的CT表现。结果：根据临床和CT表现分为两型：I型(21例)，外伤性腔隙性脑梗死，好发于基底节-内囊区，均位于豆状核、尾状核及内囊区，呈小片状腔隙性低密度区；Ⅱ型(18例)，外伤性大面积脑梗死，为脑叶梗死呈扇形低密度区，与大脑前中后供血动脉或颈内动脉分布一致，范围较大。结论：螺旋CT扫描检查对外伤性脑梗死的准确诊断、估计病变程度，分析两型脑梗死的不同发生机制，为临床诊断、治疗及判断预后提供重要信息。     

小儿外伤性基底节区腔隙性脑梗塞的CT与临床

目的：研究小儿外伤性基底节区腔隙性脑梗塞的临床与CT表现。探计其形成的机理、CT诊断价值及预后。方法：对10例有明确颅外伤史，临床上主要表现为偏瘫、癫痫等症状的小儿均作头颅CT平扫。结果：10制均为单发腔隙性脑梗塞，其中3例双侧基底节区有小钙化灶。结论：小儿外伤性基底节区腔隙性脑梗塞产生的机理可能是脑外伤引起脑血管痉挛性闭塞所致脑缺血性坏死。CT扫描对其诊断的确立和估计预后有重要价值。     

小儿外伤性脑血管闭塞(附10例报告)

目的：研究小儿外伤性脑血管闭塞的临床与ＣＴ表现。探讨其形成的机理及ＣＴ诊断价值。方法：对１０例有明确颅外伤及伤后肢体偏瘫等体征的幼儿进行了ＣＴ扫描观察并记录。结果：２例正常，１例大面积脑梗塞、７例腔隙性脑梗塞（１例于丘脑、６例于内囊）。结论：外伤性腔隙性脑梗塞在幼儿中常见，而且大部分病变都发生在内囊（６∶１）。其产生的机理可能是脑外伤引起脑血管痉挛性闭塞所致脑缺血性坏死。ＣＴ扫描对其诊断的确立具有重要价值     

螺旋CT平扫在腔隙性脑梗塞诊断中的应用价值

目的：探讨螺旋CT平扫在腔隙性脑梗塞诊断中的应用价值。方法：回顾性分析本院螺旋CT扫描,分别采用5 mm及10 mm不同层厚观察临床及其它检查诊断为腔隙性脑梗塞病例200例。结果：5 mm层厚扫描100例,诊断为腔隙性脑梗塞95例,共发现病灶120个;10 mm层厚扫描100例,诊断腔隙性脑梗塞50例,发现病灶51个。结论：螺旋CT、5 mm以下层厚扫描是诊断腔隙性脑梗塞的可靠方法。     

成人外伤性脑腔隙性梗死的CT诊断

目的：了解成人外伤性脑腔隙性梗死毋特点。方法：分析15例外伤性脑腔隙性硬死的CT表现。结果：成人外伤性脑腔隙性梗死常继发干颅脑外伤，CT表现为基底节区腔隙性梗死或脑叶内点状梗死，可伴脑水肿和颅内血肿等颅脑损伤征象。结论：CT对外伤性脑腔隙性梗死的诊断有重要价值。     

CUBE-T_2WI序列在显示腔隙性脑梗塞中的应用

目的探讨应用CUBE-T_2WI序列诊断腔隙性脑梗塞的优势。方法采用1.5T磁共振仪分别对35例腔隙性脑梗塞患者行头颅MRI CUBE-T_2WI序列及T2WI序列扫描,分析不同扫描序列所得图像,评价CUBE-T_2WI序列对腔隙性脑梗塞的诊断价值。结果对于35例腔隙性脑梗塞患者,CUBE-T2WI序列显示378个腔隙灶,其中顶叶79个,额叶147个,丘脑13个,内囊36个,基底节68个,脑干18个,小脑17个。T_2WI序列显示273个腔隙灶其中顶叶58个,额叶112个,丘脑9个,内囊28个,基底节43个,脑干13个,小脑10个。结论 CUBE-T_2WI序列较T_2WI序列对腔隙性脑梗塞的诊断更清晰、准确,提高了腔隙性脑梗塞小病灶的检出率。     

小儿外伤性腔隙性脑梗塞（附28例临床及CT分析）

报告２８例小儿外伤性脑梗塞，无发生于头部摔伤后（伤势不重），临床上主要表现为不同程度的偏瘫，梗塞灶均位于豆状，尾状核及内囊区，呈小片腔隙性。其中５７％的患儿双侧豆状核区有细小点状钙化。作者讨论了这种脑梗塞的发生机制、临床、ＣＴ特征以及预后。     

皮层下动脉硬化性脑病的CT诊断

目的探讨皮层下动脉硬化性脑病的CT诊断价值。方法回顾分析50例经我院CT诊断并治疗的皮层下动脉硬化性脑病。结果50例均呈弥漫性脑白质对称性低密度改变，并不同程度脑萎缩，48例伴腔隙性脑梗塞。结论皮层下动脉硬化性脑病是中老年人的常见脑血管病病，CT表现具有特征性，可明确诊断，可早期发现该病，是目前诊断本病的首选方法。     

MR imaging in "lacunar" hemiballismus

We compared cranial CT and proton magnetic resonance imaging in two patients with hemiballismus secondary to lacunar infarctions. Magnetic resonance, but not CT, showed lacunar infarctions in the subthalamic nucleus. To confirm the location of the infarctions, we measured the distance of the lacunae from the anteroposterior commissure line in three planes (sagittal, axial, and coronal) and demonstrated that the infarctions were located in the lateral part of the subthalamic nucleus.     

Potential Influence of Acute CT on Inpatient Costs in Patients with Ischemic Stroke

RATIONALE AND OBJECTIVES: Patients presenting with ischemic brain symptoms have widely variable outcomes dependent to some degree on the pathologic basis of their stroke syndrome. The purpose of this study was to determine the cost implications of the emergency use of a computed tomographic (CT) protocol comprising unenhanced CT, head and neck CT angiography, and whole-brain CT perfusion. MATERIALS AND METHODS: By using a retrospective patient database from a tertiary care facility and publicly available cost data, the authors derived the potential savings from the use of CT angiography. CT perfusion, or both at hospital arrival by means of a cost model. The cost of the CT angiography-CT perfusion protocol was determined from Medicare reimbursement rates and compared with that of traditional imaging protocols. Cost savings were estimated as a decrease in the length of stay for most stroke patients, whereas the most benign (lacunar) strokes were assumed to be managed in a non-acute setting. Misdiagnosis cost (erroneously not admitting a patient with nonlacunar stroke) was calculated as the cost of a severe complication. Sensitivity testing included varying the percentage of misdiagnosed patients and admitting patients with lacunar stroke. RESULTS: The nationwide net savings that would result from the adoption of the CT angiography-CT perfusion protocol are in the $1.2 billion range (-$154 million to $2.1 billion) when patients with lacunar strokes are treated nonacutely and $1.8 billion when those patients are admitted for acute care. CONCLUSION: The results demonstrate the potential effect of implementing a CT angiography-CT perfusion protocol. In particular, prompt CT angiography-CT perfusion imaging could have an effect on the cost of acute care in the treatment of stroke.     

Prediction of neurologic deterioration in patients with lacunar infarction in the territory of the lenticulostriate artery using perfusion CT

BACKGROUND AND PURPOSE: A significant proportion of patients with lacunar infarctions experience neurologic deterioration after onset. However, no clinical examination has been established for prediction of the progress of symptoms. To determine the hemodynamic predictors of such progression, we performed perfusion CT to quantitatively assess cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) of patients with lacunar infarctions in the territory of the lenticulostriate artery. METHODS: We performed MR imaging and perfusion CT of 26 patients with lacunar infarction within 24 hr after onset. On the CBF map on perfusion CT scans, a round small region of interest was set at the region, with decreased CBF in the territory of the lenticulostriate artery (region of interest 1). Another region of interest was set in the mirror position to region of interest 1 in the contralateral hemisphere (region of interest 2). Using these two regions of interest, CBF, CBV, and MTT were measured. All patients underwent neurologic and MR imaging follow-up while receiving equivalent medical treatment. RESULTS: Neurologic deterioration after onset was shown in 13 patients (progress group), whereas no neurologic deterioration was shown in the other 13 patients (control group). In the progress group, lacunar infarctions were enlarged on follow-up MR images. The ratio of region of interest 1/region of interest 2 showed significantly lower CBF and higher MTT in the progress group than in the control group. CONCLUSIONS: These results suggest that progressive lacunar infarction in the territory of the lenticulostriate artery could be predicted with a higher MTT ratio (>1.26) and a lower CBF ratio (<0.76) on perfusion CT scans obtained within 24 hr after onset.     

头颈部CT血管成像数据的综合应用

目的:探讨头颈部血管成像检查同时行血管周围组织器官成像的应用价值.方法:对30例可疑颈动脉狭窄的患者进行16层螺旋CT头颈部血管成像检查,除常规血管成像外,并行颈椎、颈部软组织、颅脑、副鼻窦成像.结果:30例患者发现15例颈椎椎体骨质增生,10例颈椎间盘突出,6例甲状腺瘤,8例腔隙性脑梗死,2例透明隔囊肿,5例副鼻窦炎.结论:16层螺旋CT头颈部血管成像检查不仅可以清晰显示头颈部血管,而且对血管周围组织器官病变的显示也有很高的价值.     

肝豆状核变性的颅脑CT分析

目的 :分析肝豆状核变性的颅脑CT表现 ,评价CT对肝豆状核变性的临床诊断价值。方法 :对临床及实验室检查证实的 110例肝豆状核变性患者均进行颅脑CT平扫 ,部分给予增强扫描。结果 :颅脑CT无异常发现 2 0例 ,有异常发现 90例 ,阳性率为 81.8%。主要表现为各灰质核团区显示低密度影和 /或脑萎缩改变。其中双侧或单侧豆状核 5 2例 (单侧 8例 ) ,双侧丘脑 2 9例 ,双侧大脑脚 4例 ,桥脑 2例 ,双侧尾状核头 2例 ,双侧侧脑室旁 2例 ,双侧额叶 2例 ,双侧小脑齿状核 1例。脑萎缩 60例 ,仅表现为脑萎缩者 2 2例。结论 :颅脑CT对肝豆状核变性有很高的诊断价值 ,可为临床提供诊断和治疗依据。     

大脑中动脉狭窄相关的脑梗塞20例临床分析

目的：分析了２０例大脑中动脉（ＭＣＡ）狭窄相关的脑梗塞患者的临床中风模式与神经影像（ＣＴ／ＭＲＩ）特点。方法；对经颅多普勒超声（ＴＣＤ）等确诊的２０例ＭＣＡ狭窄的脑梗塞患者进行临床与神经影像的对比分析，结果：２０例中，腔隙综合征１０例（５０％），ＣＴ／ＭＲＩ显示无病灶２例（１０％），基底节和内囊腔隙性脑梗塞８例（４０％）非腔隙综合征１０例（５０％），ＣＴ／ＭＲＩ显示ＭＣＡ皮层无梗塞９例（４５％），     

Repeated computed tomography in lacunar infarcts of the brain

This prospective and consecutive study of 74 patients with completed stroke elucidates occurrence, localization and evolution of lacunar infarcts on repeated CT examinations. Twenty patients had large infarcts (diameter greater than 3 cm), 25 medium-sized infarcts (diameter greater than or equal to 1.5 cm - less than or equal to 3 cm), and 16 had lacunar infarcts (diameter less than 1.5 cm). In 13 patients no infarct was seen. The lacunar infarcts were characterized by delayed appearance on CT, low incidence of fog effect, and infrequent presence of contrast enhancement. In 9 of the 16 patients (56%) the lacunar infarct could be identified on the first CT, performed approximately 3 days after the stroke. In 2 patients the infarct was first revealed on the second (2 weeks post stroke) and in 5 on the third CT (6 months post stroke). The delayed appearance might be due to a partial volume effect. Early development of fog effect may also be considered. As contrast enhancement was observed in only 8 per cent of the patients with lacunar infarcts on CT, and in 70 per cent of the entire group of patients in our series with ischemic infarcts, contrast enhancement seemed to be a function of lesion size.     

MR and CT of lacunar infarcts

Twenty-two patients with clinical signs and symptoms compatible with lacunar transient ischemic attack or stroke of varying chronicity were evaluated with MR imaging. CT was also performed in 21 of these patients. MR revealed small, deep cerebral lesions in locations appropriate to the clinical symptoms in 19 patients. Lacunar infarcts were imaged by CT in 11 patients; however, no lesions were identified on CT that were not detected with MR. Presumed lacunar infarcts were identified on MR images in 17 additional patients. Lacunae generally appeared as focal areas of decreased signal intensity on T1-weighted images and as focal areas of increased signal intensity on T2-weighted images. T2-weighted MR images detected a greater number of lacunar infarcts than did mixed T1-/T2-weighted images, which in turn detected more lacunae than did T1-weighted images. In general, acute lacunar infarcts (within 1 week of onset or recurrence of clinical symptoms) were seen only on T2-weighted images, while chronic lesions (more than 1 week) were seen on both T1- and T2-weighted images. Our results indicate that MR is superior to CT for evaluating lacunar infarcts, and second, that T2-weighted images are more sensitive than T1- and mixed T1-/T2-weighted images for detecting lacunar infarcts.