头颅移动CT灌注扫描对重型颅脑损伤患者的临床价值

目的 探讨移动CT灌注扫描（CTP）在重型颅脑损伤（TBI）患者中的临床应用价值。方法 2015年4~9月我院神经外科重症监护室收住重型TBI患者26例,受伤24 h之内同时进行头颅CT平扫（CT1）和移动CTP,并在5 d后复查头颅CT平扫（CT5）。CTP提供脑血流量（CBF）影像、脑血容量（CBV）影像及平均转运时间（MTT）影像;将CTP影像、CT1及CT5进行比较。结果 CTP平均在伤后（15.6±4）h进行。16例（61.5%）患者CTP影像显示灌注改变区域大于CT1显示的病灶区域,其中7例（27%）患者低灌注程度达到缺血水平。3例（11.5%）患者通过CTP扫描发现严重的脑灌注不足,尽管在CT5上并没有明显的缺血梗死表现,根据CTP结果,改变此3例患者的治疗方案,最终只有1例发生严重脑梗死,另外2例恢复良好。与CT1相比,CTP与CT5结果具有更好的一致性。结论 头颅移动CTP可以在创伤后早期对重型TBI患者的脑血流灌注情况作出较为准确的评估,为临床干预提供有力依据。     

犬颅脑爆炸伤后CT诊断价值的实验研究

目的探讨爆炸性武器冲击波原发效应致伤颅脑后的cT诊断价值。方法将1gTNT当量的球型爆炸源置于距右颞顶部不同距离（5mm、9mm、13mm）对犬的颅脑部引爆致伤，制造动物模型，伤后即时、6h后、12h后、24h行头颅CT冠状扫描，观察CT表现。结果伤后即时扫描发现了额窦积血、脑挫裂伤、硬膜下出血、硬膜外血肿、颅内血肿、气颅及颅骨骨折等阳性表现，动态CT扫描追踪到了脑挫裂伤病灶的低密度范围扩大趋势。结论通过首次CT检查，可以确定颅脑爆炸伤的具体伤情，连续CT扫描可以追踪颅内血肿、脑挫裂伤病灶的动态变化。     

The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department

BACKGROUND: The purpose of neuroimaging of a patient with new onset of seizures is to demonstrate cause and explore the prognosis. It was recently recommended that emergency brain computed tomography (CT) be performed only in adult seizure patients with an increased likelihood of life-threatening lesions, i.e., those with new focal deficits, persistent altered mental status, fever, recent trauma, persistent headaches, history of cancer, history of anticoagulation, or suspicion of acquired immunodeficiency syndrome. The objective of this study was to determine the diagnostic utility of emergency brain CT in children who present to the emergency department with new onset of seizures. METHODS: A 1-year retrospective chart review of all children who presented to the emergency department of the Schneider Children's Hospital with a new onset of seizures and who underwent CT of the brain, excluding children with simple febrile seizures. RESULTS: Sixty-six patients, 34 boys and 32 girls with a mean age of 4.9 years, qualified for inclusion in the study. Fifty-two patients (78.8%) had normal CT results and 14 patients (21.2%) had abnormal CT results. Seizure cause was considered cryptogenic in 33 patients, of whom 2 (6%) had abnormal CT results; neither patient required intervention. Seizure cause was considered symptomatic in 20 patients, of whom 12 (60%) had abnormal CT results (p < 0.0001). In two patients with abnormal CT scans (both acute symptomatic), the imaging findings were of immediate therapeutic significance and were predictable from the clinical history and the physical examination. None of the 13 patients with complex febrile seizure cause had an abnormal CT scan. Patients with partial convulsive seizures were more likely to have abnormal CT scans than patients with generalized convulsive seizures, but the difference was not statistically significant. CONCLUSIONS: The routine practice in many pediatric emergency departments of obtaining brain CT scans for all patients with new onset of nonfebrile seizures is unjustified. History and physical examination are sufficient to identify those patients for whom such studies are likely to be appropriate. Emergent CT is not indicated for patients with no known seizure risk factors, normal neurological examinations, no acute symptomatic cause other than fever, and reliable neurological follow-up. For these patients, referral to a pediatric neurologist for further workup, including electroencephalography and the more diagnostically valuable magnetic resonance imaging, would be more appropriate.     

320排CT在短暂性脑缺血发作中的应用价值初探

目的 初步探讨320排容积CT在短暂性脑缺血性发作(TIA)的应用价值. 方法 在11例TLA患者发作间隙期应用320排容积CT进行一站式CT扫描,收集患者的头颅平扫、CT血管造影(CTA)及全脑灌注的信息,对影像资料进行综合分析.观察TIA患者的脑血管及其组织单元的病变情况. 结果 11例患者头颅CT平扫均未发现明确的责任病灶,3例行MRI无阳性发现;CTA结果显示,10例患者责任病灶区域内脑血管网明显稀疏,8例发现有相对应的血管明显变细,2例血管栓塞同时存在代偿血管形成.11例全脑灌注图像显示与临床症状相对应的灌注区达峰时间、平均通过时间延迟,5例脑血流量下降,3例脑血容量轻度增加. 结论 320排容积CT灌注成像可以通过一次对比剂注射,获得常规CT扫描、全脑灌注、CTA的数据,实现对缺血性脑血管病的全面评估.

Abstract：

Objective To explore the application value of 320-slice volume CT in detecting the cerebral transient ischemic attack (TIA). Methods One-stop CT scan was performed at intermission of onset on 11 patients with cerebral TIA; the data of plain CT scans, CT angiography (CTA) and whole brain perfusion on these patients were collected. Analysis by synthesis was performed on these imaging data. Results No lesions responsible for the attack were found in the brains of 11 patients with TIA under plain CT scan; 3 of them performed MRI did not have positive results. CTA indicated that the vascular networks in 10 patients were obviously sparse in the region of lesions responsible for the attack;the corresponding vessels in 8 of them became thin; both vascular thrombosis and compensatory angiogenesis occurred in 2 patients. The cerebral perfusion indicated that perfusion areas corresponding to clinical symptoms displayed delayed mean transit time and time to peak level in these 11 patients.Decreased regional cerebral blood flow was noted in 5 patients and regional cerebral volume increased mildly in 3 patients. Conclusion The 320-slice-volume CT perfusion imaging can obtain the information about whole brain perfusion, routine CT scan and CTA by injecting a kind of contrast medicament for only one time, thus can assess the ischemic cerebrovascular disease comprehensively.     

磁共振关节内增强扫描评价膝关节骨质、半月板、韧带和关节软骨损伤的准确性：与常规磁共振扫描的比较

背景：常规磁共振检查可较为全面地显示关节内软组织的结构，但由于其成像后对比度欠缺等因素，在诊断关节内病变和损伤时仍存在一定的局限性。为了提高诊断的准确率，磁共振的增强扫描已应用于肝脏、脑等其他部位，但有关膝关节增强扫描的报道较少。 目的：评价磁共振关节内增强扫描对膝关节损伤诊断的临床应用价值。 方法：选择21例膝关节损伤患者(22膝)，采用美国GE公司生产的0.5T Signa Contour磁共振扫描仪先进行常规磁共振扫描。常规扫描完成后，向关节内注入增强剂，行关节内增强扫描。所有病例均由同一医师进行关节内增强操作，由两名副主任职称以上的医师进行阅片分析和对比。 结果与结论：所有病例在平扫中均发现有不同程度的关节结构损伤，包括骨质、半月板、韧带和关节软骨等。在磁共振增强扫描后进一步证实，其损伤的程度和范围上得到了更清楚的显示。同时，有2例平扫中误诊的半月板损伤，在增强扫描后得到否定；有的损伤部位在平扫中未发现的病变信号，在关节内增强扫描中被发现和证实。说明增强后磁共振扫描膝关节损伤的阳性率高于常规扫描。其中，增强前后半月板损伤诊断准确率差异有显著性意义(P =0.035)。提示，与常规扫描相比，磁共振关节内增强扫描可进一步提高膝关节损伤的诊断率。     

Brief Report: Approaches to 31P-MRS in Awake, Non-Sedated Children with and without Autism Spectrum Disorder

We piloted a suite of approaches aimed to facilitate a successful series of up to four brain and muscle (31)Phosphorus-Magnetic Resonance Spectroscopy ((31)P-MRS) scans performed in one session in 12 awake, non-sedated subjects (ages 6-18), 6 with autism spectrum disorders (ASD) and 6 controls. We targeted advanced preparation, parental input, physical comfort, short scan protocols, allocation of extra time, and subject emotional support. 100% of subjects completed at least one brain scan and one leg muscle scan: 42 of 46 attempted scans were completed (91%), with failures dominated by exercise muscle scans (completed in 6/6 controls but 3/6 cases). One completed scan lacked usable data unrelated to subject/scan procedure (orthodonture affected a frontal brain scan). As a group, these methods provide a foundation for conduct and enhancement of future MR studies in pediatric subjects with ASD.     

影响外伤性蛛网膜下腔出血病人预后的因素分析

目的 探讨可影响外伤性蛛网膜下腔出血（tSAH）病人治疗结果的因素及其CT变化的特点。方法 回顾性分析了一组连续收治的入院时经头颅CT检查确诊为tSAH的闭合性颅脑损伤病人资料，记录其入院时和病情加重时的头颅CT情况、入院时GCS评分、以Fisher分级法对出血量进行分级情况、伤后6个月以GOS评分法评估的治疗结果，并对数据加以统计分析。结果 多因素Logisitc回归分析显示，初次CT扫描tSAH出血量Fisher分级（OR=50．7，P〈0．001）、入院时GCS评分（OR=2．86，P〈0．001）、初次CT扫描基底池tSAH（OR=0．35，P=0．030）与tSAH患者的不良结果存在显著相关。最初CT显示脑挫裂伤与入院后CT出现恶化（OR=2．92，P=-0．003）及入院后CT示显著恶化（OR=3．21，P〈0．001）有显著相关性。结论 tSAH病人的治疗结果与入院时GCS评分、出血量及脑挫裂伤的存在或范围有关，这些也是头颅CT出现显著恶化的相关因素，说明头颅CT显示出的恶化与治疗结果是有其内在联系。     

头颅移动CT在NICU的临床应用价值

目的 探讨头颅移动CT在神经外科重症监护室（NICU）的应用价值。方法 我院2013年11月至2014年5月收治入住NICU病人388例,其中颅脑损伤75例,脑肿瘤155例,脑血管病119例,其他39例;共完成1 000例次头颅移动CT扫描。结果 从患者离开床位接受CT扫描至回到原先床位并妥善连接监测和支持设备所需的时间为（8.0±2.5）min,实际CT扫描所需时间为（2.5±0.6）min。200例接受1次移动CT扫描,87例接受2次移动CT扫描,34例接受3次移动CT扫描,67例接受3次以上的移动CT扫描,12例超过10次以上的移动CT扫描。每例患者在NICU接受CT扫描检查平均2.57次。移动CT影像学发现:一般术后改变共420例次,颅内出血共170例次,脑梗死共98例次,脑积水共84例次,脑水肿共106例次,颅内占位共95例次,其他发现共27例次。473例次（47.3%）显示阳性影像学发现（指需要立即干预的颅内病变如肿瘤残余、术区出血、迟发血肿、急性脑积水和脑肿胀等）。没有一个病人因移动CT图像质量问题而被重新送到放射科CT室行CT检查。结论 移动CT可为NICU患者提供及时可靠的影像学诊断,为临床干预提供强有力依据,操作便捷,使用安全。     

Serious Blood-Brain Barrier Disruption after Coil Embolization of Unruptured Intracranial Aneurysm : Report of Two Cases and Role of Immediate Postembolization CT Scan

Abnormal contrast enhancement on brain computed tomography (CT) scan after diagnostic or interventional angiography is not rare, and has known to be induced by temporary blood-brain barrier (BBB) disruption from contrast media. Furthermore, it has been regarded as clinically subtle, but reported to have no symptom or mild transient symptoms. However, we recently experienced two cases of serious BBB disruption during the acute period after coiling of an unruptured intracranial aneurysm. One patient presented with an unruptured paraclinoid internal carotid artery (ICA) aneurysm on the right and the other with an unruptured right supraclinoid ICA aneurysm. Both patients showed similar findings on immediate postembolization CT scan and clinical courses after coiling. Typical radiological, clinical characteristics of BBB disruption were described. In addition, the role of immediate postembolization CT scan are also discussed.     

Cerebrospinal fluid viral load is related to cortical atrophy and not to intracerebral calcifications in children with symptomatic HIV disease

The relationships between viral load in plasma and cerebrospinal fluid (CSF) and computed tomography (CT) brain scan abnormalities were studied in 39 children between 0.5 and 13 years of age with symptomatic HIV-1 disease. Quantitative RNA PCR was used to determine HIV-1 RNA levels and a semiquantitative analog rating technique was used to evaluate non-contrast CT brain scans. CSF HIV-1 RNA copy number correlated significantly with CT brain scan ratings for severity of cortical atrophy (r = 0.36; P < 0.05) but not with ratings of intracerebral calcifications (r = -12; NS). The difference between these two correlations was significant (P < 0.05). Plasma HIV-1 RNA copy number did not correlate significantly with any CT brain scan ratings or with CSF viral load (r = 0.05; NS). Severity of cortical atrophy appeared to reflect the level of viral load in the CSF, supporting the notion that active HIV-1 replication in the CNS is at least in part responsible for such brain abnormalities in children. The lack of correlation of intracerebral calcifications with other CT brain scan abnormalities as well as with CSF viral load suggests that this lesion is relatively independent and may reflect a different neuropathologic process.     

Erratum to: Brief Report: Approaches to 31P-MRS in Awake,Non-Sedated Children With and Without Autism Spectrum Disorder

We piloted a suite of approaches aimed to facilitate a successful series of up to four brain and muscle ³¹phosphorus-magnetic resonance spectroscopy scans performed in one session in 12 awake, non-sedated subjects (ages 6–18), 6 with autism spectrum disorders (ASD) and 6 controls. We targeted advance preparation, parental input, physical comfort, short scan protocols, allocation of extra time, and subject emotional support. One hundred percent of subjects completed at least one brain scan and one leg muscle scan: 42 of 46 attempted scans were completed (91 %), with failures dominated by exercise muscle scans (completed in 6/6 controls but 3/6 cases). One completed scan lacked usable data unrelated to subject/scan procedure (orthodonture affected a frontal brain scan). As a group, these methods provide a foundation for conduct and enhancement of future MR studies in pediatric subjects with ASD.     

Comparison of CT and MRI brain tumor imaging using a canine glioma model

A canine gliosarcoma model was used to study the effectiveness of magnetic resonance imaging (MRI) with gadolinium contrast enhancement in defining the histologic margins of brain tumors. The effectiveness of this technique was compared to conventional computed tomography (CT) using iodinated contrast enhancement. Cultured canine gliosarcoma cells were injected into the left hemisphere of adult mongrel dogs. The dogs developed brain tumors and progressive clinical signs. Serial MRI with and without gadolinium diethylene triamine penta-acetic acid was compared to serial CT with and without sodium iothalamate obtained on the same days. After the final scans, animals were sacrificed; the brains were removed and processed for routine histopathologic study. All tumors were visualized with contrast-enhanced MRI which proved most sensitive. Gadolinium di-ethylene triamine penta-acetic acid caused bright enhancement of tumors in a distribution that consistently corresponded to areas of pathologically proved tumor infiltration. Gross and microscopic autopsy findings correlated better with MRI than with CT which tended to produce poorer resolution and underrepresent the size of viable tumor. Gadolinium-enhanced MRI is more accurate than unenhanced MRI, unenhanced CT, or enhanced CT in defining the histologic margins of tumors.     

CT scan findings in mild head trauma: a series of 2,000 patients

The present study describes the cranial computed tomography (CT) scan findings of 2,000 cases of mild head trauma (HT) in Curitiba, Southern Brazil. The mean age of the entire series was 30.8 +/-19 years. The overall male to female ratio was 2:1. The most common causes of head injury were interpersonal aggression (17.9%), falls (17.4%), automobile accidents (16.2%), falls to the ground (13.1%) and pedestrian injuries (13 %). Alcohol intoxication was associated with HT in 158 cases (7.9%). A normal CT scan was seen in 60.75% (1215) and an abnormal CT scan in 39.25% (785) of patients. Out of 785 abnormal CT scan, 518(65.9%) lesions were related to HT. The most common CT scan HT related findings were: soft tissue swelling (8.9 %), skull fractures (4.3 %), intracranial and subgaleal hematomas (3.4% and 2.4 %), brain swelling (2 %) and brain contusion (1.2%). Out of 785 abnormal CT scans, 267 (34.1%) lesions were not related to head trauma. Incidental CT scan findings included brain atrophy (5.9%), one calcification (5.2%) several calcifications (2.4%) (probably neurocysticercosis in most cases), ischemic infarct (1.9%) and leukoaraiosis (1.3%). These findings showed the importance of CT scan examination in mild head injuries. Further studies to identify mild HT patients at higher risk of significant brain injury are warranted in order to optimize its use.     

Indications for brain CT scan in patients with minor head injury

OBJECTIVES: Minor head injury is the most common type of head injury. Despite of high incidence and numerous studies performed, there is much controversy about correct evaluation of these patients. The aim of this study was to find clinical signs and symptoms which help to predict the indications for brain CT scan following minor head injury. METHODS: A series of 682 consecutive patients who had been attended at two university hospitals (Alzahra and Kashani) with minor head injury (GCS=15) were prospectively enrolled in this cohort study. In all cases clinical signs and symptoms were collected and a cranial computerized tomography (CT) scan was obtained. The relationship between the occurrence of clinical findings and appearance of intracranial posttraumatic lesions on cranial CT was analyzed by chi-square tests and statistic logistic regression methods, with 95% confidence intervals. RESULTS: Of 682 patients, 46 (6.7%) presented brain injuries on CT scan. All patients with abnormal CT scans had at least one of the following factors (risk factors): posttraumatic amnesia, loss of consciousness, posttraumatic seizure, headache, vomiting, focal neurological deficit, skull fracture, coagulopathy or antecedent of treatment with anticoagulants and patient age older than 60 years. No abnormal CT scans were found among patients without any of those risk factors on admission. Vomiting, skull fracture and age greater than 60 years were risk factors significantly correlated to an abnormal cranial CT after head injury. The presence of several risk factors in a patient increased the probability of posttraumatic lesion on CT scan. CONCLUSION: Some clinical risk factors can be used as a guide to predict the probability of abnormal CT following minor head injury.     

Which CT features help predict outcome after head injury?

BACKGROUND: Information collected at baseline can be useful in predicting patient outcome after head injury. The appearance of the CT brain scan may add useful baseline information. The aim of this study was to evaluate which features on the admission CT scan might add significantly to other baseline clinical information for predicting survival in patients with head injury. METHODS: Baseline CT scans were reviewed for patients with all grades of traumatic head injury in a head injury registry, in which baseline demographic and injury status and outcome at 1 year were recorded. Details from the CT scan on haemorrhage, brain swelling, and focal or diffuse damage were noted blind to clinical or outcome information and the scans classified according to the simple seven point grading (normal, mild, moderate, or severe focal injury, mild, moderate, or severe diffuse injury). An existing CT scoring system, the trauma coma databank (TCDB) classification, was also used. Logistic regression modelling was used to test the value of the CT appearance, in addition to the other baseline clinical characteristics, in predicting survival at 1 year. RESULTS: 425 CT scans were read from patients with all severities of injury. Significant independent outcome predictors were age, Glasgow coma score (GCS), pupil reaction, presence of subarachnoid blood, and the simple grading of the overall appearance of the scan (all p<0.001). The TCDB classification was not a significant predictor of outcome. CONCLUSION: Age, GCS, and pupil reaction were all previously shown to be significant predictors of patient survival after head injury. A further two, easy to identify, CT scan variables are independent prognostic variables, and might help to identify patients at high risk of death at the time of admission.     

Predictive (subtle or overlooked) initial head CT findings in patients who develop delayed chronic subdural hematoma

With the aging population, the incidence of chronic subdural hematoma (CSDH) is expected to rise. Once symptomatic the morbidity from CSDH is not insignificant. We studied patients who had a minor head injury and CT brain scan prior to developing CSDH to determine if there were any predictors on these scans for subsequent development of a CSDH. A retrospective review was performed on all patients operated for CSDH over a 3-year period and a review performed on those who had imaging studies at the time of a preceding minor head injury. Seven of 37 patients had CT scans prior to developing CSDH. All had evidence of small increases in CSF intensity on the side or sides of the subsequent CSDH. In conclusion, in those patients with a history of minor head injury prior to developing a CSDH, CT brain demonstrated small increases in cerebral spinal fluid (CSF) intensity on the side or sides of the subsequent CSDH. Recognizing this finding may be helpful in monitoring these patients or initiating medical therapy.     

Management of pediatric pontine gliomas

We present 36 consecutive patients with intrinsic glioma of the pons. Tumors with exophytic expansion were excluded. There were 16 females and 20 males, ranging in age from 2 to 13 years, median 6 years. The most common presenting symptoms were cranial nerve dysfunction. unsteadiness of gait, and hemiparesis. Computed tomography (CT) showed a hypodense (17/21) or isodense (4/21) expansion of the pons. Five tumors had areas of contrast enhancement. Following information about prognosis and possible types of management, parents decided for or against radiation therapy: twentyfour children underwent irradiation and 12 did not. Median survival among children receiving a full course of irradiation was 280 days, compared to 140 days in an equivalent group of non-irradiated children. Hemiparesis presenting without cranial nerve symptoms and contrast enhancement on CT scan were poor prognostic factors, whereas sex, age, and duration of symptoms at diagnosis were unrelated to prognosis.     

Radionuclide imaging in subacute sclerosing panencephalitis

Three patients with subacute sclerosing panencephalitis (SSPE)--two with acute disease and one with an exacerbation--had abnormal radionuclide brain scans during periods of rapid neurologic deterioration. In two of the three patients radionuclide brain scan showed lesions of both cortex and deeper structures, indicating the panencephalic nature of the disease. There was no contrast enhancement on computerized tomography (CT) in the areas of radiopharmaceutical accumulation in the two patients studied. We feel that delayed radionuclide scanning is more sensitive in detecting acute SSPE than routine contrast-enhanced CT, because more time is allowed for tracer accumulation in lesions and for background activity to decrease.     

Computed tomographic scans in posttraumatic epilepsy

The occurrence of posttraumatic epilepsy was studied in 219 patients who had had a computed tomographic (CT) scan within three days after a civilian head trauma. Posttraumatic epilepsy was observed in 13 patients. All of them had focal brain damage shown by CT scan. The predicting power of both clinical risk factors and CT scans was analyzed by multiple logistic regression. Only an intracerebral hemorrhage and intracerebral hemorrhage plus satellite extracerebral hematoma proved significantly associated with posttraumatic epilepsy. This result has important implications in the design of posttraumatic prophylaxis trials.     

Focal electroencephalographic abnormalities and computerised tomography findings in children with seizures.

A persistent focal abnormality was observed in 157 (16%) electroencephalograms undertaken in 964 consecutive children with epileptic and non-epileptic seizures seen over one year. CT head scans were performed in 121 (77%) of the 157 children with a focus on the EEG; 26 (21%) showed an abnormality, and 21 (81%) of the abnormalities were localised. There was no difference in the proportion of abnormal scans associated with a delta or slow wave focus compared with a spike or sharp wave focus. An abnormal scan was uncommon after a single seizure. In only two patients (1.7% of all scans) did the findings on CT alter or greatly influence subsequent management.