CT、MRI检查对急性颅脑损伤鉴别诊断及其临床应用价值分析
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摘要
目的旨在探讨电子计算机断层扫描(ComputedTomography,CT)、磁共振(MagneticResonanceImaging,MRI)检查对急性颅脑损伤鉴别诊断及其临床应用价值。方法选取我院2017年3月-2018年2月收治的急性颅脑损伤患者97例为研究对象,患者均进行多层螺旋CT与MRI检查,比较CT、MRI检查对急性颅脑损伤患者颅骨骨折类型、原发性出血部位、原发性神经损伤的图像特征及诊断符合情况。结果 CT检查对急性颅脑损伤敏感度为72.16%(70/97),低于CT检查86.59%(84/97),差异具有明显差异(P<0.05);CT、MRI检查对颅骨骨折类型、原发性出血部位、原发性神经损伤的诊断符合率比较,差异无明显统计学意义(P>0.05);CT颅骨骨折图像表现为颅骨内外板不连续,凹陷性骨折颅骨局限性向颅内凹陷,而粉碎性骨折则表现为游离的骨碎片;CT、MRI血肿图像表现较为相似,均表现为"双凸镜样"异常密度影,MRI图像表现为梭型血肿,占位效应较低,急性期血肿表现为T1加权等信号,血肿在CT图像的表现随时间而变化,由高密度、等密度、液性低密度改变;CT表现为双侧大脑半球皮髓质交界处出现小片状密度减低影,边界模糊,MRI表现为长T1、长T2信号,FLAIR序列则为斑点状高信号。结论 CT、MRI检查均可有效显示急性颅脑损伤不同影像学图像特征,但MRI检查对急性颅脑损伤敏感度略高于CT,临床可根据需要选择影像学检查方式。
Objective To investigate the differential diagnosis and clinical application value of computed tomography(CT) and magnetic resonance imaging(MRI) in acute brain injury. Methods 97 patients with acute craniocerebral injury admitted to our hospital from March 2017 to February 2018 were selected as the study subjects. All patients underwent multi-slice spiral CT and MRI examinations.The types of cranial fracture, the location of primary hemorrhage, the image characteristics of primary nerve injury and the diagnostic accordance of CT and MRI in patients with acute craniocerebral injury were compared.Results The sensitivity of CT examination to acute craniocerebral injury was 72.16%(70/97), which was lower than 86.59%(84/97) of CT examination. The difference was significant(P<0.05). There was no significant difference in the coincidence rate of CT and MRI in diagnosis of cranial fracture type, primary bleeding site and primary nerve injury(P>0.05). CT images of skull fracture showed discontinuity of internal and external skull plates, localized depression of depressed skull to intracranial, and comminuted fracture showed free bone fragments. CT and MRI images of hematoma were similar,showing "double convex mirror-like" abnormal density shadow. MRI images showed spindle hematoma with low occupancy effect. In acute stage, hematoma showed T1 weighted iso-signal. The performance of hematoma on CT images changed with time,from high density, iso-density, liquid low density. CT manifestations were small patches of decreased density at the corticomedullary junction of bilateral cerebral hemisphere,blurred boundary, long T1 and long T2 signals on MRI, and spotted high signal on FLAIR sequence. Conclusion CT and MRI can effectively display different imaging features of acute craniocerebral injury, but the sensitivity of MRI to acute craniocerebral injury is slightly higher than that of CT. Imaging examination can be selected according to clinical needs.
Objective To investigate the differential diagnosis and clinical application value of computed tomography(CT) and magnetic resonance imaging(MRI) in acute brain injury. Methods 97 patients with acute craniocerebral injury admitted to our hospital from March 2017 to February 2018 were selected as the study subjects. All patients underwent multi-slice spiral CT and MRI examinations.The types of cranial fracture, the location of primary hemorrhage, the image characteristics of primary nerve injury and the diagnostic accordance of CT and MRI in patients with acute craniocerebral injury were compared.Results The sensitivity of CT examination to acute craniocerebral injury was 72.16%(70/97), which was lower than 86.59%(84/97) of CT examination. The difference was significant(P<0.05). There was no significant difference in the coincidence rate of CT and MRI in diagnosis of cranial fracture type, primary bleeding site and primary nerve injury(P>0.05). CT images of skull fracture showed discontinuity of internal and external skull plates, localized depression of depressed skull to intracranial, and comminuted fracture showed free bone fragments. CT and MRI images of hematoma were similar,showing "double convex mirror-like" abnormal density shadow. MRI images showed spindle hematoma with low occupancy effect. In acute stage, hematoma showed T1 weighted iso-signal. The performance of hematoma on CT images changed with time,from high density, iso-density, liquid low density. CT manifestations were small patches of decreased density at the corticomedullary junction of bilateral cerebral hemisphere,blurred boundary, long T1 and long T2 signals on MRI, and spotted high signal on FLAIR sequence. Conclusion CT and MRI can effectively display different imaging features of acute craniocerebral injury, but the sensitivity of MRI to acute craniocerebral injury is slightly higher than that of CT. Imaging examination can be selected according to clinical needs.
引文
[1]周丽景.颅脑CT对急性脑外伤患者手术疗效及预后的评估价值分析[J].中国CT和MRI杂志,2017,15(3):19-21.
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[7]邱崇荣,付强,眭建,等.急性ST段抬高型心肌梗死患者血液中性粒细胞/淋巴细胞比值、内皮细胞特异性分子-1水平与近期预后的关系[J].江苏大学学报(医学版),2 0 1 6,26(1):61-97.
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[9]陈唯实.重型颅脑损伤行开颅术治疗后继发大面积脑梗死的相关因素及干预价值分析[J].立体定向和功能性神经外科杂志,2016,30(2):112-114.
[10]杨勇,祝斐,黄新.重型颅脑损伤患者颅脑磁共振(MRI)和磁共振波谱(MRS)的临床研究[J].安徽医药,2014,18(4):665-668.
[11]脑弥漫性轴索损伤的CT、MRI及MRS影像特征分析[J].广西医科大学学报,2016,33(4):723-725.
[12]赵兆,于建云,吴昆华,等.磁共振弥散张量成像与质子磁共振波谱技术在脑损伤鉴定中的应用[J].法医学杂志,2012,28(3):207-210.
[1 3]秦兴虎,游红,部莉,等.载脂蛋白E拟肽对创伤性脑损伤后脑组织TNF-α仪表达和脑水肿的影响及意义[J].中华神经医学杂志,2016,15(1):35-40.
[14]刘楚伟.小牛血清去蛋白注射液联合神经节苷酯治疗急性颅脑损伤的临床疗效及对血清神经元特异性烯醇化酶及S100B的影响[J].山西医药杂志,2016,45(8):947-949.
[15]采用多回波采集T2*WI三维梯度回波序列测量兔脑损伤模型静脉血相位值及与神经功能损伤评分的相关性[J].中华放射学杂志,2016,63(2):1 32-1 37.
[2]郭杨,周兴余,GUOYang,等. 2011-2 014年四川省流行性乙型脑炎流行特征分析[J].预防医学情报杂志,2016,32(5):458-461.
[3]李保卫,耿瑞鹏,赵合保,等.轻型颅脑损伤突然死亡患者的临床表现及CT表现分析(附15例报告)[J].实用心脑肺血管病杂志,2 0 1 6,24(2):115-117.
[4]张志强,刘丽娟,张强,等.移动CT和常规CT检查对颅脑损伤后脑继发性损害及治疗效果的影响[J].中华神经医学杂志,2016,1 5(1 1):1 1 59-1163.
[5]曹一波,封灏,于君,等.螺旋CT灌注成像检测急性中重度颅脑损伤局部脑血流参数的意义[J].中国临床神经外科杂志,2015,19(2):103-106.
[6]罗荣芳,何建平.轻型脑损伤患者磁敏感加权成像评估价值及其与GCS评分的相关性分析[J].中国CT和MRI杂志,2017,15(2):14-16.
[7]邱崇荣,付强,眭建,等.急性ST段抬高型心肌梗死患者血液中性粒细胞/淋巴细胞比值、内皮细胞特异性分子-1水平与近期预后的关系[J].江苏大学学报(医学版),2 0 1 6,26(1):61-97.
[8]石璧,魏友平.脑外伤患者急性期CT检查临床特征与血清NT-proBNP的相关性分析[J].中国CT和MRI杂志,2016,14(7):24-26.
[9]陈唯实.重型颅脑损伤行开颅术治疗后继发大面积脑梗死的相关因素及干预价值分析[J].立体定向和功能性神经外科杂志,2016,30(2):112-114.
[10]杨勇,祝斐,黄新.重型颅脑损伤患者颅脑磁共振(MRI)和磁共振波谱(MRS)的临床研究[J].安徽医药,2014,18(4):665-668.
[11]脑弥漫性轴索损伤的CT、MRI及MRS影像特征分析[J].广西医科大学学报,2016,33(4):723-725.
[12]赵兆,于建云,吴昆华,等.磁共振弥散张量成像与质子磁共振波谱技术在脑损伤鉴定中的应用[J].法医学杂志,2012,28(3):207-210.
[1 3]秦兴虎,游红,部莉,等.载脂蛋白E拟肽对创伤性脑损伤后脑组织TNF-α仪表达和脑水肿的影响及意义[J].中华神经医学杂志,2016,15(1):35-40.
[14]刘楚伟.小牛血清去蛋白注射液联合神经节苷酯治疗急性颅脑损伤的临床疗效及对血清神经元特异性烯醇化酶及S100B的影响[J].山西医药杂志,2016,45(8):947-949.
[15]采用多回波采集T2*WI三维梯度回波序列测量兔脑损伤模型静脉血相位值及与神经功能损伤评分的相关性[J].中华放射学杂志,2016,63(2):1 32-1 37.