隐匿性额叶底部脑挫裂伤的影像表现及临床应用研究

IMAGING FINDINGS OF LATENT CEREBRAL LACERATION OF LOWER FRONTAL LOBE AND THEIR CLINICAL APPLICATION

目的 探讨隐匿性额叶底部脑挫裂伤的检查方法、发生机制、影像变化规律及临床应用价值。方法 收集经手术或随访证实的隐匿性额叶底部脑挫裂伤患者124例，对CT、MRI影像进行回顾性分析，探讨其病理基础及解剖学机制。结果 本组124例病人第1次CT检查在伤后5h内进行，46例疑有脑挫裂伤，随行层厚、层距3mm薄层扫描，发现相应区额叶底局部脑沟变浅平；22例侧脑室前角稍变小；18例隐约可见斑点样出血；38例未见异常。65例病人于12h、57例于24h以后行影像复查，均发现有明确脑挫裂伤，46例出现脑内血肿。动态CT观察，发现挫裂伤病灶扩大、融合；27例血肿比较稳定；19例血肿范围扩大；24例侧脑室前角和基底池受压变形；2例患者由于影像检查较晚，病史提供不准确，被误诊。本组病例中48例患者有蛛网膜下腔出血，29例有硬膜下出血，8例有硬膜外出血，67例有颅骨骨折，23例有额窦积液（血），11例合并筛窦内积液（血）。16例CT不能确诊的病例于10h内做了MRI检查，发现额底局部信号不均匀，可见稍长T1、长T2信号，7例发现有小出血点。结论 薄层CT、MRI检查能弥补隐匿性额叶底部脑挫裂伤早期常规CT检查的不足；复查的最佳时间为伤后12～24h；及时定期的影像跟踪检查是确定治疗方案的关键。

Objective To explore the detection, mechanism and imaging changes of latent cerebral laceration of lower frontal lobe as well as their clinical application. Methods Clinical data of 120 cases of latent cerebral laceration of lower frontal lobe confirmed through operations or follow-up surveys were collected and these patients＇ CT or MRI imaging findings were analyzed retrospectively to explore the pathological and anatomic mechanisms. Results 124 cases received the first CT scanning 5 hours after injury. 46 cases were suspected of cerebral laceration and then underwent thin-layer scanning of 3mm thinckness and distance. Part of sulcus of the lower frontal lobe was found to have become thin and flat in the 46 cases. The anterior horn of lateral ventricle became smaller in 22 cases. Bleeding spots were discorved in 18 cases. No changes occurred in 38 cases. Of the 65, spots were discovered in 18 cases. No changes occurred in 38 cases. Of the 65 cases, 57 cases were re-examined 24 hours later and obvious cerebral laceration were dscovered in them. Intracerebral hematoma was detected in 46 cases. Dynamic CT scans showed that the focus of laceration became larger and fused. Stability of hematoma existed 27 cases. Hematoma extended in 19 cases. The anterior horn of lateral ventricle and basilar cystern were pressed and deformed in 24 cases. 2 cases were misdiagnosed for late imaging examination and insufficient supply of history of the disease. 48 cases suffered from subarachnoid hemorrhage.29 cases had subdural bleeding. 8 cases had extradural bleeding. 67 showed fracture of skull. 23 cases had hydrops in frontal sinus. 11 cases had hydrops in both frontal lobe and ethnoidsinus. 16 cases underwent MRI examination 10 hours after CT diagnosis failed to confirm the disease. The distribution of some signals in the lower frontal lobe was found to be uneven. Longer signals like Tl and long signals like T2 were discovered there. Hemorrhagic spots were detected in 7 cases. Conclusion Thin-layer CT and MRI detection of latent cerebral laceration of lower frontal lobe can function better than CT detection alone in the early stage. The optimal time of re-examination is in 12 - 24hours. Timely and periodical follow-up imaging examination is the key to the application of therapy.