CT中脑背侧脑池出血对原发性脑干损伤的早期诊断价值

Study on the CT value of intracisternal hemorrhage around the dorsal midbrain in the early diagnosis of primary brain stem injure

目的分析颅脑外伤急诊CT中脑背侧脑池出血的表现，探讨其对临床原发性脑干损伤的早期诊断价值。方法回顾性分析52例颅脑外伤患者临床表现及影像学资料，并依据GCS评分分为轻、中、重及特重型。所有患者均在伤后48h内接受CT检查，CT采用常规程序扫描。MRI检查则根据病情变化在伤后1周内完成，采用自旋回波T1WI、T2WI序列。结果所有病例的CT表现均与MRI的T1WI、T2WI序列行比较研究，其中39例颅脑损伤患者的急诊CT有中脑背侧环池或四叠体池出血表现，合并弥漫性脑肿胀19例，脑实质出血灶单发或多发点状出血灶11例，直径小于2cm；37例MRI检查存在不同程度的脑干组织损伤表现。结论重型和特重型颅脑外伤（GCS〈9分）伤后早期CT的中脑背侧脑池出血表现高度提示原发性脑干损伤可能，对提高原发性脑干损伤早期诊断水平具有重要的参考价值。

Objective To analyze the CT manifestation of intraeistemal hemorrhage around the dorsal midbrain in the patients of acute brain injures, and explore the value of intracisternal hemorrhage around the dorsal midbrain in the early diagnosis of primary brain stern injure. Methods The clinical and imaging data of 52 patients with head injure were retrospectively analyzed, and all patients underwent the CT scans within 48 hours and MRI scans within 1 week, the routine CT scan mode, T1 WI and T2 WI sequences of MRI were adopted. Results The manifestations of CT in all the cases were compared with the routine MRI images of T1 WI, T2 WI sequence, the locations of hemorrhage were showed on early CT scanning at the cisterns around the dorsal midbrain （ambient cistern or quadrigeminal cistern ） in 39 patients, coupled with diffuse cerebral swelling in 19 cases, solitary or multiple loci of intraparenchymal hemorrhage less than 2 cm in diameter in 11 cases, while the manifestations of brainstem injure were showed on routine MRI images in 37 patients. Conclusion The early CT manifestations of intracisternal hemorrhage around the dorsal midbrain in the patients of severe acute brain injures （ GCS 〈 9 ） strongly suggestes the possibility of primary brainstem injure, the research can offer an important reference for the improvement of diagnostic level of primary brainstem injure in the early stage.