婴幼儿脑外积液60例的CT影像学分析

Analysis of CT imaging on external hydrocephalus in infants

目的分析婴幼儿脑外积液的CT特征,明确诊断并有助于鉴别脑外积液的性质及与病因的关系。方法选择经CT确诊的60例2岁以内的脑外积液患儿,分析其CT特征。并按月龄分6组,CT平扫测量脑外间隙宽度以确定诊断。结果引起婴幼儿脑外积液的主要原发病有感染性疾病、硬膜下或蛛网膜下出血、缺氧缺血性脑病(HIE)占71.67%(43/60例),原因不明占28.33%(17/60)。脑外积液主要发生在大脑凸面的前面,以蛛网膜下腔积液多见,占83.33%(50/60例),硬膜下积液6.67%(4/60例),硬膜下和蛛网膜下积液并存10.00%(6/60例)。其中,化脓性脑膜炎常引起硬膜下积液或蛛网膜下腔积液。硬膜下和(或)蛛网膜下腔出血常引起硬膜下和蛛网膜下腔积液并存。HIE所致脑外积液主要为蛛网膜下腔积液,是HIE所致的特征性改变,常伴髓鞘化落后占76.47%(13/17例)。原因不明者多为双侧对称性的蛛网膜下腔积液。脑室扩大主要见于HIE和硬膜下或蛛网膜下出血。结论婴幼儿脑外积液多有明确原因,以出血、感染和HIE为多见,积液的部位与脑发育的特性有关,CT可明确脑外积液诊断,并有助于判断病因及积液性质。

Objective To analyze the characteristics of external hydrocephalus in infancy with CT imaging,in order to definite diagnosis and help for judging nature of accumulation of extra-cerebral fluid and the relation with the etiological factor.Methods Conventional CT scanning were performed in 60 infants aged 2 years or younger with external hydrocephalus（EH）,and the results were analyzed,they were divided into 6 age groups,the width of extra-cerebral space was measured on CT plain-scanning and compared with normal standard.Results EH mainly resulted from infection,subdural hematoma or subarachnoid hemorrhage,HIE,which were 71.67%（43/60 cases）of the cases;EH with unknown cause were 28.33%（17/60 cases）.EH was mainly located at the foreside of cerebral convexity,of which 83.33%（50/60 cases）was predominantly in the subarachnoid space,6.67%（4/60 cases） in subdural space,10.00%（6/60 cases）was subdural coexisted with subarachnoid collection,and subdural or coexisted with subarachnoid collection often occurred in purulent meningitis,in subdural and（or） subarachnoid hematoma,subdural collection commonly coexisted with subarachnoid collection,caused subarachnoid collection,76.47%（13/17 cases）of which were concurred with delayed myelination,EH with unknown cause often appeared bilateral symmetrical subarachnoid collection,enlargement of ventricular size were predominantly seen in HIE,subdural hematoma or subarachnoid hemorrhage.Conclusions EH often had definite etiological factor,which were mainly hemorrhage,infection and HIE,the location was associated with brain development,CT imaging can definite diagnosis and be useful for judging nature of fluid and reason of EH.