脑外伤的术中超声造影临床研究

Clinical study on contrast-enhanced ultrasound in traumatic brain injury

目的探讨超声造影在脑外伤灶的分型、边界显示、范围测定以及判断灶内脑组织损伤程度中的应用价值。方法对83例神经外科实施急诊手术治疗的脑外伤患者行术中超声检查，观察外伤灶的特点，判断其类型；对术中超声分型不明确或边界显示不清的外伤灶行术中超声造影检查，确定类型，明确边界，测量范围，并与常规超声、术前CT及手术结果对照；根据外伤灶内超声造影的时间一强度曲线参数判断脑组织的损伤程度及存活状况。并将检查结果及时反馈，指导术者实时调整手术方案。结果83例患者经术中超声检查发现148个脑外伤灶，其中32个外伤灶分型不明确或边界显示不清，应用超声造影均准确分型并清晰显示边界；不同类型脑损伤灶的超声造影表现不同，绝对峰值强度存在差异，且随灶内脑组织损伤程度的加重而减小；同一外伤灶的范围，超声造影显示更准确，其测量值均较常规超声测值大（P=0．01）；超声造影后，术者根据反馈信息对21个脑外伤灶的手术方式进行了及时调整。结论术中超声结合超声造影可对各种脑外伤灶准确分型，超声造影可明确外伤灶的范围且可对灶内脑组织的损伤程度作出判断，指导术者及时调整手术方式并为手术操作的精准实施提供可靠依据。

Objective To explore the value of contrast-enhanced ultrasound（CEUS） in classifying lesions, measuring the range of Iesions, and the ability of manifesting the boundary and the severity of lesions after traumatic brain injury. Methods 83 patients with traumatic brain injury underwent the emergency surgery operations were enrolled in this study. Intraoperative ultrasound was applied in detecting the echo characteristics of lesions and classifying. Traumatic brain injuries which were classified indefinitely by conventional ultrasound were examined by CEUS to observe enhanced features of trauma lesions and the surrounding tissue, confirm the types of lesions, identify the border of lesions, measure the range of lesions, and compare with conventional ultrasound, preoperative CT and operative results. The severity of lesions was judged according to the parameter of time intensity curve （TIC）. The results which would help the operators to adjust the method of treatment timely was informed. Results 148 lesions were detected by intraoperative ultrasound among 83 patients in this study. Thirty-two lesions which were classified indefinitely by conventional ultrasound were examined by CEUS. The results of classifying were confirmed by CT and operations, the diagnostic accuracy rate was 100 %. The absolute peak intensity was changed with the injury severity, the more serious of the tissue, the lower absolute peak intensity was displayed. The boundary of lesions was manifested clearly after CEUS. Compare to the conventional ultrasonography, the range of lesions was larger. The difference between them was meaningful significally（ P = 0.01）. Based on the results of CEUS, the way of operation was adjusted in 21 lesions. Conclusions Using the contrast- enhanced ultrasound and intraoperative ultrasound, various traumatic brain injuries can be diagnosed accurately. By CEUS, the perfusion of lesions would be displayed, which would hint the severity of the brain tissue and help the operators adjust the methods of treatment timely, and provide the reliable evidence for the operation precisely.