脑池偏密征及其在颅脑损伤诊断中的实用价值

Hemilateral Cisternal Hyperdense Sign and Its Value in Diagnosing Craniocerebral Injury

目的 提高外伤性蛛网膜下腔出血 (TSAH)的首次CT确诊率及其与其他颅脑损伤的相关性认识。材料与方法 回顾性研究随机选择颅脑外伤有TSAH的CT资料 2 18例 ,手术证实 79例 ,其余均经CT复查证实。CT扫描均用轴位平扫。结果 2 18例TSAH中 ,以纵裂池积血 ( 2 0 7例 )最多见 ,其次为侧裂池及天幕区积血。大多数TSAH( 167例 )为局限性少量积血。TSAH并有其他颅脑内损伤 2 0 3例。首次CT检查漏诊 42例 (占 19.3 % )。 13 9例发现有脑池偏密征 ,与偏密征同侧有脑挫裂伤或颅内血肿 12 6例 ,其中迟发性病变 44例。结论 脑池偏密征是诊断TSAH少量积血的一个可靠的CT征象 ,并可提示TSAH出血的大体部位。认识此征象 ,可明显提高TSAH的首次CT确诊率和减少漏诊。

Objective To improve initial confirmative diagnostic rate of traumatic subarachnoid hemorrhage (TSAH) on CT and make a further study on the relationship between TSAH and other craniocerebral injuries.Materials and Methods 218 craniocerebral traumatic cases who demonstrated TSAH on CT scans were randomly selected, of them 79 cases were proved with surgery and the remaining cases were confirmed by reexamination of CT scan.Results In this study, interhemispheric cistern hemorrhage was most commonly seen (n=167), sylvian cistern and tentorial hemorrhage was less common. Most TSAH (n=167) was presented as localized small bleeding. In 203 cases, other intra craniocerebral damages were complicated. 42 cases (19.3%) missed diagnosis on initial CT scans. Hemilateral cisternal hyperdense sign (HCHS) was seen in 139 cases, of which 126 cases were complicated with ipsilateral cerebral contusion, laceration or intracranial hematoma, with delayed lesions seen in 44 cases among them.Conclusion HCHS is a reliable CT sign for the diagnosis of TSAH with small amount of bleeding and for the approximate localization of TSAH. Paying attention to HCHS will surely increase confirmative diagnostic rate and decrease missed diagnostic rate of TSAH on initial CT scans.