CT、MRI检查对急性颅脑损伤鉴别诊断及其临床应用价值分析

Differential Diagnosis of Acute Craniocerebral Injury by CT and MRI and Its Clinical Value

目的旨在探讨电子计算机断层扫描(Computed Tomography,CT)、磁共振(Magnetic Resonance Imaging,MRI)检查对急性颅脑损伤鉴别诊断及其临床应用价值。方法选取我院2017年3月-2018年2月收治的急性颅脑损伤患者97例为研究对象,患者均进行多层螺旋CT与MRI检查,比较CT、MRI检查对急性颅脑损伤患者颅骨骨折类型、原发性出血部位、原发性神经损伤的图像特征及诊断符合情况。结果 CT检查对急性颅脑损伤敏感度为72.16%(70/97),低于CT检查86.59%(84/97),差异具有明显差异(P<0.05);CT、MRI检查对颅骨骨折类型、原发性出血部位、原发性神经损伤的诊断符合率比较,差异无明显统计学意义(P>0.05);CT颅骨骨折图像表现为颅骨内外板不连续,凹陷性骨折颅骨局限性向颅内凹陷,而粉碎性骨折则表现为游离的骨碎片;CT、MRI血肿图像表现较为相似,均表现为"双凸镜样"异常密度影,MRI图像表现为梭型血肿,占位效应较低,急性期血肿表现为T1加权等信号,血肿在CT图像的表现随时间而变化,由高密度、等密度、液性低密度改变;CT表现为双侧大脑半球皮髓质交界处出现小片状密度减低影,边界模糊,MRI表现为长T1、长T2信号,FLAIR序列则为斑点状高信号。结论 CT、MRI检查均可有效显示急性颅脑损伤不同影像学图像特征,但MRI检查对急性颅脑损伤敏感度略高于CT,临床可根据需要选择影像学检查方式。

Objective To investigate the differential diagnosis and clinical application value of computed tomography(CT) and magnetic resonance imaging(MRI) in acute brain injury. Methods 97 patients with acute craniocerebral injury admitted to our hospital from March 2017 to February 2018 were selected as the study subjects. All patients underwent multi-slice spiral CT and MRI examinations.The types of cranial fracture, the location of primary hemorrhage, the image characteristics of primary nerve injury and the diagnostic accordance of CT and MRI in patients with acute craniocerebral injury were compared.Results The sensitivity of CT examination to acute craniocerebral injury was 72.16%(70/97), which was lower than 86.59%(84/97) of CT examination. The difference was significant(P<0.05). There was no significant difference in the coincidence rate of CT and MRI in diagnosis of cranial fracture type, primary bleeding site and primary nerve injury(P>0.05). CT images of skull fracture showed discontinuity of internal and external skull plates, localized depression of depressed skull to intracranial, and comminuted fracture showed free bone fragments. CT and MRI images of hematoma were similar,showing "double convex mirror-like" abnormal density shadow. MRI images showed spindle hematoma with low occupancy effect. In acute stage, hematoma showed T1 weighted iso-signal. The performance of hematoma on CT images changed with time,from high density, iso-density, liquid low density. CT manifestations were small patches of decreased density at the corticomedullary junction of bilateral cerebral hemisphere,blurred boundary, long T1 and long T2 signals on MRI, and spotted high signal on FLAIR sequence. Conclusion CT and MRI can effectively display different imaging features of acute craniocerebral injury, but the sensitivity of MRI to acute craniocerebral injury is slightly higher than that of CT. Imaging examination can be selected according to clinical needs.