外伤性眶上壁骨膜下血肿的CT与MRI表现

CT and MRI manifestations of traumatic subperiosteal supraorbital hematoma

目的:探讨外伤性眶上壁骨膜下间隙血肿的CT与MRI表现特征。方法:回顾分析经临床随访证实的12例创伤所致眶上壁骨膜下间隙血肿患者的临床及影像学资料。12例均行多排螺旋CT检查并行矢状位及冠状位后重建,其中2例病程中曾行MRI检查。结果:均累及单侧眼眶,其中左侧7例,右侧5例。横断位可见眼球上方团块状高密影,CT值72±4HU(95%CI, 68-75),矢状位、冠状位重建图像示眶上壁骨膜下间隙呈广基附于眶壁的梭形(矢状位)或扁平状、弧形(冠状位)类似软组织密度灶,内缘清楚,密度均匀,多不跨越骨缝,矢状位可见病灶从眶前缘向后达眶尖水平,上直肌受压下移、眼球向下移位,横断位可见患侧眼球向前突出。MRI上病灶形态与CT基本一致,随访MRI可见病灶与不同时期典型血肿演变进程的信号特征一致。结论:多排螺旋CT尤其是结合矢状位及冠状位后重建可较好诊断骨膜下血肿,随访MRl可以观察不同时期血肿的特征性信号。

Objective:To investigate the CT and MRI features of traumatic subperiosteal space hematoma of supraorbital wall.Methods:The clinical and imaging data of 12 patients with subperiosteal supraorbital hematoma caused by trauma were retrospectively analyzed. All the 12 patients underwent multi-slice spiral CT with sagittal and coronal reconstruction, and 2 of them underwent MRI in the course of disease.Results:Unilateral orbit was involved in all cases, including 7 cases on the left side and 5 cases on the right side. Cross-sectional images showed a crumb high-density shadow above the eye, with 72±4 Hounsfield units(95% CI, 68-75).Sagittal and coronal reconstruction images showed that the subperiosteal space of the superior orbital wall was fusiform(sagittal) flat or curved(coronal) lesion attached to the orbital wall.The lesion was similar to soft tissue density with a clear inner edge, the uniform, density and did not across the sultures in most cases. The sagittal images showed that the focus reached the level of the orbital apex from the anterior edge of the orbit, the superior rectus muscle was compressed and moved downward, and the downward displacement of the ocular globe. Cross-sectional images showed the affected side’s eyeball was protruding forward. The shape of the lesion on MRI was basically consistent with that on CT. Follow-up MRI showed that the lesion was consistent with the signal characteristics of typical hematoma evolution at different stages.Conclusion:Multi-slice spiral CT, especially combined with sagittal and coronal reconstruction, can better diagnose subperiosteal supraorbital hematoma. Follow-up MRI can observe the characteristic signals of hematoma at different stages.