64例内部硬膜下血肿的CT和MRI表现(1)
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[摘要] 目的：分析颅脑内部硬膜下血肿的CT和MRI表现，提高诊断准确率。方法：回顾性分析64例经临床证实的内部硬膜下血肿的CT和MRI表现。结果：①64例内部硬膜下血肿可分为2类，大脑镰旁23例，小脑幕区41例；②CT表现：大脑镰旁硬膜下血肿多为单侧，内表面与大脑镰相贴、外表面呈弧形或波浪状高密度影；小脑幕区硬膜下血肿可位于幕上、幕切迹及幕下，形态多样。血肿边界清楚，不进入邻近脑沟和脑池；③MRI表现：一般各系列均呈高信号，FLAIR显示最清晰，以T1WI高信号为特征；横断面形态与CT类似，冠状面显示血肿范围更清楚。结论：内部硬膜下血肿CT和MRI表现有特征性；MRI显示血肿形态及分布较CT更优越；亚急性期以后复查时可行MRI以免漏诊。
[关键词] 硬膜下血肿；内部；体层摄影术；X线计算机；磁共振成像
[中图分类号] R455 [文献标识码]C [文章编号]1673-7210(2011)04(b)-084-03
The CT and MRI manifestations of internal subdural hematoma
ZHANG Jianzeng, YANG Yingxin
Department of Radiology, General Hospital of Anyang Iron & Steel Group, He'nan Province, Anyang 455004, China
[Abstract] Objective: To analyze the CT and MRI manifestations of internal subdural hematoma (ISDH) and to improve the accuracy of the diagnosis. Methods: The CT and MRI characteristics of the 64 cases with clinically confirmed ISDH were reviewed. Results: ①The 64 cases could be divided into 2 types, 23 cases were about the falx cerebri and 41 Cases were about the cerebellar tentorium. ②On CT imaging, ISDH beside the cerebral falx were mostly unilateral high density with interior surface sticking to the falx and arc or wave exterior, and that about the cerebellar tentorium might be supratentorial, subtentorial or at incisuratentori with various form. All ISDH had clear borders and didn't extend to the near sulus or cisterna. ③On MRI imaging commonly, all ISDH were high signal in every series images. They were the most clearly appeared in FLAIR, and their high signal in T1WI were characteristic. ISDH had the similar form with CT in axial images, while the extents were showed more clearly in coronal ones. Conclusion: There are characteristics of ISDH on CT and MRI imaging. MRI is superior to CT on displaying the form and distribution of ISDH. After the subacute phase, MRI should be used in reexamining for not missing diagnosis.
[Key words] Subdural hematoma; Internal; Tomography; X-ray computed; Magnetic resonance imaging
颅内硬膜下血肿(SDH)作为颅脑外伤中的常见病，其CT表现—颅板下“新月征”已为大家所熟知。但这只是较多见的颅内外周部位硬膜下血肿的表现。发生于颅脑深部如大脑镰旁、小脑幕区的硬膜下血肿(笔者建议称之为内部硬膜下血肿，ISDH)相对少见，近年相关报道始多[1-2]。但由于认识不足，ISDH仍常被遗漏或误诊为蛛网膜下腔出血。笔者收集64例ISDH病例，分析其CT和MRI表现以提高认识。
1 资料与方法
1.1 一般资料
搜集ISDH患者共64例，其中，男48例，女16例；年龄1 d~84岁，中位年龄55岁，平均56.4岁。有外伤史者47例，新生儿产伤、窒息史10例，无明显外伤史4例，“血液病”史3例。由于多合并其他颅脑损伤及全身外伤，临床表现各异，一般神经系统症状主要有头痛、呕吐等颅内压增高症状以及头晕、意识障碍等；“血液病”患者合并脑内、皮下及其他脏器多发出血 ......
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