CT及MRI断面解剖.ppt

CT及MRI断面解剖.ppt

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腦部-

（1）腦部的正常CT及MRI解剖腦部解剖構造-BrainParenchyma（腦實質）Cerebrum:

frontallobe,temporallobe,parietallobe,occipitallobeCerebellumBasalganglia,thalamusBrainstem,midbrainSubarachnoidspaces（蜘蛛網膜下腔,CSFspaces）Ventricles（腦室）-lateral,3rd,4thventriclesCisterns（腦池）-suprasellar,quadrigeminalcisterns（四疊體腦池）.Fissures（腦裂）-Sylvian,interhemisphericfissuresSulci（腦溝）F:

frontallobeP:

ponsT:

temporallobes:

suprasellarcistern（碟鞍上腦池）Ce:

cerebellumd:

dorsumsellaFTCesPdparietallobe4thVFTMbCeF:

frontallobeMb:

midbrainT:

temporallobes:

suprasellarcistern（碟鞍上腦池）Ce:

cerebellumsTemporallobeparietallobeFQcMb3vTOF:

frontallobeSy:

SylvianfissureT:

temporallobeO:

occipitallobeMb:

midbrain3v:

3rdventriclelv:

lateralventricleCC:

corpuscallosum（genu）Qc:

quadrigeminalcistern（四疊體腦池）SyCCparietallobelvFPOSpCCF:

frontallobeCC:

corpuscallosumP:

parietallobeSp:

spleniumofCCO:

occipitallobelv:

lateralventricles:

sulcusparietallobelvssFPCiCSIfF:

frontallobeIf:

interhemisphericP:

parietallobefissureCi:

cingulumcs:

centralsulcusCS:

centrumsemiovalcsparietallobepgctic:

caudatenucleus尾狀核p:

putamen被核g:

globuspallidus蒼白核t:

thalamus視丘i:

internalcapsule內囊Basalganglialv:

lateralventricle,frontalhorn3v:

3rdventricleqc:

quadrigeminalcisternSy:

Sylvianfissureqcsf3vlvsc:

suprasellarcisternaq:

aqueductth:

temporalhornoflateralventricle認識腦室及腦池scaqthSyth3vlv頭部外傷ClassificationofHeadInjury腦外病灶（ExtracerebralLesions）腦內病灶（IntracerebralLesions）其他傷害頭部外傷的後遺症ExtracerebralLesionsEpiduralhematoma（硬腦膜上腔血腫）Subduralhematoma（硬腦膜下腔血腫）Subduraleffusion（硬腦膜下積水）Counter-coupInjuryThelesionisintheoppositesideofimpactsite30%incidence.ScalpswellingEDH同側撞擊同側出血Counter-coupInjuryDura（硬腦膜）Subdural（硬腦膜下）Epidural（硬腦膜上）二.ExtracerebrallesionsEpiduralhematomaSubduralhematomaSubduraleffusionAcuteEpiduralHematomaFusiform（紡綞狀）orbiconvex（雙凸狀）hyperdenselesion腫塊效應強，可造成herniation（疝脫）Thehematomastillcontainsuncoagulatedblood,orstillhasactivebleeding.Round,stream-likefillingdefectsmaybeseeninthehematoma.需緊急處理AcuteEpiduralHematoma血塊內含較灰區（箭），代表正在出血中，有未凝結的血塊EDH：

紡垂型，高濃度血塊頭皮腫（箭），撞擊處AcuteSubduralHematomaSickle-shape（鐮刀型）ornewlunarshape（新月型）ofhyperdenselesionoverlargeportionofcerebralhemisphereThehematomamayextendingintothesubduralspaceoftentorialregionorinterhemisphericfissureSDH：

新月型（A.B）SDH可能在interhemisphericfissure內（C）。

SDH也可在tentorium下（D）（不要誤為腦內出血）ABCDAcuteSubduralHematomaChronicSubduralhematomaShape:

Semilunar,Fusiform,OvalshapeDensity:

HyperdenseIsodenseHypodenseMixeddensityChronicSubduralHematomaT1WIT2WImethemoglobinHyperintenseSubduralHematomaSubduralEffusionOccurredinagedpatientorinfantDevelopedseveraldayslaterafteraheadinjuryOftenbilateralSpontaneouslyresorbedCraniotomy,V-Pshunt,meningitisalsomaycausesubduraleffusionSubduralEffusion4dayslater10dayslaterIntracerebralLesionsBraincontusion腦挫傷（edema,hemorrhage.）Subarachnoidhemorrhage（SAH）蜘蛛網膜下腔出血Intraventricularhemorrhage（IVH）腦室內出血BrainContusionBrainedemamixedwithmultiplesmallhemorrhages腦水腫合併出血：

最常見SolitaryhematomaCircumscribedareaofbrainedema局部腦水腫：

很少見DiffusebrainedemaDiffuseaxonalinjury廣泛神經軸受傷BrainContusionPunctatehemorrhagesandedemasinthesubcorticalwhitematterofleftfrontallobe（A）andcorpuscallosum（B,C）ABCHeadinjury,GCS:

3Diffuseaxonalinjury（DAI）TraumaticSAHOftenassociateswithotherintracerebralorextracerebrallesionsCTfindings:

Linearhighdensityinthesubarachnoidspaces（sulci,fissures,cisterns）MaycausehydrocephalusTraumaticSAH112345521.SDH2.EDH3.Contusionhemorrhageandedema4.IVH（外傷性腦室內出血）5.SAH（外傷性蜘蛛網膜下腔出血）SAH：

在腦溝、腦裂、腦池內看到出血5OpenCranialInjurySkullfracturePneumoencephalus頭部外傷後遺症廣泛腦萎縮（Diffusebrainatrophy）腦室積水（Hydrocephalus）腦組織軟化（Encephalomalacia）86,5,14AcuteSDH&contusionhemorrhage86,5,16Post-craniotomy,theSDHdisappeared,delayedhemorrhage;SAHinRt.tentorium86,8,13EncephalomalaciachangewithmildhydrocephalusDecompressionhemorrhagewithencephalomalaciachange1stday4monthslater-brainatrophy5thdayComaafterheadinjury4monthslater,semi-vegetatestageMultiplepunctatehemorrhagesDiffuseaxonalinjury（DAI）causedbrainatrophy86,9,10:

Communicatinghydrocephalus86,2,6:

TraumaticSAHinthesulci,interhemisphericfissureSAHcausedcommunicatinghydrocephalusToBeContinued.