脑部的正常CT及MRI解剖

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,occipitallobe•Cerebellum•Basalganglia,thalamus•Brainstem,midbrainSubarachnoidspaces(蜘蛛網膜下腔,CSFspaces)•Ventricles(腦室)---lateral,3rd,4thventricles•Cisterns(腦池)---suprasellar,quadrigeminalcisterns(四疊體腦池)….•Fissures(腦裂)---Sylvian,interhemisphericfissures…•Sulci(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ExtracerebralLesions•Epiduralhematoma（硬腦膜上腔血腫）•Subduralhematoma(硬腦膜下腔血腫)•Subduraleffusion(硬腦膜下積水）Counter-coupInjury•Thelesionisintheoppositesideofimpactsite•30%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.ExtracerebrallesionsEpiduralhematomaSubduralhematomaSubduraleffusionAcuteEpiduralHematoma•Fusiform(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AcuteSubduralHematoma•Sickle-shape(鐮刀型)ornewlunarshape(新月型)ofhyperdenselesionoverlargeportionofcerebralhemisphere•ThehematomamayextendingintothesubduralspaceoftentorialregionorinterhemisphericfissureSDH：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)ABCDAcuteSubduralHematomaChronicSubduralhematoma•Shape:Semilunar,Fusiform,Ovalshape•Density:–Hyperdense–Isodense–Hypodense–MixeddensityChronicSubduralHematomaT1WIT2WImethemoglobinHyperintenseSubduralHematomaSubduralEffusion•Occurredinagedpatientorinfant•Developedseveraldayslaterafteraheadinjury•Oftenbilateral•Spontaneouslyresorbed•Craniotomy,V-Pshunt,meningitisalsomaycausesubduraleffusionSubduralEffusion4dayslater10dayslaterIntracerebralLesions•Braincontusion腦挫傷(edema,hemorrhage..)•Subarachnoidhemorrhage(SAH)蜘蛛網膜下腔出血•Intraventricularhemorrhage(IVH)腦室內出血BrainContusion•Brainedemamixedwithmultiplesmallhemorrhages腦水腫合併出血：最常見•Solitaryhematoma•Circumscribedareaofbrainedema局部腦水腫：很少見•Diffusebrainedema•Diffuseaxonalinjury廣泛神經軸受傷BrainContusionPunctatehemorrhagesandedemasinthesubcorticalwhitematterofleftfrontallobe(A)andcorpuscallosum(B,C)ABCHeadinjury,GCS:3’Diffuseaxonalinjury(DAI)TraumaticSAH•Oftenassociateswithotherintracerebralorextracerebrallesions•CTfindings:–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5OpenCranialInjury•Skullfracture•Pneumoencephalus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……….