Traumatic injuries: imaging of head injuries
Traumatic injuries: imaging of head injuries
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DOI：
10.1007/s00330-002-1355-9
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发表时间：
2002-06-01
影响因子：
5.9
通讯作者：
Besenski, N
中科院分区：
文献类型：
--
作者：
Besenski, N
由于加速度、直线平移以及旋转和角加速度的作用，大脑会发生变形和变形，这取决于创伤力方向、伤害力的严重程度和大脑的组织阻力。闭合性颅脑损伤中加速的直线平移可沿颅骨较短的外侧方向移动，主要引起轴外病变(硬膜下血肿、硬膜外血肿、蛛网膜下腔出血)或相当明显的撞击和反击挫伤。挫伤在内侧或旁正中轴位打击(额枕部或枕额部)较少出现。中心轴撞击会产生不同的损害模式，主要发生在深层结构，在某些情况下会导致一种特殊类型的脑损伤，即弥漫性轴索损伤(DAI)。脑干也可能受损，但在经历过中心轴创伤性力量方向的患者中，脑干受损更常见。计算机断层扫描和核磁共振成像是脑损伤患者最常用的技术，计算机断层扫描是目前脑损伤后使用的第一种成像技术，在那些可以使用CT的环境中。使用CT可以显示头皮、骨骼、轴外血肿和实质损伤。在被监测的患者中，计算机断层扫描也是快速和容易进行的。它是外科病变最相关的影像检查方法。计算机断层扫描是一种合适的方法来跟踪病变发展的动力学，以洞察相应的脑损伤的病理发展。磁共振成像对除颅骨骨折和蛛网膜下腔出血外的所有创伤后病变都更敏感，但扫描时间较长，而且在MRI领域外对患者的监测存在问题。如果CT不能显示可以充分解释临床状态的病理，MRI是有根据的。随访最好用MRI，因为它对实质改变更敏感。在常规MR检查中，梯度回声序列在检测含铁血黄素和无含铁血黄素的原有血肿时非常敏感，因此应在创伤事件发生后的任何其他时间包括在内。创伤后MR信号强度随扫描顺序和时间不同而不同。
Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for clinical state, MRI is warranted. Follow-up is best done with MRI as it is more sensitive to parenchymal changes. In routine MR protocol gradient-recalled-echo sequences should be included at any other time after a traumatic event since they are very sensitive in detection of hemosiderin as well as former hematoma without hemosiderin. The MR signal intensity varies depending on sequences and time scanning after trauma.