中枢神经系统影像学脑肿瘤外.ppt

Subdural hematoma (SDH) Terminology: Hemorrhagic collection in subdural space between the meningeal layer of the dura and arachnoid. ~ can occur either at the coup or contracoup site, although the latter is more common. Pathology: stretching and tearing of bridging cortical veins as they cross subdural space to drain into dural sinus. Injury to bridging veins results in bleeding in subdural space , and blood may continue to accumulate in this space as bridging veins are progressively stretched and injured. Clinical prognosis: poor, 35%~90% mortality. crescent-shaped, homogeneously hyperdense (60%) collection on CT in acute stage and spreads diffusely over affected hemisphere . may cross cranial sutures, not dural attachments. May extend along falx and tentorium. Can compress and displace underlying brain. Recurrent, mixed-age hemorrhage common. Imaging findings in acute stage: hyperdense (60%) on CT . 40% mixed hyper-hypodense: active bleeding, clot retraction, torn arachnoid with CSF accumulation rarely isodense: anemia, coagulopathy. Injury to superficial bridging veins results in bleeding between the meningeal layer of the dura and arachnoid Acute left convexity subdural hematoma, typical crescent shape,more mass effect than EDH SDH Fluid level-Uncloted blood Acute SDH, spreads along the falx and tentorium. Subcute SDH Late subacute SDH Extracelluler methemoglobin: 亚急性硬膜下血肿 颅骨内板下新月形， 高、低、等、混杂密度影 Mixed age, multiple fluid level, loculations Subarachnoid hemorrhage (SAH) Terminology : blood within subarachnoid spaces between pial and arachnoid membranes. Acute SAH is readily identified on NECT as linear areas of high attenuation within cerebral sulci, basilar cisterns , interhemispheric cistern or Sylvian fissures . MR-FLAIR sequence: hyperintense sulci/ cisterns. Linear lesions of high attenuation within sulci, basilar cisterns , Sylvian fissures,suprasellar cistern and interhemispheric cistern .