脑部的正常CT及MRI解剖课件

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,interhemisphericfissures…Sulci(腦溝)F:frontallobe P:ponsT:temporallobe s:suprasellarcistern(碟鞍上腦池)Ce:cerebellum d:dorsumsellaFTCesPdparietallobe4thVFTMbCeF:frontallobe Mb:midbrainT:temporallobe s:suprasellarcistern(碟鞍上腦池)Ce:cerebellumsTemporallobeparietallobeFQcMb3vTOF:frontallobe Sy:SylvianfissureT:temporallobe O:occipitallobe Mb:midbrain 3v:3rdventriclelv:lateralventricleCC:corpuscallosum(genu)Qc:quadrigeminalcistern(四疊體腦池)SyCCparietallobelvFPOSpCCF:frontallobe CC:corpuscallosumP:parietallobe Sp:spleniumofCCO:occipitallobelv:lateralventricles:sulcusparietallobelvssFPCiCSIfF:frontallobe If:interhemisphericP:parietallobe fissureCi:cingulum cs: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-likefilling

defectsmaybeseeninthehematoma.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:3’

Diffuseaxonalinjury(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-veget