创伤性与动脉瘤破裂性蛛网膜下腔出血的CT诊断鉴别分析  

CT Differential Diagnosis of Traumatic and Aneurysmal Rupture Subarachnoid Hemorrhage

作　　者：林文敏 康雅清 LIN Wenmin;KANG Yaqing(Yongchun County HospitalImaging Department,Yongchun 362601,China;The First Affiliated Hospital of Fujian Medical UniversityMedical Imaging Department,Fuzhou 350004,China)

机构地区：[1]永春县医院影像科,福建永春362601 [2]福建医科大学附属第一医院医学影像科,福建福州350004

出　　处：《中华灾害救援医学》2024年第12期1424-1426,1431,共4页Chinese Journal of Disaster Medicine

摘　　要：目的比较分析创伤和动脉瘤破裂所导致蛛网膜下腔出血的CT表现。方法回顾性分析2022年1月至2023年12月永春县医院收治的120例蛛网膜下腔出血患者的临床资料,其中60例为创伤性蛛网膜下腔出血(创伤性组),60例为动脉瘤破裂性蛛网膜下腔出血(动脉瘤性组)。比较两组患者积血程度和位置分布差异。结果创伤性蛛网膜下腔出血组患者积血积分以≤5分为主,其比例显著高于动脉瘤性蛛网膜下腔出血组(P<0.001);动脉瘤性蛛网膜下腔出血组患者积血积分以≥10分为主,其比例显著高于创伤性蛛网膜下腔出血组(P<0.001);且创伤组积血平均积分显著低于动脉瘤性蛛网膜下腔出血组(P<0.001)。相较于创伤性蛛网膜下腔出血组,动脉瘤性组积血分布更易累积第三脑室(P=0.002)、第四脑室(P<0.001)、大脑纵裂池(P<0.001)、一侧大脑外侧裂池(P=0.012)、两侧大脑外侧裂池(P<0.001)、小脑延髓池(P=0.007)、四叠体池(P<0.001)、鞍上池(P<0.001)、脑桥小脑脚池(P=0.002)、额叶脑沟(P<0.001)、两侧额叶脑沟(P=0.001)、顶叶脑沟(P=0.001)、两侧顶叶脑沟(P<0.001)、颞叶脑沟(P<0.001)、枕叶脑沟(P<0.001)、两侧枕叶脑沟(P<0.001)。结论CT对于鉴别动脉瘤性和创伤性蛛网膜下腔出血有一定价值,动脉瘤性蛛网膜下腔出血患者积血范围广泛,以颅底为中心,向周围邻居脑室、脑池、脑沟扩散;而创伤性蛛网膜下腔出血患者积血范围相对局限,主要在脑皮层面。Objective To compare and analyze the CT manifestations of subarachnoid hemorrhage(SAH)caused by trauma and aneurysmal rupture.Methods A retrospective analysis was conducted on the clinical data of 120 patients with subarachnoid hemorrhage admitted to Yongchun County Hospital between January 2022 and December 2023.Of these,60 patients had traumatic subarachnoid hemorrhage(trauma group),and 60 had aneurysmal subarachnoid hemorrhage(aneurysmal group).The extent and distribution of blood accumulation in the two groups were compared.Results In the trauma group,the majority of patients had a blood accumulation score of≤5,a significantly higher proportion than in the aneurysmal group(P<0.001).Conversely,the aneurysmal group showed a higher proportion of patients with a blood accumulation score of≥10(P<0.001).The average blood accumulation score was significantly lower in the trauma group compared to the aneurysmal group(P<0.001).In terms of blood distribution,the aneurysmal group exhibited more extensive blood accumulation in regions such as the third ventricle(P=0.002),fourth ventricle(P<0.001),sylvian fissures(P=0.012),basal cisterns(P<0.001),cerebellomedullary cistern(P=0.007),interpeduncular cistern(P<0.001),and others,with significant differences observed between the two groups(P<0.001).Conclusion CT imaging is valuable in distinguishing aneurysmal from traumatic subarachnoid hemorrhage.Aneurysmal SAH is characterized by a more extensive blood accumulation,predominantly centered around the skull base and extending to adjacent brain ventricles,cisterns,and sulci.In contrast,traumatic SAH typically presents with more localized blood accumulation,primarily at the cortical level.

关 键 词：蛛网膜下腔出血 体层摄影术 X线计算机 

分 类 号：R743.35[医药卫生—神经病学与精神病学]