CT诊断早期颞叶型天幕疝的标准及临床价值  

Early transtentorium hernia:CT findings and diagnostic criterion

作　　者：巩若箴[1] 王涛[1] 刘艾艳[1] 柳澄[1] 周存升[1] 陈颉[1] 

机构地区：[1]山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2003年第3期145-148,共4页Journal of Medical Imaging

摘　　要：目的 :探讨CT诊断早期颞叶型天幕疝的标准及临床价值。方法 :选择 1 38例偏侧占位效应明显的患者及 1 0 0例无颅脑症状及体征的志愿者 ,应用斜坡垂线扫描法进行CT扫描 ,研究早期颞叶型天幕疝的CT表现及临床价值。结果 :斜坡垂线扫描图像上 ,74例显示天幕疝的直接征象即小脑幕内侧环池内软组织块 ,与颞叶组织相延续。颞叶疝至幕下 3 .0mm以内者 5例 ,疝至幕下 3 .0～ 6 .0mm者 2 8例 ,疝至幕下 6 .0mm以上者 41例。 1 0 0例正常人中 98例颞叶组织位于小脑幕外侧 ,仅 2例在小脑幕切迹层面上见到颞叶位于小脑幕内侧。结论 :①早期颞叶型天幕疝的CT诊断标准为 :颞叶伸入幕下≥ 3 .0mm可诊断为颞叶下疝 ;<3 .0mm应视为可疑。以颞叶下移 3 .0mm为阈值诊断颞叶下疝的敏感度为90 7% ,特异度为 1 0 0 % ,准确度为 90 .7% ;Objective:To study the diagnostic criterion and meaning of direct sign of early transtentorium herniation.Methods:118 patients with unilateral high intracranial pressure and 100 volunteers without any cranial symptom and sign were scanned in the ways of the scanning vertical to clivus.The scanning line for vertical to clivus scanning method was vertical to joining line between the apex of the dorsum sellae and the base of the clivus.Results:Vertical to clivus scanning method directly demonstrated the temporal transtentorial hernia in 74 of 138 patients with unilateral high intracranial pressure,but the orbitomeatal line scanning method was not able to show this direct finding.The downward shift of the temporal lobe was less than 3.0mm in 5 patients,between 3.0～6.0mm in 28 patients,more than 6.0mm in 41 patients.Conclusion:The projected tissue of the hernia could be judged directly on the CT imagings from the vertical to clivus scanning method.The CT diagnosis criterion of the hernia was suggested as follow:the hernia whould be determined if the downward shift of the temporal lobe was more than 3.0mm and suspected if the downward shift of the temporal lobe were less than 3.0mm with ipsilateral high intracranial pressure.

关 键 词：脑疝 体层摄影术 X线计算机 

分 类 号：R651.1[医药卫生—外科学] R814.42[医药卫生—临床医学]