纵裂池偏密征在外伤性蛛网膜下腔出血中的诊断价值  

Value of interhemispheric hemilateral cisternal hyperdense sign in the diagnosis of traumatic subarachnoid hemorrhage

作　　者：黄花开[1] 王秀河[1] 林志超[1] 廖祖元[2] 郑兆华[2] 马峰[2] 

机构地区：[1]暨南大学附属第一医院医学影像中心,广东广州510630 [2]深圳市宝安区西乡人民医院CT室,广东深圳518102

出　　处：《暨南大学学报（自然科学与医学版）》2003年第2期71-75,共5页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省医学科研基金资助项目(A2002354)

摘　　要：　目的:提高对纵裂池偏密征的认识,评价该征对外伤性蛛网膜下腔出血(TSAH)首次CT确诊的价值。方法:回顾性分析TSAH300例CT资料中有纵裂池偏密征者136例的CT表现;分甲乙两组医生对疑诊或漏诊TSAH的43例行盲法复阅CT片,并统计学处理其测试结果。结果:TSAH以纵裂池少量积血最多见(212例);纵裂池偏密征136例,其中出现前纵裂池偏密征109例次,后纵裂池偏密征52例次,以前者更多见;疑诊或漏诊TSAH的43例复阅CT结果:甲组医生确诊TSAH19例,疑漏诊24例;乙组确诊TSAH34例,疑漏诊9例;两组比较有统计学意义(χ2=11 06,P<0 005)。本组136例均有其它颅脑内损伤,首次CT发现病变154个,迟发病变57个,其中首发病变111个和迟发病变51个均在纵裂池偏密征同一侧发病。结论:纵裂池偏密征是CT诊断外伤性蛛网膜下腔少量积血的一个可靠征象,是否认识此征象,直接影响TSAH的首次CT确诊率;纵裂池偏密征也是迟发性外伤性颅脑内病变的早期征象之一。Aim: To improve the recognition of interhemispheric hemilateral cisternal hyperdense sign (IHCHS) and evaluate its value in initial confirmative diagnosing traumatic subarachnoid hemorrhage (TSAH) on CT. Methods: CT information of 300 TSAH cases were analyzed retrospectively, 136 of which showed IHCHS; The first CT images with missing and uncertain diagnoses were reviewed by two group doctors, data obtained were analyzed by using a chi-square test with blind method. Results: In the 300 TSAH cases, interhemispheric cistern hemorrhage was most commonly seen (n=212), IHCHS was seen in 136 cases,of which 109 cases showed pre-interhemispheric hemilateral cisternal hyperdense sign and 52 cases showed post-interhemispheric hemilateral cisternal hyerdense sign. In the 136 IHCHS cases, associated with other intra-craniocerebral damages, of which, 154 lesions were found on initial CT scans and 57 lesions on the delayed CT scans. 111 initial and 51 delayed lesions were seen with ipsilateral IHCHS. In the review for 43 uncertain and missing cases. 19 cases (in group 1) and 34 cases (in group 2) were confirmatively diagnosed with TSAH, 24 cases (in group 1) and 9 cases (in group 2) were missed diagnosed or uncertain on initial CT scans. There was significant increase in the initial confirmative diagnostic rate of TSAH in group 2 when compared with group 1(χ2=11.06 P<0.005). Conclusion: IHCHS is a reliable CT sign for diagnosis of TSAH with small amount of bleeding. Paying attention to IHCHS will surely increase confirmative diagnostic rate of TSAH on initial CT scans. IHCHS is a early sign for diagnosis of traumatic delayed intra-craniocerebral damages on CT scans.B

关 键 词：纵裂池偏密征 颅脑损伤 蛛网膜下腔出血 体层摄影术 X线计算机 

分 类 号：R445[医药卫生—影像医学与核医学]