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1、硬膜外血肿的影像诊断硬膜外血肿的影像诊断Imaging Diagnosis of Imaging Diagnosis of Epidural Hematoma Epidural Hematoma 目的目的 （objectiveobjective）1、掌握硬膜外血肿的CT及MRI诊断。Master the CT and MRI diagnosis of the Epidural Hematoma.2、掌握硬膜外血肿影像检查方法的选择。Master the choice of imaging method in Epidural Hematoma.一、定义一、定义 （DefinitionDefin
2、ition）一、定义一、定义 （DefinitionDefinition）颅内出血积聚于颅骨与硬膜之间称为硬膜外血肿。Epidural hematoma is an extra blood collection,located between the dura and the inner table of the skull.硬膜硬膜颅骨颅骨血肿血肿二、临床表现二、临床表现 （Clinical FindingsClinical Findings）二、临床表现二、临床表现 （Clinical FindingsClinical Findings）临床出现头痛、呕吐、昏迷等症状，严重者出现脑疝。Cl
3、inical manifestations include headache、vomit、coma，in severe case appear hernia of brain.三、影像诊断（三、影像诊断（Imaging Diagnosis)Imaging Diagnosis)X X线诊断线诊断 CT CT诊断诊断 MRI MRI诊断诊断1、X线诊断（X-ray DiagnosisDiagnosis)仅能显示颅骨骨折，诊断价值有限。血肿血肿脑脑颅骨颅骨2 2、CTCT及及MRIMRI诊断诊断 (CT and MRI Diagnosis(CT and MRI Diagnosis)2 2、CTCT及
4、及MRIMRI诊断诊断 (CT and MRI Diagnosis(CT and MRI Diagnosis)双凸形血肿 biconvex hematoma双凸形血肿 Biconvex HematomaCT双凸形血肿 biconvex hematomaMRI T1WI2 2、CTCT及及MRIMRI诊断诊断 (CT and MRI Diagnosis(CT and MRI Diagnosis)双凸形血肿 Biconvex Hematoma 颅骨骨折 Skull Fracture脑窗Cerebral windowCT颅骨骨折颅骨骨折 Skull FractureSkull Fracture骨窗骨
5、窗Bone WindowBone WindowCT颅骨骨折 Skull Fracture脑窗脑窗Cerebral WindowCerebral Window骨窗骨窗Bone WindowBone WindowCTCT2 2、CTCT及及MRIMRI诊断诊断 (CT and MRI Diagnosis(CT and MRI Diagnosis)双凸形血肿 Biconvex Hematoma 颅骨骨折 Skull Fracture 占位效应 Mass Effect占位效应占位效应 Mass EffectMass EffectCTCT占位效应占位效应 Mass EffectMass EffectMR
6、I T1WI MRI T1WI 冠状冠状2 2、CTCT及及MRIMRI诊断诊断 (CT and MRI Diagnosis(CT and MRI Diagnosis)双凸形血肿 Biconvex Hematoma 颅骨骨折 Skull Fracture 占位效应 Mass Effect 头皮软组织肿胀 Scalp Soft Tissue Swelling头皮软组织肿胀 Scalp Soft Tissue SwellingCTCT头皮软组织肿胀头皮软组织肿胀 Scalp Soft Tissue SwellingScalp Soft Tissue SwellingMRI T2WI MRI T2W
7、I 矢状矢状我们还能为我们还能为临床提供更临床提供更多的诊断信多的诊断信息吗？息吗？答案是答案是肯定肯定的！的！血肿在不同时期的表现血肿在不同时期的表现CTCTT1WIT1WIT2WIT2WI急性期急性期Acute PhaseAcute Phase高密度高密度High DensityHigh Density等信号等信号EquisignalEquisignal 低信号低信号Low SignalLow Signal亚急性期亚急性期SubacuteSubacute PhasePhase等或等或混杂密度混杂密度EquidensityEquidensityMixed Mixed DensityDensi
8、ty逐渐逐渐增高信号增高信号GraduallyGradually IncreasesIncreasesSignalSignal逐渐逐渐增高信号增高信号GraduallyGradually IncreasesIncreasesSignalSignal慢性期慢性期Chronic PhaseChronic Phase低密度低密度Low DensityLow Density低信号低信号Low SignalLow Signal高信号高信号High SignalHigh Signal急性期血肿急性期血肿CT MRI T1WI MRI T2WICT MRI T1WI MRI T2WI亚急性期血肿亚急性期血肿
9、CT MRI T1WI MRI T2WICT MRI T1WI MRI T2WI慢性期血肿慢性期血肿CT MRI T1WI MRI T2WICT MRI T1WI MRI T2WI 血肿在不同时期的表现血肿在不同时期的表现CTCTT1WIT1WIT2WIT2WI急性期急性期Acute PhaseAcute Phase高密度高密度High DensityHigh Density等信号等信号EquisignalEquisignal 低信号低信号Low SignalLow Signal亚急性期亚急性期SubacuteSubacute PhasePhase等或等或混杂密度混杂密度Equidensity
10、EquidensityMixed Mixed DensityDensity逐渐逐渐增高信号增高信号GraduallyGradually IncreasesIncreasesSignalSignal逐渐逐渐增高信号增高信号GraduallyGradually IncreasesIncreasesSignalSignal慢性期慢性期Chronic PhaseChronic Phase低密度低密度Low DensityLow Density低信号低信号Low SignalLow Signal高信号高信号High SignalHigh Signal3 3、影像方法的选择、影像方法的选择 (choice
11、 of imaging modalities)(choice of imaging modalities)CT是最主要的检查方法。对于亚急性期和慢性期的血肿，MRI的显示优于CT。CT is the main inspection method,MRI showed better than CT in hematoma in subacute phase and chronic phase.MRI DWIMRI DWI四、鉴别诊断（Differential Diagnosis）与硬膜下血肿鉴别 血肿的形状。(The shape of the hematoma.)是否跨越中线或颅缝。(Wheth
12、er the cranial seam or midline across.)硬膜外血肿硬膜外血肿 硬膜下血肿硬膜下血肿CTCT硬膜外血肿硬膜外血肿 硬膜下血肿硬膜下血肿MRI T2WIMRI T2WI 五、小结（五、小结（Brief SummaryBrief Summary）双凸形双凸形 BiconvexBiconvex 骨折骨折 FractureFracture 移位移位 ShiftShift 肿胀肿胀 Swelling Swelling 重点词汇重点词汇（Key WordsKey Words）硬膜外血肿硬膜外血肿 Epidural HematomaEpidural Hematoma 颅骨
13、骨折颅骨骨折 Skull FractureSkull Fracture 脑窗脑窗 Cerebral WindowCerebral Window 骨窗骨窗 Bone WindowBone Window 占位效应占位效应 Mass EffectMass Effect If the hematoma happened in If the hematoma happened in cerebral,what typical image cerebral,what typical image sign will be shown?sign will be shown?参考书籍参考书籍 脑与脊髓CT及MR
14、I诊断学图谱主编李联忠，人民卫生出版社,2009年9月 中枢神经系统CT和MRI诊断主编沈天真，上海医科大学出版社,2006年1月 CT Clinical CT Clinical Applications,and Quality Applications,and Quality ControlControl Euclid Euclid seemramseemram RT(R)BSc MSC,RT(R)BSc MSC,20102010 CT CT and MRI of the Whole and MRI of the Whole BodyBody John John R.HaagaR.Haaga MD,2010MD,2010
