RADIONUCLIDE BRAIN SCANNING IN PATIENTS WITH HEAD INJURY

放射性核種腦部閃爍描繪圖用於頭部外傷患者之檢查

陳傳慶(Chung-Ching Chen)

《中華放射線醫學雜誌》 2卷4期 (1977/12) Pp. 281-294

摘要

Brain scans of 60 patients with head injury were reviewed in order to evaluate the clinical usefulness. The dynamic, static early and delayed brain scannings were made by using 99mTc-pertechnetate with a scintillation camera. Cerebral contusion is readily detected by brain scannings. The dynamic scan shows a displacement and/or an alternation of cerebral vessels, and static scan presents radionuclide accumulation in the contused area of brain and the site of fracture. All of 10 patients with cerebral contusion and 18 with fracture and cerebral contusion had positive brain scans. Two of them sufferred from cerebral contrecoup contusions and their diagnoses were mady by brain scannings only. Brain edema is indistinguishable from cerebral contusion on brain scans. All of 5 patients with brain edema were not correctly diagnosed. Subdural hematoma presents different characteristic perfusion defects on dynamic scan and various shapes of radionuclide accumulation along the affected lateral portion of the brain on static scan. The shapes of radionuclide accumulation become more obviously positive on delayed scans. The combination of dynamic, static early and delayed brain scannings makes the detection of unilateral and bilateral subdural hematomas accurately. In 7 of 19 patients with subdural hematoma, the brain scans were characteristic enough allowing to plan the therapeutic measures; 4 patients received surgical managements and 3 treated medically. Brain scanning detects about 84%of subdural hematomas proved surgically. Brain scanning does not appear to be accurate in the detection of epidural hematoma but it is helpful in assessing the presence of a hematoma. A definitive diagnosis of an epidural hematoma lies in angiographic study or surgical exploration. One patient included in the study and the brain scan was suspicious of an epidural hematoma. Intracerebral hematoma presents a displacement of cerebral vessels on dynamic scan and a well defined area of radionuclide accumulation in different locations within the brain substances on static scan. All of 3 patients with intracerebral hematoma had a correct positive localization on brain scans. . Head trauma can cause subarachnoid hemorrhage, cerebral infarction, aneurysm and arteriovenous malformation. Brain scanning can provide diagnostic information of these intracranial lesions. The advantage of brain scanning is the ease of performance, lack of technical hazard and miminal radiation exposure to the patient. Brain scanning is a noninvasive method for evaluating the effects of trauma upon the brain and its coverings of the patients with head injury. The method is not only a valuable diagnostic alternative in the evaluation of intracranial lesions of patients with head injury but also is suitable for follow-up such patients operated upon or treated conservatively.

並列摘要

國立台灣大學醫學院附設醫院放射線科，於民國64年7 月至65年12月，18 個月期間曾為60名頭部外傷患者作腦部閃爍描繪之檢查。男性49名，女性11名；病人年齡自4個月至68歲，中年男性占最大的比例，車禍為其主要的原因。放射性^(99m)鎝-Pertechnetate 及閃爍照像診斷器經採用攝製動態腦內血流行逕之閃爍描繪圖及靜態早期與晚期之閃爍描繪圖之合併應用，可以確定頭部外傷所引起的腦組織及其覆蓋物的病變。10例腦部挫傷在腦部閃爍描繪圖上顯示腦部血管的移位和變異，18例腦組織挫傷部及顱骨骨折處有放射性藥物的存積。硬膜下血腫時，腦部閃爍描繪圖顯示病灶側有血流行逕的特殊缺損，血腫在腦部側面，有各種形狀的放射性藥物的聚積。硬膜下血腫可單側(17例)或雙側(2例)，容易判斷。硬腦膜外血腫1倒，腦部閃爍描繪圖指示病變部位，為腦血管攝影或手術處理時的指標。3例腦內血腫亦引起腦血管的移位，但血腫所聚積的放射性藥物均在腦內一些特定的區域。頭部外傷所造成的蜘蛛膜下出血、腦梗塞、腦血管瘤以及動靜脈畸型各1例，腦部閃爍描繪圖，均予以正確的診斷。腦水腫由於頭部外傷所致者，在腦部閃爍描繪圖上不易與腦挫傷區別。腦部閃爍描繪圖的撿查，方法簡便而安全，同一病人可以反覆檢查，除用來診斷腦部疾病外，並可用於病情的觀察，治療放果的評估。頭部外傷病人，該三項腦部閃爍描繪圖應列為常規例行之檢查。