電腦斷層攝影對慢性硬腦膜下血腫之診斷

Computed Tomography in the Diagnosis of Chronic Subdural Hematoma

沈戊忠(Wu-Chung Shen) ； 李仁杰(Reng-Jye Lee) ； 張遵(Tsuen Chang)

《中華放射線醫學雜誌》 6卷4期 (1981/12) Pp. 299-314

摘要

榮民總醫院在過去二年五個月間，經CT診斷且手術證明為慢性硬腦膜下血腫者，共有68位病人，80個血腫。病患年齡在50歲以上者佔72%。慢性硬腦膜下血腫在CT上可表現出各種不同的形狀及衰減值，80個血腫中，新月形32個(40%)，半月形31個(38.7%)，紡垂形21個(33.7%)。15個慢性硬腦膜下血腫為低衰減值，29個(36.2%)為混合型，呈兩種不同衰減值，22個(27.5%)為等衰減值，14個(17.5%)為高衰減值。這些血腫在常規CT檢查中有些可看到外膜，共9例(11.2%)，而注射對比劑後，31例(38.7%)其外膜因被強化而更清晰可見。本文亦討論慢性硬腦膜下血腫形狀及衰減值的病理生理機轉。

並列摘要

Clinical diagnosis of a chronic subdural hematoma (chr. SDH) is extremely difficult because neurological deficit and psychiatric manifestations are not consistent but C-T (computed tomogram) provides accurated diagnosis, particularly for most chronic SHD significantly different attenuation from the adjacent brain tissue.
In the two year period from October 1978 to March 1981, 91 patients were diagnosed as chronic SDH, and 68 cases were confirmed by surgical intervention. There were altogether 80 chronic SDH's in these 68 patients, because 10 patients has bilateral SDH and two patients developed another chronic SDH several weeks after surgical removal of a previous chronic SDH.
Chronic SDH may demonstrate different subtypes according to attenuation value: hypodense chronic SDH, 15 cases (18.7%), mixed density 21(36.2%), isodense, 22 (27.5%), and hyperdense 14 (17.5%). Factors relevant to the different attenuation values may include: duration between head injury to C-T examination, evolution of the hematoma, rebleeding, sedimentation phenomenon, and individual factors.
There are three shapes of chronic SHD: crescent form 32 cases (40%), semilunar form 21 (38.7%), and fusiform, 21(33.7%). The shape of chronic SDH seems unrelated to the duration of the injury.
65 cases (81.2%) have mass effect, 34 (42.5%) of them caused contralateral ventricular dilatation.