Vakil Mona T, Singh Ajay K
Massachusetts General Hospital, 55 Fruit Street, Blake SB0029A, Boston, MA, 02114, USA.
Emerg Radiol. 2017 Jun;24(3):301-309. doi: 10.1007/s10140-016-1477-z. Epub 2017 Jan 14.
Gunshot injuries are the most common cause of penetrating brain injury (PBI) and carry a high morbidity and mortality. The incidence of PBI has increased over the last decade with an estimated 35,000 civilian deaths annually. Patients that survive to reach the hospital require rapid triage and imaging evaluation. CT findings in conjunction with the Glasgow Coma Scale are typically used to determine which patients are surgical candidates. Radiologists should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators, notably brainstem, bilateral hemispheric, multilobar, or transventricular injuries. Post-traumatic complications, including intracranial infections, cerebrospinal fluid leaks, traumatic intracranial aneurysms, intraventricular hemorrhage, dural venous sinus thrombus, and bullet fragment migration, also have specific imaging features and serious treatment implications. In this article, we review the initial imaging evaluation of penetrating brain injury using computed tomography with and without angiography. We also describe the imaging features of various post-traumatic complications and their treatment implications. Finally, we discuss the clinical and imaging parameters that serve as important prognostic indicators and the surgical management.
枪伤是穿透性脑损伤（PBI）最常见的原因，具有较高的发病率和死亡率。在过去十年中，PBI的发病率有所上升，估计每年有35000名平民死亡。存活至医院的患者需要快速分诊和影像学评估。CT检查结果结合格拉斯哥昏迷量表通常用于确定哪些患者是手术候选者。放射科医生应熟悉各种损伤模式和影像学表现，这些表现是预后不良的指标，特别是脑干、双侧半球、多叶或经脑室损伤。创伤后并发症，包括颅内感染、脑脊液漏、创伤性颅内动脉瘤、脑室内出血、硬脑膜静脉窦血栓形成和子弹碎片迁移，也有特定的影像学特征和严重的治疗意义。在本文中，我们回顾了使用计算机断层扫描（有无血管造影）对穿透性脑损伤进行的初始影像学评估。我们还描述了各种创伤后并发症的影像学特征及其治疗意义。最后，我们讨论了作为重要预后指标的临床和影像学参数以及手术管理。
