Gentry L R, Godersky J C, Thompson B
Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242.
AJR Am J Roentgenol. 1988 Mar;150(3):663-72. doi: 10.2214/ajr.150.3.663.
The distribution and extent of traumatic lesions were prospectively evaluated with MR imaging in 40 patients with closed head injuries. Primary intraaxial lesions were classified according to their distinctive topographical distribution within the brain and were of four main types: (1) diffuse axonal injury (48.2%), (2) cortical contusion (43.7%), (3) subcortical gray-matter injury (4.5%), and (4) primary brainstem injury (3.6%). Diffuse axonal injury most commonly involved the white matter of the frontal and temporal lobes, the body and splenium of the corpus callosum, and the corona radiata. Cortical contusions most frequently involved the inferior, lateral, and anterior aspects of the frontal and temporal lobes. Primary brainstem lesions were most commonly seen in the dorsolateral aspects of the rostral brainstem. The pattern and distribution of primary lesions seen by MR were compared with those expected from previous pathologic studies and found to be quite similar. Our data and review of the literature would also indicate that MR detects a more complete spectrum of traumatic lesions than does CT. Secondary forms of injury (territorial arterial infarction, pressure necrosis from increased intracranial pressure, cerebral herniation, secondary brainstem injury) were also visible by MR in some cases. The level of consciousness was most impaired in patients with primary brainstem injury, followed by those with widespread diffuse axonal injury and subcortical gray-matter injury. The best MR imaging planes, pulse sequences, and imaging strategies for evaluating and classifying traumatic lesions were evaluated, and the mechanisms by which traumatic stresses result in injury were reviewed. MR was found to be superior to CT and to be very effective in the detection of traumatic head lesions and some secondary forms of injury. While T2-weighted images were most useful for lesion detection, T1-weighted images proved to be most useful for anatomic localization and classification.
对40例闭合性颅脑损伤患者进行了磁共振成像（MR）检查，以前瞻性评估创伤性病变的分布和范围。原发性脑内病变根据其在脑内独特的地形分布进行分类，主要有四种类型：（1）弥漫性轴索损伤（48.2%），（2）脑皮质挫伤（43.7%），（3）皮质下灰质损伤（4.5%），以及（4）原发性脑干损伤（3.6%）。弥漫性轴索损伤最常累及额叶和颞叶白质、胼胝体膝部和压部以及放射冠。脑皮质挫伤最常累及额叶和颞叶的下部、外侧和前部。原发性脑干病变最常见于脑干上部的背外侧。将MR所见原发性病变的模式和分布与先前病理研究预期的情况进行比较，发现两者非常相似。我们的数据以及对文献的回顾还表明，MR比CT能检测到更完整的创伤性病变谱。在某些情况下，MR也能显示继发性损伤形式（区域性动脉梗死、颅内压升高导致的压迫性坏死、脑疝、继发性脑干损伤）。原发性脑干损伤患者的意识水平受损最严重，其次是广泛弥漫性轴索损伤和皮质下灰质损伤患者。评估了用于评估和分类创伤性病变的最佳MR成像平面、脉冲序列和成像策略，并回顾了创伤性应力导致损伤的机制。发现MR优于CT，在检测创伤性头部病变和一些继发性损伤形式方面非常有效。虽然T2加权图像对病变检测最有用，但T1加权图像对解剖定位和分类最有用。
