Hiramatsu Masafumi, Haruma Jun, Hishikawa Tomohito, Sugiu Kenji, Date Isao
Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University.
No Shinkei Geka. 2021 Mar;49(2):284-292. doi: 10.11477/mf.1436204390.
CT angiography(CTA)plays a crucial role in the diagnosis of intracerebral hemorrhage(ICH). An 85-year-old woman presented with a disturbance of consciousness and right hemiparesis. Non-contrast CT of the brain revealed intracerebral hemorrhage in the left thalamus spreading to the internal capsule, corona radiata, and midbrain and a "swirl sign." CTA revealed no vascular anomaly. The early and delayed CTA phases revealed the"spot sign" and "leakage sign," respectively. Non-contrast CT three hours after the initial CT showed the enlargement of the hematoma. After the detection of ICH by initial non-contrast CT, CTA should be performed to differentiate between the causes of secondary ICH and detect the imaging markers of hematoma expansion or rebleeding. Previous studies have demonstrated that the "spot sign" detected by CTA is a valid imaging marker for hematoma expansion. In this article, the differential diagnosis of ICH and the detection of the imaging markers of hematoma expansion using non-contrast CT and CTA have been discussed.
CT血管造影(CTA)在脑出血(ICH)的诊断中起着关键作用。一名85岁女性出现意识障碍和右侧偏瘫。脑部非增强CT显示左侧丘脑脑出血,血肿蔓延至内囊、放射冠和中脑,并出现“漩涡征”。CTA未显示血管异常。CTA的早期和延迟期分别显示出“斑点征”和“渗漏征”。初始CT检查三小时后的非增强CT显示血肿增大。在初始非增强CT检测到ICH后,应进行CTA以鉴别继发性ICH的病因,并检测血肿扩大或再出血的影像学标志物。先前的研究表明,CTA检测到的“斑点征”是血肿扩大的有效影像学标志物。本文讨论了ICH的鉴别诊断以及使用非增强CT和CTA检测血肿扩大的影像学标志物。