Takamura Y, Uede T, Igarashi K, Tatewaki K
Department of Neurosurgery, Kushiro City General Hospital.
No Shinkei Geka. 1995 Jan;23(1):61-4.
The authors report the MR imaging of two patients with multiple subdural empyemas, including one in the interhemispheric fissure. MRI demonstrated convexity and interhemispheric collections which were mild hyperintense relative to CSF, hypointense relative to gray and white matter on T1W1, and marked hyperintense relative to CSF, and brain on T2W1. On the basis of signal intensity differences, MRI can distinguish subdural empyemas from most sterile effusions and chronic subdural hematomas with similar CT appearances. MRI was found to be clearly more sensitive to subdural empyemas than CT, though such lesions missed on CT were considered to be relevant. MR was superior to CT in demonstrating the nature, presence, and extent of these lesions. In both cases, the capsule of the lesions demonstrated enhancement, and connection between each lesion was obvious on contrast-enhanced MRI. It seems that contrast-enhanced MR image may detect encapsulation of an abscess which can not be detected from contrast-enhanced CT. We emphasized that the most significant factor in the successful surgical management of multiple subdural empyema, particularly including interhemispheric collections is the accurate location of pus. This can be reliably achieved with MR imaging.
作者报告了两名患有多发性硬膜下积脓患者的磁共振成像（MR）情况，其中一例位于大脑镰旁。磁共振成像显示脑凸面和大脑镰旁有积液，在T1加权像（T1W1）上相对于脑脊液呈轻度高信号，相对于灰质和白质呈低信号，在T2加权像（T2W1）上相对于脑脊液和脑呈明显高信号。基于信号强度差异，磁共振成像能够将硬膜下积脓与大多数无菌性积液以及具有相似CT表现的慢性硬膜下血肿区分开来。结果发现，磁共振成像对硬膜下积脓的敏感性明显高于CT，不过CT漏诊的此类病变也被认为具有相关性。在显示这些病变的性质、存在情况及范围方面，磁共振成像优于CT。在这两例中，病变包膜均有强化，在增强磁共振成像上各病变之间的连接清晰可见。似乎增强磁共振图像可能检测到增强CT无法检测到的脓肿包膜。我们强调，对于多发性硬膜下积脓，尤其是包括大脑镰旁积液在内的成功手术治疗，最重要的因素是准确确定脓液的位置。这可以通过磁共振成像可靠地实现。
