DIỄN GIẢI HÌNH ẢNH CT SCAN ĐẦU

DIỄN GIẢI HÌNH ẢNH CT SCAN ĐẦU
Người dịch: BSNT Huỳnh Hữu Năm
<<Adam Marcus, Hani Marcus, Ramez Kirollos, 5/32013, DOI: 10.1136/sbmj.f871, Cite this as:
Student BMJ 2013;21:f871>>


 
 
 


1. Yêu cầu của một CT đầu
     
 cao.   
  
 Anh 
   
 


Bảng 1: Những chỉ định chung để chụp CT đầu


)

-xe (ang)
 [1]
2. Giải phẫu não
neurocranium)
 


 
   (pia)    
   v
gyri  
   (sisterns) ch
 [1]

Hình 1:      so   
bao
 insula lobe)
(paired thalamus)  (basal ganglia)  (caudate nucleus), 
(globus pallidus) putamen).   
vermis)  hai   flocculonodular lobe) 
   [2].

Hình 2.      
falx falx cerebelli)
 tentorium cerebelli) 
    (brain sterm). 
(diaphragma sellae)   
  H
                  
(foramina of Monroe) cerebral aqueduct)   
 
(foramen of Magendie) ( Luschka (foramina of Luschka) (
 arachnoid granulations) [3].

 3:    
3. Sự hiểu biết về “những lát cắt” của CT đầu


  

  [4], [5].



Hình 4:     ngang  nhau       
Khi   nhu ,    CT scan   tia X    X quang .
Thang    Hounsfield (HU),     sau khi  Godfrey Hounsfield,  
    CT,     tia (radiodensity) ( 2) [3].     
 quang     ng             
  (hypodense)           (isodense).    
   nh     thay  theo  gian:       
(hyperdense),        (isodense),     ( gian   
   (hypodense).
Bảng 2: Thang điểm đơn vị Hounsfield (HU) (giá trị xấp xỉ) đối với nhiều chất
 -1000 ()
 -90
 0
 5
 30
 40 ()
 50-70
 >1000 ()
3.1. Mặt cắt X

3.2. Mắt cắt ngôi sao (Star)
       suprasellar cistern),  
 
t 


3.3.Khuôn mặt hạnh phúc
con  
                  (the
quadrigeminal plate)  
3.4. Hình khuôn mặt buồn (Sad face)
       
 pellucidum) "  

3.5. Giun (worms)
 

3.6. Hạt cà phê (Coffee beans)
ee beans). furrows
: gyri) 
 
.
4. Phương pháp tiếp cận có hệ thống
Khi     
 xem 
xem 

4.1. Cửa sổ xương
   

4.2. Ngoài trục (bên ngoài não)
 
 
.
   

do transtentorial herniation) 
4.3. Trong trục (bên trong nhu mô não)
.
4.4. Hệ thống não thất (Ventricular system)
              
.    

,   
 quan (
   
       m            
khoang  (herniation of the cingulate gyrus) 
) (subfalcine herniation) 
septum pellucidum).  
 tentorium cerebelli) () 
(suprasellar cistern). (cerebellar tonsils) 
Magnum ( 

5. Một số bệnh lý
5.1. Chấn thương
5.1.1. Gãy xương sọ
                
   
 
                

(). (paranasal sinuses) 
 (mastoid air cells)  
 
  [6]

 6: nh CT scan     cho            

5.1.2. Tụ máu cấp tính ngoài màng cứng (Acute extradural haematoma)
                    
           cho     .    cho
               cao    ra kh
        (suture line),          do
   i.  7A cho         
[7].

nh 7: CT cho      (extra-axial haemorrhage). (A)    
        trong nhu  ( ),       
    (B)         . (C)     
  hai . (D)    .

5.1.3. Tụ máu dưới màng cứng cấp tính
                n   
  ,            . Tuy , k 
     ,         qua   (suture lines)
        7B cho          
,              di   
5.1.4. Tụ máu dưới màng cứng mãn tính
 
 (crescent shape) 
    
.   
 , 
cho 
5.2. Mạch máu

5.2.1. Xuất huyết dưới nhện
       
  do 
 
 trong (deep intracranial cisterns

          h   
 Sylvian Sylvian cistern).
5.2.2. Xuất huyết nội sọ
  

  
ganglia) [8].  
  
nhu
.

 8:   CT cho      nhau. (A   trong     
. ( B )          trong khu      cung 
. ( C )  u    sinh   qua   . ( D  u   sinh  
   .
5.2.3. Tai biến mạch máu não thể nhồi máu
Tai                   CT cho 
12  .      -  insula   trong       
   .  nghi  tai        CT    
,     CT sau. Khi    ,         
   (   ) do            sau  sinh
    Willis cung   cho n ,   sau, tuy     
      9 ).      cung       ,
       cao      cung         

    sau cung   cho   [9].
 8 ( B ) cho           V  trong khu    c
      [9].

Hình 9: Các vùng cung cấp máu của các nhánh mạch máu não
5.3. Các khối u
  u         quang  u trong  (intra-axial)  
 nhu          (extra-axial)  sinh       
        quan  khi    u      
     quang.            
quang      ,    u   cao (high grade tumours), 
           quang    Trong   
   u         trung          
quang  . Tuy  trong     quang       
   bao       xe  (xem  3).    k u  sinh
       quang do       
            

 (Metastasis)
 (Abscess)
Glioma
(Infart)
 (Contusion) 
 (Demyelinating disease)
 (Radiation necrosis)
(Cách để dễ nhớ MAGIC DR)
 
sinh 
 u 
falx- cerebri).

5.4. Não úng thủy
 
.   
  
periventricular lucency),
  (ependymal wall

do 
). Trong
 .
    m  
 
[10].

 10.               3  
Bảng 4 : Thuật ngữ
Basal ganglia (  -  
caudate nucleus), substantia nigra,   (subthalamic nucleus).
x khi xem 
 ( 500 HU )  
.
    
HU).
Willis: .
= B(Cisterns ,   

): .
-.
 (Gyrus)  .
 -1000 HU ( hypod

1000 HU ().
  axial): .
  h
 (insular lobe) (  "limbic".
    
.
: 

Neurocranium
  
 (sulcus)   

Tài liệu tham khảo
1. Royal College of Radiologists. Making the best use of clinical radiology. MBUR7/iRefer V. 7.
2011www.rcr.ac.uk/content.aspx?pageid=995.
2.  Clinical radiology made ridiculously simple. MedMaster, 2003.
3. Samandouras G. The neurosurgeon’s handbook. Oxford University Press, 2010.
4. Moore AJ, Newell DW. Neurosurgery: Principles and practice. Springer, 2005:431.
 Name: HUYNHNAM
 Email: