Thang xam HOUNSFIELD

Thang xam HOUNSFIELD

+1000 xng ac

+200
O nc
- 200

+200 voi hoa nhe

tuyen tung, am roi
mau tu cu
+70 +50 : mau mi
+50 +35: chat xam
+35 +25: chat trang
+ 25 +10: phu, hoai t
+10
0 : dch nao tuy
-10
cac cau truc m

- 1000 khong kh

-200

KHI NiM V CA S (WINDOW

(WINDOW--WIDTH)
V MC NGANG GiA (LEVEL)
(LEVEL)

October 31, 2013

Ca s
m mm
W=80, L=35

Ca s
xng
W=1200,L=300

CA S TRUNG THT
LEVEL=40 , WINDOW=400

CA S PHI
LEVEL=-600 , WINDOW=1600
LEVEL=-

October 31, 2013

CCH C PHIM CT S
S--NO:
NO:
1/ T PHIM LN DN N XEM PHIM CHO NG CCH:
CCH: ch xem

c tn h bnh nhn xui chiu

2/ XEM HNH SCOUT
SCOUT VIEW
VIEW BiT V TR LT CT
3/ PHN BiT HNH CA S M MM V CA S XNG.
XNG.
4/ XEM HNH KHNG CHCH CHT TNG PHN (CE(CE-) TRC
RI MI N HNH C CHCH CHT TNG PHN (CE+)
5/ O M (T TRNG) CA MT VNG HOC MT TN THNG
INTEREST) KHI CN.
BNG NT ROI (REGION OF INTEREST)
6/ PHN TCH CC HNH CT DA VO CC HiU BiT V GiI PHU
HC CT LP V V TRIU CHNG HC CT.
7/TNG HP CC DU HiU BT THNG.
8/ A RA CHN ON CT HOC NHNG CHN ON PHN BIT
DA VO BNH S V CC TRIU CHNG LM SNG HOC XT
6
October 31, 2013
NGHIM.

ong am o (Isodense)
Giam am o (Hypodense)
Tang am o (Hyperdense)

CA S M MM
W=80, L=35

CA S XNG
W=1200,L=300

Phan biet tu mau ngoai mang cng va di mang cng

km theo bin chng v tin lng

"People only see what they are prepared to see."

Ralph Waldo Emerson

CHN THNG S NO
(CRANIO--CEREBRAL TRAUMA)
(CRANIO
Phn 1
BS. NGUYN QUANG TRNG
BS H TH THANH TUYN
BS. NGUYN QU KHONG

10/31/2013

Mng no

1. Vm s
2. Mng cng
3.Mng nhn
4. Mng mm
5. Bn cu i no

Khoang ngoi mng cng (gia 1-2)

Khoang di mng cng (gia 2-3)
Khoang di nhn ( gia 3-4)

12

TON THNG TRONG CHAN THNG SO NAO

Ngoai truc
Hop so

Mang
cng

Tu mau ngoai
mang cng

Mang
nhen

Trong truc
Mang
mem

Nhu mo nao

Tu mau di Xuat huyet khoang di

mang cng
nhen

TON THNG NGUYEN PHAT

V hop so: Nt so dang ng,lun so,
dan khp so, ton thng phan mem
Ton thng ngoai truc (extra-axial)
-Tu mau ngoai mang cng
-Tu mau di mang cng
-Xuat huyet khoang di nhen

Ton thng trong truc (intra-axial)

-Dap nao
-Xuat huyet trong nao
-Ton thng truc lan toa
-Ton thng chat xam sau
-Ton thng cuong nao
-Xuat huyet trong nao that

TON THNG TH PHAT

-Thoat v nao
-Nhoi-thieu mau nao do chan thng
-Phu nao
-Ton thng do thieu oxy nao, cht no

V s:
Tn thng ngoi trc:
EDH (epidural hematoma):
SDH (subdural hematoma):
SAH (subarachnoid hemorrhage):
Tn thng trong trc:
trc:
Tn thng si trc lan ta:
Dp v no:
Tn thng cht xm su:
Tn thng thn no (brainstem):
Xut huyt no tht/m ri mch mc:
Tn thng th pht:
pht:
Thot v no:
Thiu mu no:
Ph no lan ta:
Cht no:
Chn thng khng do tai nn (tr b ngc i).
Tin trin ca mu t.
t.
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994 (modified)

60%
<5%
15%
80%
50%
45%
05%
05%
10%
70%
40%
15%

17

V s:
Tn thng ngoi trc:
EDH (epidural hematoma):
SDH (subdural hematoma):
SAH (subarachnoid hemorrhage):
Tn thng trong trc:
Tn thng si trc lan ta:
Dp v no:
Tn thng cht xm su:
Tn thng thn no (brainstem):
Xut huyt no tht/m ri mch mc:
Tn thng th pht:
Thot v no:
Thiu mu no:
Ph no lan ta:
Cht no:
Chn thng khng do tai nn (tr b ngc i).
Tin trin ca mu t.
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994 (modified)

60%
<5%
15%
80%
50%
45%
05%
05%
10%
70%
40%
15%

18

V S
(SKULL FRACTURE)
V s gp khong 60% bnh nhn chn thng
s no.
no.
50% trng hp v s c tn thng no kt hp.
Tuy vy khong 30% bnh nhn chn thng s
no nng khng c v s, do vy phim X quang s
no khng c ngha g trong chn on chn
thng s no.
10% bnh nhn chn thng s no nng c tn
thng C1 hoc C2 kt hp.
A.Osborn et al. La Radiologie de poche-Cerveau.00-04
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994

19

V S
(SKULL FRACTURE)
V s nt (linear)
(linear) thng kt hp vi t mu ngoi mng
EDH) hoc t mu di mng cng (SDH)
(SDH) hn v s
cng ((EDH)
ln (depressed).
V s ln thng kt hp vi tn thng nhu m no.
V tch khp s (khp s >4mm) thng gp tr em
em,, c
th tn thng xoang tnh mch gy t mu ngoi mng
cng.
V nn s thng kt hp tn thng mch mu, dy thn
kinh s no.
V s c th gy gy t kh trong no (pneumocephalus)
hoc r dch no ty.
A.Osborn et al. La Radiologie de poche-Cerveau.00-04
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994

20

V s nt kt hp t kh ngoi mng cng

(pneumocephalus).

V s nt kt hp t mu di
mng cng.

10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994.

21

V s ln kt hp dp v no.

10/31/2013

V s ln kt hp xut huyt di nhn.

22

V S
(SKULL FRACTURE)
V nn s khng phi lc
no cng tm thy c.
Lm sng chy dch no
ty qua ng mi (CSF
rhinorrhoea), chy mu tai,
trn hnh nh hin din
chy mu xoang bm th
phi ngh n v nn s
cho d ta khng tm c
ng v.
10/31/2013

23

10/31/2013

24

V s:
Tn thng ngoi trc:
EDH (epidural hematoma):
SDH (subdural hematoma):
SAH (subarachnoid hemorrhage):
Tn thng trong trc:
Tn thng si trc lan ta:
Dp v no:
Tn thng cht xm su:
Tn thng thn no (brainstem):
Xut huyt no tht/m ri mch mc:
Tn thng th pht:
Thot v no:
Thiu mu no:
Ph no lan ta:
Cht no:
Chn thng khng do tai nn (tr b ngc i).
Tin trin ca mu t.
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994 (modified)

60%
<5%
15%
80%
50%
45%
05%
05%
10%
70%
40%
15%

25

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)

Tn sut:
sut: gp < 5% bnh nhn chn thng
s no.
50% bnh nhn c khong tnh.
>95% tn thng mt bn.
>95% trn lu (thng gp nht vng
thi dngdng-nh).
Him khi bng qua khp s (sutural line),ni
mng cng bm rt chc vo xng).
10/31/2013

26

Hnh thau knh loi hai mat, tang am o,

Gii han ro, ac biet bi cac khp so

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)
C ch:
ch: Chn thng s, x rch ng mch mng
no gia (middle meningeal artery) (90%) hoc
xoang tnh mch (10%). Mu t ti khoang ngoi
mng cng (epidural space) to thnh hnh nh li hai
mt kinh in (biconvex(biconvex-shaped).

10/31/2013

A.Osborn et al. Handbook of Neuroradiology. 1996.

29

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)

-Chy vt qua np mng no (lim,lu no)

-Thng ket hp vi nt so cung ben va tu mau di
mang cng oi ben (90%)

Atlas of topographical and applied human anatomy E Pernko

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)
HNH NH TRN CT:

90% trng hp c v s.
20% trng hp c bng kh trong s.
s.
Khi ngoi trc (extra(extra-axial mass): mt ngn cch
(interface) cht xmxm-cht trng b y lch.
lch.

10/31/2013

32

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)

2/3 thu knh li tng m

1/3 trng hp c vng trung tm gim m
, iu ny chng t ang chy mu (Du
hiu xoy nc).

10/31/2013

A.Osborn et al. La Radiologie de poche-Cerveau.00-04

33

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)

Biconvex shaped, swirl sign,

pneumocephalus, subfalcine
herniation.
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994.

34

T MU NGOI MNG CNG

(EPIDURAL HOC EXTRADURAL HEMATOMA)
HEMATOMA)

T mu ngoi mng cng hai bn

(5% trng hp).
10/31/2013

T mu ngoi mng cng

phi hp vi cc tn thng khc
35

V s:
Tn thng ngoi trc:
EDH (epidural hematoma):
SDH (subdural hematoma):
SAH (subarachnoid hemorrhage):
Tn thng trong trc:
Tn thng si trc lan ta:
Dp v no:
Tn thng cht xm su:
Tn thng thn no (brainstem):
Xut huyt no tht/m ri mch mc:
Tn thng th pht:
Thot v no:
Thiu mu no:
Ph no lan ta:
Cht no:
Chn thng khng do tai nn (tr b ngc i).
Tin trin ca mu t.
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994 (modified)

60%
<5%
15%
80%
50%
45%
05%
05%
10%
70%
40%
15%

36

T MU DI MNG CNG
(SUBDURAL HEMATOMA)
C ch:
ch: S gim tc t ngt gy cng v x rch
tnh mch cu ni v no, ni chng bng ngang
khoang di mng cng, hnh thnh mu t gia
mng cng v mng nhn.

10/31/2013

A.Osborn et al. Handbook of Neuroradiology. 1996.

37

-oi ben vi
chan ong
-Khong nt so
-Cac tt phoi hp
( tien lng)
-T vong cao

T MU DI MNG CNG
(SUBDURAL HEMATOMA)
Tn sut: gp 15% bnh nhn chn thng s no.
Bnh nhn khng c khong tnh
tnh.
.
15% tn thng hai bn.
>95% trn lu (thng gp nht vng trntrn-nh).
Vi tr b ngc i th thng t mu di mng cng hai
bn, cnh lim no.
Bng qua khp s (sutural line) nhng khng bao gi bng
qua lim no.
Tuy tu mau cap, ban cap hay man ma am o khac nhau
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994.

39

T MU DI MNG CNG
Khi ngoi trc (extra(extra-axial mass): mt ngn cch
(interface) cht xmxm-cht trng b y lch.
lch.
Hnh lim (crescent shaped)
shaped) (Lu : t mu mn
tnh c th c hnh thu knh hai mt li).
60% tng m , 40% c m hn hp.

10/31/2013

40

T MU DI MNG CNG
(SUBDURAL HEMATOMA)

SDH cp

10/31/2013

SDH mn, nhiu la tui

Andrew Downie. Tutorial: CT in Head Trauma.

41

T MU DI MNG CNG
Tin lng ca t mu di mng cng thng xu
(70% t vong).
Tin lng xu khi ng gia b y lch > 20mm.
20mm.
Thng t vong khi th tch khi mu t > 10% th
tch no.

10/31/2013

42

XUAT
HUYET
TRONG NAO
THAT
(Intraventricular
hemorrhage)

-Hnh liem lan rong

-Khong ton trong khp
-Ton trong liem va leu
-Hieu ng choan cho
rat nhieu
-Cac tt phoi hp.

Hai ben 15 % , Tre b anh ap

Tiem can quang neu nghi ng

T MU DI MNG CNG CP

SDH cp, tng m .

10/31/2013

SDH cp, m hn
hp (ang chy mu).

A.Osborn et al. Handbook of Neuroradiology. 1996.

47

T MU DI MNG CNG MN

SDH mn tnh, hai bn. Bn

(T) c hnh lim, gim m
. Bn (P) c hnh thu knh
li vi mc dch-dch.
10/31/2013

SDH mn tnh calci ha.

A.Osborn et al. Handbook of Neuroradiology. 1996.

48

TIN TRIN CA MU T
TRN CT

10/31/2013

A.Osborn et al. Handbook of Neuroradiology. 1996.

49

TIN TRIN CA MU T
TRN CT

SDH cp

10/31/2013

SDH bn cp

SDH mn

SDH mn+chy
mu cp

50

V s:
Tn thng ngoi trc:
EDH (epidural hematoma):
SDH (subdural hematoma):
SAH (subarachnoid hemorrhage):
Tn thng trong trc:
Tn thng si trc lan ta:
Dp v no:
Tn thng cht xm su:
Tn thng thn no (brainstem):
Xut huyt no tht/m ri mch mc:
Tn thng th pht:
Thot v no:
Thiu mu no:
Ph no lan ta:
Cht no:
Chn thng khng do tai nn (tr b ngc i).
Tin trin ca mu t.
10/31/2013

A. Osborn. Diagnostic Neuroradiology. 1994 (modified)

60%
<5%
15%
80%
50%
45%
05%
05%
10%
70%
40%
15%

51

XUT HUYT KHOANG DI NHN

(SUBARACHNOID HEMORRHAGE)

Tn sut:
sut: gp 80% bnh nhn chn thng
s no.
C ch:
ch: do v cc tnh mch khoang di
nhn.
Chn thng l nguyn nhn thng gp
nht ca xut huyt khoang di nhn,
V phnh mch no l nguyn nhn khc t
gp hn.
10/31/2013

52

10/31/2013

54

XUT HUYT KHOANG DI NHN

(SUBARACHNOID HEMORRHAGE)

CT: Tng m khoang di nhn v cc

CT:
b dch no ty. c bit lu n vng
thung lng Sylvius v b gian cung no.
no.

10/31/2013

55

Xut huyt vng cnh lim no c th to ra du hiu delta gi

(pseudodelta sign): xut huyt di mng cng hoc xut
huyt khoang di nhn to nn hnh delta tng m vi
CT khng chch thuc (ng lm vi thuyn tc xoang TM).

10/31/2013

57

XUT HUYT KHOANG DI NHN

(SUBARACHNOID HEMORRHAGE)
Gi xut huyt khoang
di nhn (pseudoSAH) c th gp cc
trng hp ph no
nng, no tr nn rt
gim m , lc ny
khoang di nhn tr
nn tng m mt
cch tng i.

10/31/2013

SDH (cc mi tn) v ph no lan ta

c hai bn cu
58

CM N QU ANH CH CH THEO DI