Application Of Skull Fractures And Cerebrovascular Injury With MSCT

PART ONE NORMAL APPEARANCE OF 3D RECONSTRUCTION OF MULTI-SLICE COMPUTED TOMOGRAPHY IN ADULT SKULLObjective: To describe the normal appearances of skull on 3D-reconstruction of Multi-slice CT in adult. Methods:130 patient's data of Volume CT digital subtraction angiography (VCTDSA) with cephalocervical and cephalic vessel that were checked at our hospital from May to July 2009 were analyzed. All of them were subjected to 3D reconstruction of the skull by volume render (VR) and maximum intensity projection (MIP). The anatomy of skull, vascular grooves, pacchionian impressions, the types and closure status of cranial sutures were observed. Results:27 pacchionian impressions (20.8%, 27/130) and 51 vascular grooves (39.2%, 51/130) were detected. There were three distinct forms of the general modality of cranial sutures:Ⅰconventional type(86.2%,112/130),Ⅱfontanelle ossification type(5.0%,7/130) andⅢcranial suture within a cranium (8.5%,11/130). Furthermore, Status of each suture closure was divided into following five types: typeⅠcomplete closure(3.01%,16/531); typeⅡgomphosis(78.34%,416/531); typeⅢsutural bone (6.97%,37/531); typeⅣincomplete closure(3.59%,19/531), the average width of non-closed suture was 1.41 mm±0.70 mm; typeⅤMixed type (8.10%,43/531). Conclusion:3D reconstruction of Multi-slice Computed Tomography was proved to be a reliable technique capable of defining anatomy of skull. VR displayed three-dimensional structure better than MIP ,however, Cranial sutures, vascular grooves, pacchionian impressions were more definite and hypersensitive on MIP. Status of each suture closure was divided into five types, and three distinct forms of general modality of cranial sutures were showed.PART TWO THE VALUE OF DETECTION OF SKULL FRACTURES: COMPARED THREE-DIMENSIONAL RECONSTRUCTION WITH AXIAL BONE WINDOW IMAGES IN MULTI-SLICE COMPUTED TOMOGRAPHYObjective:To compare the value of detecting skull fractures in three-dimensional reconstruction with axial bone window images by MSCT. Methods:500 continuity cranial CT examinations of patients with previous head trauma that were admitted to our hospital from May to October 2009 were analyzed. All of them were subjected to 3D reconstruction of the skull by volume render (VR) and maximum intensity projection (MIP). The detection of skull fractures were blindly evaluated by VR, MIP as well as axial bone window images. Results:There were 53(10.60%, 53/500), 73(14.60%, 73/500), 87(17.40%, 87/500) cases of fractures for all readers in axial bone window, VR and MIP respectively. And 10 cases of splintered fractures detected by three methods independently. Excluding the cases of splintered fractures, the mean fracture lines for detecting were 86, 139, 210 for axial bone window, VR and MIP respectively. The detection rate of MIP were significantly different from axial bone window (P<0.05), but not significantly different from VR (P>0.05). 34(39.08%,34/87) cases and 124(59.05%,124/210) fracture lines were missed in axial bone window. Particularly, axial bone window, VR and MIP respectively demonstrated 2, 1 and 21 cases of dissociated cranial sutures. Conclusion:High accuracy of MSCT depicts skull fractures in MIP , while high rate of missing in axial bone window. VR has advantages in displaying 3D anatomical structures, we recommend MIP in addition to necessary VR as a conventional technique to improve skull fractures detection. PART THREE VCTDSA FOR THE DIAGNOSIS OF POST-TRAUMATIC CEREBRAL VASCULAR CHANGESObjective : To evaluate Volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing and following up post-traumatic cerebral vascular changes. Methods : 124 VCTDSA examinations in 104 patients with previous head trauma were retrospective analyzed. The features of traumatic cerebral vascular injury (TCVI) and secondary changes of post-traumatic cerebral vascular were observed with VCTDSA. Results:In this study, there were 68 patients of normal appearances, 21 patients with TCVIs, including 15 traumatic carotid cavernous fistulas, 4 Traumatic intracranial aneurysms, and 4 cranial venous sinus injuries. There were 16 patients with secondary changes of post-traumatic cerebral vascular, including 1 arterial thrombosis, 5 traumatic cerebral vasospasm, 9 cerebrovascular displaced, 1 vein expansion. Conclusion:VCTDSA of variety post-processing techniques, multi-dimensional accurately displays post-traumatic cerebral vascular changes, has important clinical value in diagnosing and following up in these diseases.