Imagistica SN

SNC
 Patologie intracraniana (continut, continator)
 Patologia coloanei vertebrale (idem)
 Patologia regiunii craniene
 Metode de evaluare:
 Radiografia craniana (AP, LL, Pozitionari
speciale:- Stenvers, Hirtz etc)
 Pneumoencefalografia gazoasa (PEGG)

 Computer-Tomografia

 Imagistica prin Rezonanta Magnetica

 Echo transfontanelar
 Ultrasonografia
 La fat si nou-nascut
 Pina la maximum 1 an
 Ferestre de examinare
 Patologie decelabile echo
 Hidrocefalie si cauze
 Hemoragie intraventriculara
 Anomalii congenitale
 Procese inlocuitoare de spatiu
 ANOMALII CONGENITALE
 ARNOLD- CHIARI (tip I, II, III)
 DANDY- WALKER
 AGENEZIA CORPULUI CALOS
 HOLOPROZENCEFALIE
 LISENCEFALIE, PACHIGIRIE
 ALTE ANOMALII (Schizencefalie,
Neurofacomatoze - Bourneville, NF, von Hippel-
Lindau, Sturge-Weber)
 CHIARI II (Foramen Occipitale larg, cu
luxarea structurilor fosei post. si hidrocefalie)
DANDY WALKER
AGENEZIA CORPULUI
CALOS
HOLOPROZENCEFALIE ALOBARA

TALAMUSI
fuzati inf

VENTRICOL
UNIC
HOLOPROZENCEFALIE SEMILOBARA
 HIDROCEFALIA

 OBSTRUCTIVA INTRAVENTRICULARA
 STENOZA APEDUCTALA
 OBSTRUCTIA FORAMENULUI MONRO (unilat)

 OBSTRUCTIVA EXTRAVENTRICULARA
 INFLAMATII Meninge, Subarachnoidiana - Aderente
 HIDRANENCEFALIA
HEMORAGIA INTRACRANIANA
 INTRAVENTRICULARA
 GRADE (I, II, III, IV)
 SUBARACHNOIDIANA
 INTRAPARENCHIMATOASA
 PERICEREBRALA (Epidurala, subdurala)
 LEUCOMALACIA PERIVENTRICULARA
GR I
GR II
GR III
GR IV
GR IV (efractie in parenchim)
LEUCOMALACIE PERIVENTRICULARA
TRANSFORMARE
CHISTICA
POSTLEUCOMALACIE
PROCESE INLOCUITOARE DE
SPATIU
 CHISTE
 ARACHNOID, ANEVRISM GALEN
 TUMORI
 MALIGNE (SUPRA sau SUBTENTORIALE)
 MEDULOBLASTOM, ASTROCITOM etc.
 BENIGNE
 PAPILOM de PLEX COROID, LIPOM de CORP CALOS
etc
PAPILOM PLEX COROID
ENCEFALITA IN FOCARE
HEMORAGICE
 CT
 Plan axial
 Reconstructii
 Spiral
 Multislice
 Contrast i.v.
 Contrast cisternal
 CT
 AVANTAJE
 Vizualizare osoasa
 Vizualizare hematica

 Rapida

 DEZAVANTAJE
 Iradiere
 S/N mai scazut

 Plan axial
 Patologie dobindita
 AVC ischemic
 AVC hemoragic
 Hematom
 HSA
 PEIC
 Traumatism osos
 ETC….
 CLASIFICARE (WHO):

 TUMORI GLIALE
 ASTROCITOAME
 EPENDIMOAME

 OLIGODENDROGLIOAME

 TU PLEX COROID

 TUMORI NON-GLIALE (toate celelalte)

ELEMENTE DE DIAGNOSTIC CT
LOCALIZARE:
- SUPRATENTORIAL
- SUBTENTORIAL
- INTRANEVRAXIAL
- EXTRANEVRAXIAL
ELEMENTE DE DIAGNOSTIC CT
LOCALIZARE:
-ANATOMICA
-EPICENTRUL TUM.
CONTIGUITATEA CU:
-MENINGELE
-CALOTA OSOASA
RELATIA CU:
-SIST. VENTRICULAR
-STR. MEDIENE
-VASE CEREBRALE
-NERVI CRANIENI
-FISURI, GIRUSURI
 ELEMENTE DE DIAGNOSTIC CT
 CARACTERISTICILE PROCESULUI EXPANSIV:
 DENSITATEA SPONTANA
 OMOGENITATEA SI CONTURUL
 IODOFILIA
 PREZENTA SI EXTINDEREA EDEMULUI PERIFOCAL (EFECTUL
DE MASA)
 PREZENTA UNOR ELEMENTE INTRALEZIONALE:
 CALCIFIERI
 FOCARE HEMORAGICE
 ARII DE NECROZA
 ELEMENTE CHISTICE
 AVC ischemice
 Teritorialitate vasculara
 Parcelar
 Watershed
 Lacunar
 Transformat hemoragic
 Iodofilia
 AVC hemoragice
 Traumatism – hematom sau hematom – traumatism
 Evolutie in timp
 Patologie vasculara
 Anevrisme
 MAV
Traumatisme craniene
 Probleme medicale
 Frecventa mare
 Cauza de morbiditate-mortalitate
 Urgenta (diagnostic si tratament)
 Asociere in cazul politraumatismelor
 Pregatire pacient
 Metode imagistice aplicabile
 Radiografia craniana simpla (pozitionari)
 Computer-tomografia
 Angiografia, pneumoencefalografia – istoric,
neutilizate actualmente
 Echografia – numai la copil sub 1 an,
performanta redusa sub convexitate
 IRM, nu in primele ore – performanta redusa
in HSA, fracturi, laborioasa
 “1.Non-penetrating head injury with no loss of consciousness and
normal results on clinical examination of the central nervous system:
 LEVEL I
 Scull radiography is not indicated. Clinical observation should continue as necessary
 LEVELS II and III
 No imaging is indicated
 2.Non penetrating head injury with loss of consciousness and \ or
abnormal results on clinical examination of the central nervous system
 LEVEL I
 Scull radiography is indicated only when there is clinical suspicion of a depressed
fracture; in the absence of such a fracture, 98% of skull radiographs do not influence
patient management or outcome. The discovery of a linear fracture is of very limited
significance
 LEVEL II
 CT should be the first examination.
 LEVEL III
 MRI is not indicated in causes of acute cerebral trauma, and is less sensitive than CT
in detecting haemorrhage in CNS in immediate posttraumatic period (up to 3 days). ”

“Effective choices for diagnostic imaging”; W.H.O., 1990

 Patologie traumatica diagnosticabila
imagistic:
 A. Leziuni ale craniului osos:
 Fracturi craniene si complicatii ale acestora
 B. Leziuni ale continutului cutiei craniene :
 Leziuni axonale difuze
 Contuzii corticale
 Hematom epidural
 Hematom subdural
 Hemoragie subarachnoidiana
 Hematom intraparenchimatos
 Edem cerebral
 Fracturi craniene

 Cu infundare
 ! Traumatism cranian acut DESCHIS = LEZAREA DUREI!
 ! Leziuni vasculare arteriale sau venoase prin fragment osos!

 Interesarea sinusurilor, masivului facial, orbite etc

 Fara infundare
 Diagnostic diferential cu suturi, santuri vasculare, granulatii
Pachioni

Performanta radiografiei este superioara CT in fracturile simple!

 Leziuni axonale
 Hemoragice
 Nehemoragice
 Localizate sau difuze

! CT posibil normal in stadiu precoce, cu pacient comatos

Evolutie CT in citeva zile, cu/fara hemoragie
Evolutie clinica imprevizibila
 Contuzii corticale
 Impact direct cortex-tablie osoasa interna
 Frecvent “de contralovitura”

Petesii hemoragice la contactul cu osul, frecv. frontal, temporal, sylvian

Evolutie CT frecvent spre agravare (initial leziuni minime, ce se extind
 Hematom epidural
 Mai rar si mai grav! (compresiv si migrant)
 Frecvent la nivelul fracturii
 Lenticular biconvex
 Nu traverseaza suturile, traverseaza linia
mijlocie si atasamentele durale
OS DURA ARAHN PIA PARENCHIM

H.INTRAPARENCH.

H.SUBARAHN.

H.SUBDURAL
H.EPIDURAL
 Hematom subdural
 Uneori fara fractura (accelerare-decelerare)
 Semilunar, efect de masa
 Acut-cronic!!
OS DURA ARAHN PIA PARENCHIM

H.INTRAPARENCH.

H.SUBARAHN.

H.SUBDURAL
H.EPIDURAL
 Hemoragie subarachnoidiana
 Distributie diferita fata de HSA prin ruptura
anevrismala
 Densitati hematice pericerebrale

OS DURA ARAHN PIA PARENCHIM

H.INTRAPARENCH.

H.SUBARAHN.

H.SUBDURAL
H.EPIDURAL
 Hematom intraparenchimatos
 Frecvent dilacerare-edem
 Mai rar hematom posttraumatic organizat
 Efect de masa
 Dificil de apreciat secventialitatea trauma-
hematom sau hematom-trauma
OS DURA ARAHN PIA PARENCHIM

H.INTRAPARENCH.

H.SUBARAHN.

H.SUBDURAL
H.EPIDURAL
 IRM cerebral
 AVANTAJE
 S/N superior
 Multiplan

 Angio

 DEZAVANTAJE
 Durata
 Pret

 Nevizualizare HSA si os
 Patologie
 Tumori
 Demielinizare substanta alba
 AVC (perfuzie-difuzie)
 Nervi cranieni
 Anomalii congenitale
 Functional
 Coloana vertebrala
 CT – doar pentru modificari osoase
 IRM – de electie