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Neurological Surgery No Shinkei Geka Volume 20, Issue 1 （January 1992）

Neurological Surgery 脳神経外科 20巻1号（1992年1月発行）

Japanese English

研究

Magnetic Resonance Imaging（MRI）によるび漫性脳損傷の考察 Magnetic Resonance Imaging in Diffuse Brain Injury 横田裕行 ¹ , 安田和弘 ¹ , 益子邦洋 ¹ , 辺見弘 ¹ , 大塚敏文 ¹ , 小林士郎 ² , 中沢省三 ² Hiroyuki YOKOTA ¹ , Kazuhiro YASHDA ¹ , Kunihiro MASHIKO ¹ , Hiroshi HENMI ¹ , Toshibumi OTSUKA ¹ , Shiro KOBAYASHI ² , Shozo NAKAZAWA ² ¹日本医科大学救急医学科 ²日本医科大学脳神経外科 ¹Department of Emergency and Critical Care Medicine, Nippon Medical School ²Department of Neurosurgery, Nippon Medical School キーワード： Diffuse brain injury , Computerized tomography , Magnetic resonance imaging Keyword: Diffuse brain injury , Computerized tomography , Magnetic resonance imaging pp.15-20

発行日 1992年1月10日 Published Date 1992/1/10

DOI https://doi.org/10.11477/mf.1436900378

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Abstract 文献概要
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I．はじめに

　最近，頭部外傷のなかでDiffuse brain injury（DBI）なる病態が注目されている^1-3）．かかる病態をGennarel—liらは臨床所見より脳振盪型とび漫性軸索損傷型に分類している^2,3）．び漫性軸索損傷型の重症例に関してはその特徴的なcomputerized tomography（CT）所見によりCTの有用性が強調されている^6,20,21）．今回われわれは臨床的にDBIと診断された症例の急性期にMRIを施行し，その所見からび漫性脳損傷の病態について考察し，若干の知見を得たので報告する．

Forty cases diagnosed as diffuse brain injury (DBI) were studied by magnetic resonance imaging (MRI) performed within 3 days after injury. These cases were divided into two groups, which were the concussion group and diffuse axonal injury (DAI) group estab-lished by Gennarelli. There were no findings on com-puterized tomography (CT) in the concussion group except for two cases which had a brain edema or sub-arachnoid hemorrhage. But on MRI, high intensity areas on T2 weighted imaging were demonstrated in the cerebral white matter in this group. Many lesions in this group were thought to be edemas of the cerebral white matter, because of the fact that, on serial MRI, they were isointense.

In mild types of DAI, the lesions on MRI were lo-cated only in the cerebral white matter, whereas, in the severe types of DAI, lesions were located in the basal ganglia, the corpus callosum, the dorsal part of the brain stem as well as in the cerebral white matter. As for CT findings, parencymal lesions were not visualized especially in mild DAI.

Our results suggested that the lesions in cerebral con-cussion were edemas in cerebral white matter. In mild DAI they were non-hemorrhagic contusion; and in se-vere DAI they were hemorrhagic contusions in the cerebral white matter, the basal ganglia, the corpus cal-losum or the dorsal part of the brain stem.