HNH ANH MINH HOA GIAI PHAU SO NAO TREN CT

Bs. Le van Phc Bs. Pham ngoc Hoa Khoa chan oan hnh anh Benh vien Ch ray

Cau truc liem-leu nao va khoang noi so

TRIEU CHNG HOC CT

BENH LY NOI SO
Bs. Le van Phc Bs. Pham ngoc Hoa Khoa chan oan hnh anh Benh vien Ch ray

Khai niem AM O TREN CT

AM O CT
o Hounsfield (Hounsfield unit) Thang xam (Gray scale) Hieu ng the tch tng phan (Partial volume effect)

MO TA AM O
am o cao (Hyperdensity) am o thap (Hypodensity) ong am o (isodensity) So vi cau truc nhu mo nao lan can

Cau truc

HU

Xng
Voi

1000
100

Chay mau cap

Chat xam Chat trang Dch nao tuy M Kh

85
35-40 25-30 0 -100 -1000

am o cac cau truc noi so

AM O CAO
ong voi bnh thng ong voi bat thng

Mang cng
am roi mach mac

Mau ong
Protein cao (dch nang) Mat o te bao cao (meningioma,medull oblastoma)

Mach mau

AM O THAP
Dch nao tuy
M hoc mat Kh xoang Phu nao Dch (nang) M (lipoma, dermoid) Kh (chan thng, abscess)

THAY OI AM O SAU TIEM CAN QUANG

THAY OI AM O SAU TIEM CAN QUANG

Trc tiem can quang

Tang am o Giam am o ong am o

Sau tiem can quang

So sanh cung lat cat, cung v tr

THAY OI AM O SAU TIEM CAN QUANG

Thay oi Mc o tang quang Dang tang quang

THAY OI AM O SAU TIEM CAN QUANG

THAY OI

Khong bat quang

(Khong tang am o)

Co bat quang
(Co tang am o)

THAY OI AM O SAU TIEM CAN QUANG

MC O

Nhieu

THAY OI AM O SAU TIEM CAN QUANG

DANG BAT QUANG -ong nhat > < Khong ong nhat -Toan bo hay mot phan -Vien, ngoai bien, thanh, dang nhan (ring)

-Not thanh (mural nodular )

-Ngoan ngoeo (serpentine)

DANG BAT QUANG ong nhat > < Khong ong nhat

ong nhat
(Homogenous)
Glioma grade thap-va
Lymphoma Meningioma

Khong ong nhat

(Heterogenous)
Glioma grade cao
Di can Viem nao Nhoi mau

DANG BAT QUANG Tang quang vien, thanh, ngoai bien (Ring Enhancemant)

DANG BAT QUANG Tang quang vien, thanh, ngoai bien (Ring Enhancemant)
-Metastases: Di can -Abscess:Abscess/ Viem nao

-Gliomas: U te bao em
-Infarction: Nhoi mau -Contusion: Dap nao -Demyelinating disease: Benh mat myelin -resolving hematoma: Khoi mau tu ang hap thu

THAY OI AM O SAU TIEM CAN QUANG

DANG BAT QUANG

Not thanh (mural nodular )

+Hemangioblastoma +Cystic astrocytoma..

Ngoan ngoeo (serpentine)

+D dang mach mau +Nhoi mau

Khai niem

TRONG TRUC- NGOAI TRUC

(Intra-axial) (Extra-axial)

Phan biet
Lien tuc mang cng Thay oi xng

TON THNG
Trong truc gan xng Ngoai truc + +

Ranh gii trang-xam,

mach mau vo nao

xa xng

Dch nao tuy ben canh

hep

rong
+

Tang quang mang cng -

DAU HIEU TON THNG

NOI SO KHU TRU

DAU HIEU TRC TIEP

V tr

am o
Hnh dang Kch thc So lng

V TR

Trong truc - ngoai truc

Tren - di leu
V tr cac thuy nao

AM O

-Phim khong bm thuoc (PL/ Plain): am o cao, bang hay thap hn so vi nhu mo nao lan can

-Phim sau bm thuoc (CE/ Contrast enhancement):

Thay oi sau tiem thuoc can quang nh the nao?

HNH DANG

Hnh the: Tron, bau duc, nhieu canh, hnh bia, khong ro

ng b: eu, khong eu
Gii han: Ro, khong ro so vi cau truc xung quanh.

KCH THC

o theo 3 chieu khong gian

Theo mat cat ln nhat Tnh bang cm

SO LNG

Mot hay nhieu ton thng ?

Di can, nhiem trung, a u te bao em, neurofibromas

DAU HIEU GIAN TIEP

Phu nao

Hieu ng choan cho

Thoat v nao Thay oi nao that Thay oi xng

PHU NAO
(BRAIN OEDEMA)

PHU NAO

Phu nguyen (vasogenic)

nhan

thanh

mach

Phu thieu mau (ischemic)

Phu oc te bao (cytoxic)

Phu mo ke canh nao (periventricular interstitial )

that

PHU NAO

Phu nguyen nhan thanh mach

-Do v hang rao mach mau nao

(Blood Brain Barrier)

-Ngoai bao -Chu yeu chat trang

-Vung quanh u, viem, theo he thong chat trang..

PHU NAO

Phu thieu mau (ischemic)

-Do thieu mau nao

-Noi va ngoai bao

-Chat trang va xam eu b -Theo vung phan bo mach mau

PHU NAO

Phu oc te bao (cytoxic)

-Do thieu Oxy nao (thieu mau)

-Noi va ngoai bao -Chat trang va xam eu b

-Chu yeu tren leu

PHU NAO

Phu mo ke canh nao (periventricular interstitial) -Tang ap trong nao that

that

-Thoat dch nao tuy vao khoang ngoai bao cua mo ke canh nao that -Quanh nao that

LIEN QUAN
DAU HIEU TRC TIEP VA GIAN TIEP

Kch thc ton thng >< phu xung quanh

Kch thc ton thng-phu xung quanh > < hieu ng choan cho : TRE-GIABENH LY

Ton thng phat trien dang tham nhiem hay e ay >< hieu ng choan cho

HIEU NG CHOAN CHO

(MASS EFFECT)

HIEU NG CHOAN CHO

Ton thng gay ay , ep cau truc bnh thng noi so Hieu ng choan cho

PHAT HIEN HIEU NG CHOAN CHO

-Cau truc nao (chat trang, xam..) -ng gia -Nao that, be nao, ranh nao -Mach mau

Di lech ng gia

THOAT V NAO (CEREBRAL HERNIATION)

EDH

THOAT V NAO

Thoat v nao la s e ay to chc nao t khoang nay sang khoang khac trong noi so

Cau truc liem-leu nao va khoang noi so

THOAT V NAO
-Thoat v di liem (Subfalcial H.) -Thoat v xuyen leu (Transtentorial H.) +Tren xuong di +Di len tren -Thoat v hanh nhan tieu nao (Tonsilar H.)
EDH

Thoat v nao

THOAT V DI LIEM NAO

-Thoat v di liem: hoi vien (cingulate gyrus) qua di b t do liem nao ng gia lech. -Ep nao that cung ben -Co the rong nao that oi ben

-Nhoi mau ong mach nao trc

EDH

THOAT V XUYEN LEU TREN XUONG DI -Thoat v xuyen leu t tren xuong di: do mom moc (uncus) hoi canh hai ma thoat v qua khe leu tieu nao (e day III (dan ong t)
+Xoa be tren yen

+Rong be goc cau tieu nao cung ben

EDH

Thoat v nao xuyen leu tren xuong di

Thoat v nao xuyen leu tren xuong di

THOAT V XUYEN LEU DI LEN TREN -Thoat v xuyen leu t di len tren: do khoi choan cho ho sau ay tieu nao len cao qua khe leu tieu nao +Xoa - bien dang be quanh cuong nao

Thoat v nao xuyen leu di len tren

THOAT V HANH NHAN TIEU NAO

-Hanh nhan tieu nao b ay xuong thap qua lo cham

THAY OI

HE THONG NAO THAT

NAO UNG THUY

(HYDROCEPHALUS)

He thong nao that

Lu thong DNT

NAO UNG THUY-C che

-Tang tao DNT

-Tac nghen
+Trong nao that +Ngoai nao that (khoang di nhen) -Giam hap thu -Nao ung thuy ap lc bnh thng
EDH

NAO UNG THUY-Hnh anh -Dan he thong nao that -Giam am o chat trang quanh nao that -Dan tren cho tac V tr tac nghen
EDH

RONG HAY HEP NAO THAT KHU TRU -Hep do chen ep -Rong do teo nao lan can (ton thng
cu: rong nao that, khoang di nhen, rong ranh-khe nao)

-Bam sinh
EDH

THAY OI XNG

THAY OI XNG
-Tang sinh, bao mon, huy xng.. -Rong cac lo nen so -Xem tren ca so xng

EDH

DAU HIEU TON THNG

NOI SO LAN TOA

DAN NAO THAT OI XNG

-Nao ung thuy

-Teo nao

-Bam sinh

TEO NAO
-Tuoi gia

-Benh ly
-Khu tru, hay lan toa -Trung tam hay ngoai bien

Hnh anh: Nao that va khoang di nhen rong

HEP NAO THAT OI XNG -Phu nao -Gia u nao

EDH

THAY OI AM O NHU MO HAI BEN

-Giam am Myelin..] o [phu, huy

-Tang am o: ong voi..

TRIEU CHNG-CHAN OAN -Xac nh bat thng

-Tm cac dau hieu trc tiep va gian tiep (trieu chng) -Hoi chng benh ly

-Phoi hp lam sang Chan oan

Trieu chng lam sang

Can lam sang Trieu chng hnh anh

Chan oan hnh anh

KET LUAN
-Trieu chng hnh anh quan trong trong phan tch phim CT
-Can phoi hp lam sang Chan oan

XIN CAM N