🔙 Quay lại trang tải sách pdf ebook Hình ảnh học sọ não X Quang cắt lớp điện toán cộng hưởng từ Ebooks Nhóm Zalo Cao DSng Y te Phu Tho - Tlur vi§n KM .007126 JACQUES CLARISSE NGUYEN THI HUNG PHAM NGOC HOA • • H I N H A N H H O C SON AO X q u a n g c a t la p d i e n t o a n C o n g h a a n g tCf \JJ NHAXUiT BAN Y HOC C h u bien : - J. CLARISSE Giao su bac si Hinh anh hoc, Dai hoc Y khoa Lille N guyen T ruong khoa Bo m on Hinh anh hoc Benh vien R oger Salengro - Dai hoc Y khoa Lille, Phap - NGUYEN THI HUNG Bac si y khoa, Tien si Y hoc G iam doc Benh vien N guyen Tri Phucmg, TP Ho Chi M inh Pho chu tich H oi Than Kinh Hoc TP Ho Chi M inh - PHAM NGOC HOA Bac si y khoa, Tien sT Y hoc Truong khoa Bo m on Chan doan hinh anh, Vien T ruong C ho Ray - D ai hoc Y Duoc, TP H6 Chi Minh Chu tich hoi Chan doan hinh anh TP Ho Chi M inh N g iro i d ich : - PHI ICH NGHI Nguyen Giao su thinh giang , Dai hocY khoa Henri Poincare - N A N C Y , Phap Truong khoa Chan doan hinh anh Benh vien FV, TP H6 Chi M inh V oi sir cong tac cua : - LE T U PHUCKNG THAO Bac si Y khoa, Tien si Y hoc Giang vien Bo m on T h in kinh Dai hoc Y khoa Pham N goc Thach (TTD T BD CBYT) Truong khoa ThSn kinh, Benh vien Nhan dan G ia Dinh, TP H6 Chi M inh - HA THJ THANH TUYEN Bac si Y khoa, Thac si Y hoc Bac sT chuyen khoa Chan doan hinh anh B enh vien 115, TP H o Chi M inh H ieu dl'nh : NGUYEN THI HUNG, PHAM NGOC HOA h in h An h hoc• • so n a o X Q U A N G C A T L O f P D I $ N T O A N C Q N G H l J d N G T L f TRUONG CAO DANG Y T§' PHU THO •THU VIEN so _____ cHO/iol/ LCH G ia i THIEU Vcri circmg vi la Chu tich Hoi Chan doan hinh anh Thanh pho Ho Chi M inh tir nam 1995 den 2005, cho phep toi dugc co doi Idi to bay long ton kinh voi Giao su Jacques Clarisse ve nhirng viec ong da lam cho tat ca chiing ta, nhirng bac si chan doan hinh anh. bac si noi than kinh va ngoai than kinh cua Viet Nam. Tir khoang mirdi hai nam nay Giao su Jacques Clarisse cua CHU De Lille da danh nhieu tinh cam, thoi gian cho Viet Nam cung nhu ong da su dung phucmg tien cua chinh ong de den Viet Nam giang day ve Hinh anh hoc than kinh trong khuon kho chuong trinh dao tao FFI va chuong trinh dao tao lien tuc FM C ve hinh anh hoc y khoa dirge to chuc bcri GREF va Dai sir quan Phap phoi hop voi Dai Hoc Y Ha Noi va Trung Tam Dao Tao Boi Ducmg Can Bo Y Te. Chuong trinh FFI ve hinh anh hoc y khoa da dat nhieu thanh tiru Ion voi hang tram bac sT Chan doan hinh anh Viet Nam dugc dao tao tai Phap FFI cap 1, FFI cap 2, Pho Giao su hay Giao su cong tac. Ho hien tai xay dung nen nganh Chan doan hinh anh hoc Viet Nam. C huong trinh dao tao lien tuc ve hinh anh hoc y khoa ma Giao su Jaques Clarisse la ngucri ggi y dau tien da giup ich rat nhieu cho cac bac si Viet Nam, du noi tieng Anh, cung tan dung duoc co hoi dugc dao tao cac kien thirc moi ve Hinh anh hoc Y khoa boi cac giao su va bac si chan doan hinh anh Phap. Ngoai hai chuong trinh tren, Giao su Jaques Clarisse con den Viet Nam nhu m ot ky si don thuong doc ma tir 7 nam nay, moi nam it nhat 2 lan den Viet Nam de giang day ve Hinh anh hoc than kinh o TP Ho Chi M inh, Hue va Ha Noi. Dac biet, tai benh vien C hg Ray tat ca cac bac si chan doan hinh anh, bac si noi than kinh va ngoai than kinh m ien nam V iet N am ai cung deu biet den Giao su Jaques Clarisse. Nam nay, vao thang 4 Giao su Jaques Clarisse dugc Uy ban N han Dan Thanh pho trao Bac dau boi tinh vi su nghiep cong hien cua ong cho Viet Nam. Dieu lam toi an tuong nhat a ong la su trung thuc, loi song don gian, su thang than va them vao do la ly luan hgp logic cua ong trong chan doan hinh anh hoc, do la dieu lam toi nhd lai cau cham ngon cua M ontaigne : « M ot cai dau co to chuc thi tot hon mot cai dau chira day kien thirc ». N ho vao cac chuong trinh nay ma trinh do chan doan hinh anh hoc V iet Nam , dac biet la trinh do chan doan hinh anh hgc than kinh, tien bo nhieu trong vai nam vira qua. Nhirng bai giang cua Giao su Jaques Clarisse dugc hieu dinh moi nam va hien thoi dugc xuat ban trong quyen sach Hinh anh hoc than kinh voi su tham gia cua Bac si Pham Ngoc Hoa, Nguyen Thi Hung va Phi Ich Nghi. Dai dien cho Hoi Chan doan hinh anh Thanh Pho Ho Chi M inh toi bay to long biet on sau sac den Giao su Jaques Clarisse va gidi thieu quyen sach nay den tat ca dong nghiep va sinh vien y khoa. Toi xin cam doan voi quy dong nghiep rang quyen sach nay co the giiip ich rat nhieu trong chan doan benh ly than kinh. BAC Si NGUYEN QUY KHOANG V LILLE LILLE M A RSEILLE TP HO CHI MINH V I X in ch an th a n h ca m on: - JP FRANCKE Bo mon Giai phau hoc Dai Hoc Y K hoa Lille - Vien Dai Hoc Luat va Y Te - JP PRUVO va cong sir Khoa X quang Than Kinh, Trung Tam Vien Trucrng - G SALAMON Dai Hoc Y Khoa - NG UYEN QUY KHOANG - NG UYEN AN THANH - N GUYEN THANH THUY - HO HOANG PHUONG - NG UYEN BA THANG - NG UY EN THI KIM HUONG - NG UYEN THJ CAM TU - t r A n DUG s i LOfI NOI DAU Day la m ot quyen sach nhap mon ve hinh anh hoc than kinh va cung la m ot « so tay thirc hanh » hinh anh hoc. Sach bao gom 3 phan : Phan nhac lai m ot so diem can luu y ve giai phau va giai phau benh can thiet Phan gicri thieu ve ky thuat tien hanh khao sat Phucmg phap doc va ly giai hinh anh Muc dich chung toi giai thieu sach nay la de cac ban co the tham khao cac sach kinh dien, dac biet hai quyen sach m ai cua Ann Osborn So tay bac si X quang / nao bo / 100 chan doan thuong gap (Pocket radiologist / brain / lop 100 diagnoses / Osbom / Amyrsis editions) Hinh anh hoc chan doan / nao bo Muc tieu cua sach la : 1 / Thiet lap m ot ngan hang hinh anh du lieu - N hu tat ca cac loai hinh anh khac, hinh anh hoc y khoa chira dung nhung thong tin ma khong the dien dat bang tir ngu de doc gia suy dien ra hinh anh ... nhieu thong tin se bi bien doi hoac that lac trong qua trinh chuyen doi hinh anh - tir ngu - hinh anh. - Chinh vi the can cho doc gia nhieu thong tin nhin thay dugc qua « ngan hang du lieu » do ca nhan tu thu thap va luu tru thucrng xuyen. Sach nay la m ot quyen sach ve hinh anh giiip doc gia nhin vao do ma lien he lai voi ngan hang dir lieu ca nhan cua minh. ' tram nghe khong b anc m at thav " 2 / Xin dugc trinh bay voi doc gia m ot « kirn chi nam » trong viec ly giai cac hinh anh thSn kinh so nao. CAC TAC GIA BANG CHU VIET TAT ADC Apparent Diffusion Coefficient - He so khuyech tan bieu kien ADC BJ Dong kinh Bravais Jacksion CHT Cong hirong tif CHT-MM Cong hirong ti> mach mau DM Dong mach DNET Dysembryoplasic neuroepithelial tumor - U bieu mo than kinh loan san phoi DNT Djch nao tuy DSA Digital Substraction Angiography - Chup mach so hoa xoa nen gado Gadolinium IR Inversion Recovery - Ky thuat hoi phuc dao ngu’O’c MIP Maximum intensity projection - Ky thuat MIP MPR Multiplanar reformation - Ky thuat tai tao nhieu mat phlng PNET Primary neuroectodermal tumor - U bieu mo than kinh nguyen phat T1 Fat Sat T1 bao hoa mo T1 SE Chuoi xung T1 Spin Echo T2 FLAIR T2 Fluid attenuated inversion recovery - Chuoi xung hoa tin hieu cac dich T2 SE Chuoi xung T2 Spin Echo T2* T2 Echo Gradient TE Temps d'Echo - Thoi gian phan am TK Than kinh TOF Time of flight - Ky thuat mau sang TOF UH Unites Hounsfield - Don vi Hounsfield XQCLBT X quang c lt lop dien toan V III MUC LUC Lfri gioi thifu Lai noi dau Bang chfr viet tit NHCrNG DIEU CAN BIET KHI THVTC HIEN KY THUAT HINH ANH HQC 1 - 1 / GIAI PHAU VA GIAI PHAU X QUANG : 3 - Hop so - M ang nao va khoang mang nao - Nao bo - Dong mach - Tinh m ach 3 - 2 / KY THUAT VA HINH ANH : mat dp tren XQCLDT, tin hifu tren CHT 25 - XQCLDT ky thuat, mat do, tuong quan giai phau 25 - CHT ky thuat, tin hieu, tuong quan giai phau 35 i6i 1 - CAC CHUOI CHINH - T1 Spin Echo 39 - T2 Spin Echo : 1° echo ( mat do proton ) 39 2° echo 39 - T2 Inversion Recuperation : T2 FLAIR 44 - T2 Echo G ra d ie n t: T2 * 45 - Hinh anh hoc khuech tan : b 1000, ban do ADC 46 - T1 GADOLINIUM 53 2 - CAC CHUOI DAC BIET - Hinh anh hoc . Dong m ach co, dong mach nao : dong, gado 57 . Cac tinh mach nao : dong, gado 67 . Dong dich nao tiiy 71 - T1 Inversion Recuperation, T1 Fat Sat, T1 gado bii dong 73 - Phan giai rat cao : CISS 75 - Hinh anh hoc trong tir cung ... 76 - Hinh anh hoc khuech tan : gadolinium 77 - Hinh bo than kinh : hinh anh hoc sue c&ng khuech tan (tenseur de difusion) 80 - Hinh anh hoc chuc nang nao Echo Planar Imaging 81 - Phep do pho CHT 82 - 3 / DQC VA LY GIAI : 81 . A / DOC hinh anh : - DSu hieu ton thuong (dau hieu true tie p ): 1 - M uc do ve m at do hoac tin hieu; tuong quan voi loai cau true 81 2 - Vi tri cua ton thuong, giai phau - X quang, tuong quan voi dau hieu lam sang : 83 roi loan van dong, roi loan cam giac, roi loan chuc nang cao cap, day than kinh so 3 - Hinh thai va vi tri co goi y mot vung tuoi dong m ach khong? (xem trang 145) 4 - C4u true ben trong nao co con nguyen ven khong? khoang V irchov Robin con nguyen ven ? 100 5 - Ton thuong duy nhat hay nhieu ton thuong? 101 - Cac hau qua cua ton thuong len cac cau true binh thuong (dau hieu gian tiep) : 6 - Phu 103 7 - Day lech cac cau true lan can : ranh vo nao, duong giua. ban trong ... 105 8 - Thoat vi : the chai, moc thai duong, thuy nhong phan tren, hanh nhan tieu nao 105 9 - G ian nao that : 109 . Do tac nghen DN T trong nao: bj u dong, lo M onro, kenh Sylvius, nao that IV, lo M agendie 109 . Do tac nghen DNT ngoai nao : viem mang nao, tran dich nao that ap lire binh thucmg 114 . Do teo nao; phoi hop voi : gian cac khoang V irchov - Robin, thoai hoa chat trang 116 . Do di dang nao 1 18 IX . B / Cac dau hi?u ggi y CAN N GUYEN 1 - U trong nao : - Benh than kinh dem u te b a o d e m 119 - M o than kinh PNET, D N ET 129 - M o tao mau lym phom , u lircri m ach 131 - Di can nao theo duomg mau, duong ducri nhen 133 - Truong hcrp dac biet u trong nao that, u quai 136 gia u : u mach dang hang, phinh dong m ach 140 hoi chung can ung thu 140 2 - Tai bien mach m au nao : - Nhoi m au nao : vung tuoi dong m ach, m at do va tin hieu, can nguyen 143 - X uat huyet nao, xuat huyet mang nao 174 - U mach dang hang, u m ach tinh mach 191 - Viem tac tinh mach nao 199 3 - Benh ly viem : X o cung rai rac, benh chat trang cap tinh, benh saccoit 208 * 4 - N hiem trung : - N hiem vi trung : ap xe, chan doan cac ton thuong " dang nang " 218 tu mil, viem m ang nao, viem day m ang nao - N hiem virut : viem nao herpes, H IV ,... 231 - N hiem ky sinh trung, nhiem nam 235 5 - B?nh ly thoai hoa : benh Parkinson, teo nao da o he thong, benh A lzheim er ... 239 xo cung hai m a 245 6 - Benh ly nhiem doc : rucru, ma tuy, oxyt c a c b o n ... 247 7 - Benh ly bien duong : loan duong chat trang thircmg than, tang m ucopolysaccarit, Leigh ... 249 - TON T H U O N G N G O A l NAO : tuy theo VI TRI 8 - V om so : - ton thuong xucmg, ton thuong m ang nao khu tru 250 - ton thuong so lan toa, ton thucrng m ang nao lan toa : viem day m ang nao 260 - bien doi hinh the hop so : dinh khcrp hop so, hop so khong can xung 262 9 - N en so - tang truoc ( khong ke hoc m a t) 265 10 - T uyenyen 270 11 - Viing ho yen : ton thuong tren yen, ben yen va ducri yen 283 12 - Phan truoc duong giua : the chai. vach, the tam giac 296 13 - Phan sau duong giua : tuyen tiing , goc liem ldu . 16i th^ chai 299 14 - Ho sau : goc cau tieu nao, doc yen, than nen ... 301 ( ngoai trir xucmg da ) dau nhan phSn n in 310 - TON TH U O N G TRON G N AO VA / HOAC N G O A I N AO 15 - C han thuong so - nao 312 16 - Di dang nao, dj dang m ang nao : 324 17 - Benh than kinh-da : benh u xo TK , xo nao cii, Sturge W eber, V on H ippel / u lucri m ach 335 - M OT SO TH U A T NGU THLTONG DUNG TR O N G C O NG H U O N G T l j SO N A O 340 * : V iet chung vai Bac si Nguyen Thi Hung X NHU’NG DIEU CAN BIET KHI T H U t HIEN KY THUAT HiNH ANH HOC C*ch viet giay YEU CAU KHAO SAT : - Loai khao sat nao ? ... X Q C L D T ? C H T ? ... co ch o n g chi djn h C H T hay k h o n g ? - T hirc hien toi k h an ? tircmg doi k h an cap ? - C ac tien c&n - C ac dau hi?u lam san g : cac d au than kinh c h u c nan g , kham than kin h , k h am to n g quat L u u y . D ien tien : k h a i phat d o t n gpt ? tien trien theo gio , n g ay , th an g , nam ? . Vj tri c o the cu a ton th u o n g neu lam san g nghi n g o . N g u y en n h an co the : di c&n ? x o c u n g rai rac ? ... - K et q u a cu a nhum g khao sat c u : hin h anh, sinh hoa, ng h iem p h ap c h u c n a n g th an kinh CHI DINH : - X Q C L D T - K h an cap th an kinh - C h an th u o n g so - T ai bien m ach m au nao - T an g ap noi so cap - H in h an h hoc v u n g m at : T ai m ui h o n g ( T M H ) , nhan k h o a , k h o a m ien g - N goai le X Q C L D T m o i b o sung ch o C H T : d o n g voi ? k h ao sat nen so ? - C H T - T at ca c ac b en h ly than kin h k h o n g khan c a p : . N ghi n g o b en h ly . U , n h iem tru n g , v iem , n h iem ky sin h trung . T h o ai hoa, n h iem d o c, di d an g . L am san g k h o n g y nghTa : D o n g k inh, n hin do i, n h u c d au , sa su t tri tue ... - C H T b o su n g ch o X Q C L D T : C h an th u o n g so va X Q C L D T k h o ly giai , N h o i m au nao, khoi m au tu : b o su n g th o n g tin - T ru o n g h o p k h an : N ghi n g o nhoi m au n ao scrm ducri 3 g io : thirc hien ly g iai h u y et khoi ? V iem tac tin h m ach nao, v iem n ao do h erp es M at thj g iac d o t ng o t ... DQC VA LY GIAI : . P han tich to n g th e : - D u lieu lam san g : tu o i, tien can, dau hieu lam san g , d ien tien ton th u o n g th eo th o i gian - K et q u a k h a o sat hin h anh cu v a cac k h ao sat can lam sa n g khac - D o c h in h an h tren m an hin h , xur ly h in h anh ngay khi do - T o n g h o p tam then cac th o n g tin : . V i tri to n th u o n g , kich th u o c , h inh th ai, so lu o n g ; tu o n g h o p voi cac d au h ieu lam san g . M at d o tren X Q C L D T , tin h ieu tren C H T , va d o i ch ieu v o i loai cau true giai p h lu . C a c y eu to hin h an h g o i y ve m ot can n g u y en d ac b iet . V iet tu o n g trin h ket q u a : 1 / D o c h in h anh 2 / C ac y eu to goi y c a n n g uyen GUI CAC TH O NG TIN den bac si lam sang : - K et q u a viet v a ghi h in h an h len p h im / tat c a h in h an h hay k h o n g ? co ch u th ich k h o n g ? s o d o ? - G u i nhirng gi ? D e n g h i : . T h o i g ian p h o n g d in h : can guri ch o bac sT lam sa n g n h u sau : - T o an b o h in h an h in tren d ia C D R - M p t p h im v o i cac hin h co y nghTa : ch u o i T 2 F L A IR cat n g an g - B en h ly "d o n g ian ” : g u i 1 p h im v o i 12 - 20 hin h y n g h la v a 1 dia C D R . K h ao sat b e n h ly , ton th u o n g n h ieu kha n an g p h au th u at : can giri cho b ac sT lam san g : - T o an b o h in h an h tren C D R - T o a n b o cac ch u o i h oac 4 - 6 ch u o i co y nghTa C h o p h e p . T h a m k h ao , k h a o sat d e d an g . T re o p h im tro n g p h o n g m o , th o n g tin ro ran g voi b e n h n h an , hoi ch an .. .C H T / NHAN SV VA K H O A : . B ac si - T h e o d o i k h a o sat tie n h a n h : th ay d o i cach thirc h ien ? can tie m h ay k h o n g tuy k h o n g d u tru ? - C h u a n bi k h a o sat tiep th eo : . C o d at d u o n g tru y e n tin h m ach k h o n g ? . C h a m soc b e n h n h a n ra sao ? . C ach thirc h ien : ch u o i n ao ? cat th eo m at p h a n g nao - Ly g iai cac k h ao sat cu v a thirc h ien k h ao sat - T ie p n h a n y k ien c u a d o n g n g h iep ve chi d jn h ky th u at, ly giai . K y th u at v ien : - N a m ro cac ch o n g chi din h cu a C H T - D at d u o n g tru y e n tin h m ach n cu can - T h u c h ien k h a o sat - S ao c h e p len C D , in ph im 1 TEN CHI DJNH C H T S Q - N A O TlTONG TRINH KET QUA / TIT KHOA NGAY : N ao b $ , .... T uy£n yen, ... D ong m ach vung co KY TH U A T - Loai chuoi : hinh anh T l. T2 Spin E cho 1° echo, 2° echo. T2 FLA IR, T2 *, khuech tan b 1000 va ban do A D C. T l gadolinium - trucmg hgp dac biet : hinh anh hpc dong m ach, tinh m ach : dong, gado T l Inversion Recuperation, T2 CISS, T l Fat Sat, ... hinh anh tuoi m au, hinh bo th£n kinh, hinh anh chuc nang, phep do pho - Cat ngang ( hucmg nao ? CA- CP , theo sung thai ducmg ), m at phang tran, m at phang d ung dpc________ LY GIAI . A / DQ C hinh anh : mo ta dau h if u, ly giai dua theo v| tri, cau true giai phau, so lu vn g Dau hi?u ton thuong : dau hieu true tiep 1 - Tin hieu trong moi chuoi khong tiem ? tin hieu sau tiem ? Ket q u a :. Ton thucrng : phu, ton thuong dac . Xuat huyet, voi hoa, mo . D ang nang : tin hieu cua dich thay doi theo nong dQ protein . D ong nhanh, dong cham ... . Bat hay khong bat gadolinium . Ton thuong dong nhat ? khong dong nhat , 2 - Vi tri ton th uong : thuy nao, ducmg giua, ho sau, nen sp ... C o tu o n g hgrp v6i dau hi?u lam sang khong ? 3 - Hinh thai va vi tri phu hpp voi vung tucri dQng m ach khong ? 4 - Ton trpng, khong thay doi cau true ben trong nao bo ? C ac khoang V irchov Robin khong bj anh hucm g? 5 - Ton thuong duy nhat hay nhieu ton thuong ? - Tac dpng cua ton thuong len cac cau true binh thucrng lan can : dau hieu gian tiep 6 - Phil ne 7 - Day cac cau true lan can : cac ranh vo nao, ducmg giua, ban trong xucmg so ... 8 - Tyt nao - Ton thuong tren leu : tut the chai , m oc thai ducmg, hanh nhan tieu n3o - Ho sau: thuy nhong tren, hanh nhan tieu nao 9 - G ian no nao that B / C4c dau hieu gyi y CAN NGUYEN TON TH U O N G TRONG N A O Do tac nghen DNT : tac nghen trong nao ? hay ngoai nao ? - Do teo nao - Do nao khong phat trien : dj dang tuy theo . Tien can, lam s&ng, khao s&t khac, dien tien . Doc cac dau hi£u tren CHT 1 - U trong nao : - T han kinh dem - M o than kinh - M o tao huyet - Di can nao u te bao dem u nguyen bao tuy, D N ET lym phom , u lucri m ach theo d u o n g m au, theo ducmg ducri nhen - T ruong hop dac biet: u quai, u trong nao that, hoi chung can ung thu Tai bien m ach m au nao : - nhoi m au nao: vung tucri dong m ach, m at do va tin hieu, can nguyen - xuat huyet nao, xuat huyet m ang nao - u hang, u m ach tinh m ach 3 - Benh ly viem 4 - B?nh ly nhiem trung 6 - Benh ly nhiem virut 5 - Nhiem ky sinh trung 6 - Benh ly thoai hoa 7 - Benh ly nhiem doc 8 - Benh ly bien duong viem huyet khoi trnh m ach nao x o cung rai rac. benh chat trang nao cap, benh s a c c o it... nhiem vi trung : ap xe, tu m u, viem m ang nao benh nao do herpes, HIV , ... benh gao, ... benh Parkinson, teo nhieu o h? thong, benh A lzheim er ... rucru, m a tuy, oxyt cacbon... loan d u o n g chat trang thuong than, tang m ucopolysaccarit, B enh Leigh ... - TON TH U O N G NG OA I N A O : u va gia u tuy theo vi tri I 9 - Vdm so 10 - Nen so : tang truoc, tuyen yen. vung yen. d u o n g giua. ho sau TON TH U O N G T R O N G N A O - - N G O A I N A O 11 - Chan thuong so-nao 12 - Di dang nao, di dang m ang nao. di dang so Di dang toan nao truoc, vo sinh. di nguyen. u m a. u quai, Chiari . N ang m ang nhen. thoat vi m ang nao . Dinh lien khcrp so Hoi chung than kinh-da : u x o TK . xcr cim g nao cu. S turge W eber. V on Hippel Lindau da u lucn m ad 13 - - DT nhien co the thao luan nhieu can nguyen cac kha nang? do chac chan ? Tuv y kien dong nghiep co hucmg \ u tri : khan'1 khao sat hinh anh khac? khao sat can lam sang khac'1 KY TEN GlAl PHAU va GlAl PHAU X QUANG T A l L IE U : - J P F R A N C K E , X D E M O N D IO N Bp m on G iai phau D a i h p c Y khoa L ille - V ie n D a i h oc L ua t - Y te - L ille 2 - G S A L A M O N : D a i h o c Y k h oa M A R S E IL L E , D a i h oc U C L A U S A A tla s g iai p h iu c l t la p, N X B S an d oz XQCLDT : 120 lat, be day 1 mm, tai tao be mat 1 h o m £ t 8 lo bau due 1 xu’a n g h am tren 7 2 xu’a n g sa ng 9 lo rach 2 c u ng g o m a 8 3 m g t tre n th a n xu’a n g b u a m 1 0 d in h x u ’a n g da 3 m o m ch an xu’a n g b i/a m 9 4 c a n h Idm xu-ong b iro m 11 lo ong ta i tro ng 4 c a nh x u a n g h am du ’a i 1 0 5 m a u g iu ’o n g tru’a c 1 2 d o c ye n (c liv u s ) 5 lo rach 11 6 cu yen 13 ra n g d o t true 6 lo bau due 1 2 7 ho ye n 14 16 c h a m la n d au xu'cm g h am dipa i 16 g ai h a y lo c a n h m au nen lo c h a m Ion d o t doi 3 CAC BAO CUA NAO BQ HOP SO VA CAC KHOANG MANG NAO QUANH NAO da va mo te bao dirai da : ma hop so ban ngoai : xu’ang dac tuy : mo ban trong : xu’ang dac khoang ngoai mang cimg: boc tach dupe mang cimg khoang diroi mang cirng: ao, boc tach du mang ngoai cua mang nhen khoang dirai nhen: co thuc, dich nao tuy (D N T ) mang trong cua mang nhen dinh vao mang nuoi khoang Virchow Robin dong mach nho, tinh mach nho. Dfd da, mo du'O’i da doi khi co the thay nai bam cua cor nhai ban ngoai tuy (diploe) ban trong mang cim g dinh vai ban trong khoang du'O ’i mang cifng ( bi bong ra : khi a tren xac mang nhen : la trong la ngoai khoang dLfai nhen : DNT mang nuoi khong thay dirge vo nao : chat xam chat tr§ng CHT sau tiem 4 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHI' M AN G C U N G : LI6M0AI N AO -L£U Tl£U NAO M£ng ci>ng c6 vai trd ca hpc thiet y&u, cung v6i he thong dich trong khoang duoi nhen va cac nao that: hpp s q cimg ch3c, mang cung chlic trung binh, lap djch dem bao ve M£ng cimg ^n dinh pham vi ba khoang trong s q : ho nao phai, ho nao trai, ho sau Mcing cung tao nen thanh cua cac xoang tinh mgch L iem d ai n ao va leu tie u nao K ha nang th o a t vi (tu t) nao : - thoat vi the chai duoi liem dai nao - th o a t vi thai du’O’ng vao lo bau due - th o a t vi h an h nhan tie u nao va o lo c h a m Ion 5 HE THONG n a o t h At , c Ac k h o a n g m A n g n Ao QUANH NAO D|CH NAO TUY . Bai tiet - cuon mach mac, mai mach mac nao that III - dam roi mach mach nao that IV va dam roi ngach Luschka . Dong - nao that III, kenh Sylvius, nao that IV, lo Magendi - cac khoang ducri nhen quanh nao . Hap thu - cac hat Paccionni / xoang tinh mach doc tren, xoang ben Vai trd ca hpc, vai tro tham thau, vai tro nuoi du&ng 1. si>ng tran, 2. sung thai ducrng, 3. moc thai du'cng, 4. than nao that, 5. nga tu> nao that 6. sung cham, 7. ho ben hay thung lung Sylvius, 9. thuy dao - C a c dam roi m ach m g c cua n ao tha t ben lien tuc v o i m ai m a ch m a c cua n ao th a t III - N ao th a t IV lien tgc v o i o ng npi tuy cu a tu y song - T ra n djch n ao tha t kh on g tho n g th u o n g 1 do ta c n gh en D N T tai c a c n ao th a t ben, ca c 16 lien nao tha t, ke nh sylviu s, n a o th a t IV h a y lo M a g e n d i - T ra n djch n ao that tho n g th u o n g ' d o t^ c n gh en D N T tai c a c k h o a n g m a n g n ao q u a n h tie u nao, lo b au due. c a c ranh ben, ca c k h oa ng m a n g n ao cu a pha n loi ban ca u n ao h a y ca c h a t P a c c io n n i tro n g ca c xo a n g tTnh m a d - 6 DAM R 6 l MACH MAC : hinh thai binh thim ng va cac bien the D£m r6i Lushka D£m roi cua sung thai duong Hinh 3nh T1 sau tiem V| TRl . Cu0n mgch mgc : . nga tu nao thlit ben, san cua cac than nao that . lo lien nao that Monro, mai mach mac cua nao that III . dam roi lan den dau mut phia truftc cua cac sung th&i duong . khong co dam roi mach mach trong cac sung tran lan sung cham . D£m roi mgch mgc O’ ho sau : cac ngach ben cua nao that IV Id Lushka, goc cau tieu nao MAT 0Q, TlN HiEU : - thuong co hien tuong hoa nang va dong voi - b it manh chat tuong phan T2 FLAIR T1 gadolinium T2 Spin Echo B ie n th e cua d am roi m a ch m a c : hoa nan g o b en p hai. voi hoa a b en tra i 7 N A O B Q 1 d au n h§ n d uo i 2 beo sim 3 pha n n g o a i cu a ca u n ha t 4 pha n tro n g c u a ca u n ha t 5 nha n tru ’frc t i l i n g 6 b ao n go 3i 7 bao trong 8 c3 nh ta y tru-oc cua b ao tro ng 9 c3 nh ta y sa u cu a bao tro ng 10,17 th e ta m gicic 11,12,13 ca c nhan d oi thj 14 doi c h am cu a d oi th j (p u lvin ar) 19 ph&n idi th e chai 2 0 d u o i nha n d uo i 2 1 d am roi m a ch m a c 2 3 n ga t if n ao tha t 2 4 g oi cu a b ao tro ng 1 d au nhan duoi 2 b eo sam 3 cau n ha t phan tro ng 4 nhan tru’crc tip d n g 5 b ao n goai 6 b ao c i/c n go ai 8 canh ta y tru’crc cu a bao tro ng 1 0 m e p t r ln g tru crc 11 n ao th a t III 1 2 ha doi 13 dai thj 16 tha n th e ch ai 17 hoi d ai (g y ru s c in g u la ire ) 2 0 d o n g m a c h th a n nen 24 the h a n h n h a n (a m y g d a lo id e ) cua h oi hai m a 15 the g6i trong 16 h£i m3 17 the hgnh nhin 18 nao thlt ben: sung du6i hay sung th£i duang 19 h6i hoc mlt-tr£n 20 ho b£n cua nao hay thung IQng Sylvius 21 dong mach nao giua hay dm Sylvius 22 dong mach nao sau 23 doi chlm cua d6i thj (pulvinar) 24 the goi ngoai 25 khe ngang cua nao hay khe Bichat 26 hoi canh hai ma 27 d£i khuu 1 th^n nhin dudi 3 b6o s5m 5-10 ccic nh3n d6i thj 11, 12. 13. 16 bao trong 14 li&m den 15 nhin d6 17 c£u n§o 20 th& chai 21 c£c try cua th i tam gi£c 24 thin nSo that ben 25 n3o thcit III 26 ch6 dinh li£n doi thi 10 1 than kinh thj 2 giao thoa thj giac 3 dai thj 4 ha doi 5 nao that III, ng£ch tuyen yen 6 the vu 7 be thj-giao thoa thj gi£c 8 be lien cuong 9 nhan do 10 chat den phiin dac 11 chat den phln ludri 12 bo vo-gai hay bo thap 13 trung nao : chat xam 14 cong nao p h A n b 6 c u a c h A t t r A n g v A c h A t x A m - C a c b ^ n c iu d ai n§o : gidri han ro giCra ch a t trSng v i c h it xam - C £ c n h in x £ m tru n g t im : c£ c v£ n c h it tr in g tro ng nhan xam , g g i y ten gpi la the van h$ q ua : k h i n£ng hi$n d i$n ton th u o n g m it m ye lin ben tro ng c a c nhan xa m tru ng tam Ho sau : . than nao : - chat xam : chat lu’O’i, nguyen uy thu-c su cua cac day than kinh so - chat trin g : bo vo-gai, bo gai-vo cac cuong tieu nao : chat trang va nhan rang cac ban cau tieu nao va thuy giun : thanh phan chu yeu la chat xam. chua rat nhieu te bao TO CHl>C B£N TRONG CUA NAO BQ - C a c cong trin h g iai phau X q ua ng cu a V irc h o v R o bin v a cu a S alam o n ch o th a y to c h u c c u a n§o b<> tuy th e o cac true m a n g n ao -m a ch m au : ca c kh oa ng m a n g nao c h u a djch, c ic dpn g m a ch n ho v i c ic tTnh m a ch nh6 . - T o c h u c nao nhu1 va y d u p e th a y tren h inh anh C H T th i T 2 dp phan g ia i c a o : . tang tin hieu cu a ca c cau true v o i s u tu o n g pha n d ich : D N T + c&c tTnh m a ch nho co don g c h $m . ca c tieu dong m ach, n ho h o n , kh on g th a y d u p e - T o c h u c n ay cho phep h ieu d u p e m ot so h in h anh C H T th i T 2 dp pha n g iai cao : - g ian n o ca c kh oa ng m ang n ao -m a ch m au tro ng tru o n g h o p te o n a o lien qua n d en tuo i h ay do t6 n thuo^ng lam o ch a t tr ln g , h in h anh ca c ton th u o n g m a t m ye lin d p c th e o c ic trg c n iy , - g iu n gu yen s u phan bo ca c true n ay tro ng nhoi m au nao, x io trp n c a c c iu tru e n a y tro n g b en h ly u. - H inh anh T 2 d u p e qua n sa t tre n m an h in h q ua c u a so ra t hep ca c kh oa ng V irc h o v R obin 12 G. SALAMON tiem vao cac mau gi^i phllu, cat nhieu lat lien tiep va chyp X quang lat c it mong 13 CAC 0QNG MACH NAO Dong mach nao Dong mach nao giOa Dong m$ch n3o truo’C hay dong mach Sylvius sau D a g ia c W illis : d o n g m a c h n a o t m a c d on g m ach tho n g tri/a c xip ho n g canh dong m ach nao giOa dong m ach tho n g sau dong m ach nao sau than nen 14 D p c he th 6 ng d $n g m a ch tro ng m at p h in g c i t n ga ng : cac d on g m ach canh, he d o t so ng -th an nen. 0 Qng m ach c 6 tin h ieu thap do hieu i/n g dong 15 C A C TTNH M A C H M A N G N A O , C A C X O A N G TTNH M A C H Cac tTnh mgch nao sau 2 xoang thing 3 xoang doc dirai 4 bau Galien 5 tTnh mgch nen Rosenthal 6 tTnh mach nao trong 8 tTnh mgch doi thj-th& van 9 tTnh mach v^ch 10 tTnh mach tripac trung tam 11 tTnh mach thuy nhpng trSn CAC XOANG TlNH MACH cua vom sq va nkn sq 1 xoang ngang 2 xoang doc tren 3 xoang thing 4 xoang ngang du'O’i 5 tTnh mach Labbe 6 xoang da tren 7 xoang da duoi 8 xoang hang 9,16 dam roi tTnh mach chan bu’dm 10 tTnh mach nao giCra nong 11 tTnh mach Trolard 12 xoang sigma 13 tTnh mach canh trong 14, 15 tTnh mach hoc milt T 1 g a d o lin iu m 80 lat ch o n g nhau, d a y 1 m m tro n g tai ta o M P R 16 Xoang hang - tTnh mach m it - xoang vanh - xoang hang - xoang bu’di'm - xoang da tren mao xu’O'ng da - xoang da dim i mat doc (clivus) - xoang ben - xoang nen - xoang cham - hop Ilfu xoang sau - xoang doc tren Moi lien quan giD-a da giac Willis va giao thoa thj giac: . p ha n tru 'o c cu a da g ia c W illis nam 6 tre n g ia o tho a thi g iac . pha n sa u cua da g iac W illis n im ben d u o i g ia o tho a thj g iac h O s a u - than nao: chat trang v i chat xim - tieu nao : it chat tring - cuong tieu nao giua va nhan rang - hanh nhin tieu nao - phan loi ciia the chai - cu nao sinh tip - cuong tieu nao - cau nao - hinh tuy hay tuy keo d ii - thuy giun phan duoi - hanh nhin tieu nio - be Ion - lo Ion hay lo cham Tieu chuan binh thu’O’ng cua ban le so-cot song - tieu ch u a n n g a n g : d u o n g C h a m b e rla in tip kh au cai c u n g d en b o sau cu a lo cham k5rr m a u ra n g ben d u o i d ucrng nay - tie u ch u a n tru c rc -s a u : d u a n g nen. la d u o n g ke o d i i cu a m a t d o c (divus) m a u r in g n im tru crc d u o n g nay 18 le tam giac Di thj nh mach nao trong ay tTnh mach Galien >ng thai duong, hai ma j nao sinh tu jo n g tie u n ao tren jo n g tie u n ao giu'a „Jo n g tie u n ao duoi an cau tieu nao anh tuy hay tuy keo dai »Ion hay 16 cham 19 - t £ n G O I - LO S O N O I D A Y T K 01 R A - l A m s A n g 1 than kinh khipu giac m anh sang m it m ui II tha n kinh thj o ng thi n h in m o , m il m at III than kin h van nhan ( h ay va n nhan ch un g) khe o m it tren hay khe bipom su p mi, g ia n d o n g tu \ le m it ra ngoai IV than kinh rong roc khe o m it tren n h in doi V than kinh sinh ba - than kinh m it W illis - than kinh ham tren - tha n kinh h im d u o i khe o m a t tren 16 tron (h a y 16 tro n Ion ) 16 bau due d au th a n kinh V 6 m at (tran, le, m ui) dau tha n kin h V 6 m it. co t h i t ni>a m at d au th a n kinh V 6 m at VI than kinh van nhan n g o ii khe o m it tren le m it v io tro ng VII than kinh m a t va T K tru ng g ian (VII bis) lo o ng tai tro ng h ay o ng tai tro ng Net m a t n g o a i bien V III IX X XI than kinh tien d in h -o c tai than kinh th ie t hau than kinh lang tha n g h ay p he vj than kinh phu 16 ong tai tro ng h ay o ng tai tro ng 16 canh lo canh lo canh d ie c m o t ben ch o n g m at, u tai roi lo an vi g iac k h iu c i i m e m ( m in kh au cai) te o c o tha n g XII tha n kinh ha thiet ong ha thiet te o ni>a Iifo i A T L A S C U A G. S A L A M O N tie m v a o ca c m au g ia i p h iu , c i t n hi§ u lat lien tie p va c h u p X q u a n g lat c i t m o n g 21 1 th u y tran 6 th u y dinh 2 ranh ben 7 ranh d inh -ch a m 3 ranh tru o c tru ng tam 8 th u y thai d u o n g 4 ranh tru ng tam 9 th u y ch am 5 ranh sau tru ng tam 1 0 b in cau tie u nao 1 liem d ai n ao 2 the chai 3 tuye n yen 4 n ao th a t III 5 n ao t h l t IV 6 leu tieu n ao 7 cu o n g nao 8 cau nao 9 han h tuy 1 0 pha n lo i t h i chai 1 1 leu tie u nao 1 2 h an h n h in tieu n io 1 m au tram 2 TM canh trong 3 D M canh trong 4 loi cau x u o n g cham 1 m at d o c (clivus) 2 tra m h an h tuy 3 tha p hanh tuy 4 h an h nha n tie u nao 5 voi th in h g iac 6 n ga ch hau 7 b an cau tieu nao 1 xo an g sig m a 2 T K th ie t hau 3 T K lang tha n g h ay tk p he vi 4 xoang da d u o i 5 cu on g tieu n ao d u o i 6 phan tha p nhat cu a nao tha t IV 1 n ga ch sau ben cu a n ao th a t IV 2 m ai m a ch m a c 3 cau nao 4 nhan rang 5 cu o n g tie u nao gift 6 tha n kin h m it 8 T K tie n d in h -o c ta i 1 th u y d ao 4 g ia o tho a thj 2 h oi h o c m it 5 cu o n g tieu n ao 3 hoi t h in g 6 s u n g cham (G iru s re c tu s ) 7 c u pn m ach m a c 1 th u y tha i d u o n g 4 b ao tro ng 2 ra n h ben h ay 5 nha n d uo i thu n g lOng S y lv iu s 6 d oi thi 3 b eo sa m 7 th e tam g iac 1 ca u n ha t 4 b ao tro ng 2 the tam g iac 5 th u y dao co t tru o c 6 nga tu n a o t h it 3 n ao t h it III 1 va ch tro ng su ot 2 the chai 3 nao t h it ben 4 nhan d uo i 1 khe sylviu s 5 m ai m ach m a c 2 beo sa m 6 th e chai 3 s u n g tra n 7 cu 0n m a ch m ac 4 lo M onro lo lien nao t h it 1 xo a n g d oc tren 2 liem dai nao 3 tru ng tam ban b au due 4 ranh tru ng ta m h ay ra n h R o la nd o 5 ranh tru o c tru ng tam 1 su ng tra n 2 s u n g tha i d u o n g 3 m o c thai d u o n g 4 tha n n ao t h it 5 n ga tu n ao t h it 6 s u n g c h a m 7 th u n g lung S y lv iu s 8 th u y d a o 9 s u n g tha i d u o n g 10 hai ma 23 X QUANG CAT LOP DIEN TOAN (XQCLDT) VA CONG HIKING TU’ (CHT) : _____________________ CAT THEO m a t p h An g nAo ?____________________ 1 / Mat p h ln g CA - CP Mat p h ln g doi chieu (mep trln g trua c - mep trln g sau) c A m6 p trSng tap6 c commissure blanche ant6 rieu C P m6 p trlng sau commissure blanche post&rieuse B ie n th e : m a t p h in g n oi h ai th e c h a i tiep tuyen . vdri mo the chai . va v6 i loi the chai m$t phing nay gan giong mat p hin g CA - CP va d i dang djnh vj han - 2 / C ac mat phang khac - LOM (ligne orbito meatale) du’drng hoc m it lo tai ngoai bd1 ngoai hoc m it / ong tai ngoai m$t p hln g tifang ty mat p hin g CA-CP dung trong XQCLDT dau sao cung chi phong chung vi djnh vi bo ngoai hoc m it khong ro rang tren trim ng quan sat (scout view) - Mat phing VIRCHOV bd1 du-ai hoc m it / ong tai ngoai mat phing co tinh chat " Ijch sir thing goc vai than nao - Mat phing CAC SUNG THAI DUONG va th in g goc vai mat phing n&y song mui dau duai / ong tai ngoai khao sat hoi hai ma / benh canh sa sut tri tue mat phing nay ti/ang ti/ mat phang than kinh hoc m it 25 XQCLDT : Ky thuat, mat do 0 6 d£y lat cat 0.5 den 5mm Tia X : phat ra. h ^p thu. khuech tin Co 100 - 500 so do tir 400 • 1.000 ng diem kh6 t Chuyen doi cac con so thanh cucrng do s£ng 2.000 m uc m$t do UH Unites Hounsfield don v| Hounsfield Cua so hep : chpn 100 don vi trong s6 2 000 UH va chinh xac hon la 1 0 0 mat d6 tuong Cmg vfri nao bp May tinh tai tgo c£c con so cua m$t dp cua tung diem C£c khai niem : ma tran (thi du 256 h£nq / 256 hana). pixel : be mat. voxel (diem khoi) the tich (pixel x do dav cua lat cat) 1 2 0 lat / 1 . 2 mm / tai tao : Trong tru o n g hop kho ly giai tren cac lat cat day 5m m th u o n g lam, can th y c hien lai mot ch*JOi thu- hai voi 100 l£t mong theo mat p h in g c it ngang va tai tgo theo mat p h ln g tran va dung doc 26 XQCLDT MAT OQ / U H (do-n vj Hounsfield) - xirong d$c - v 6 i hoa M A T 0 0 C AO + 100 UH- iot - cuc mau dong © O N G + 3 0 UH c ^ at xam M AT 0 Q + 1Q UH Chat trln g - phu - ONT - mo M A T 0 0 THAP c u c m iu dfing 27 MAT DQ CAO - X U O N G - VOl HOA - c u e m A u o O n g nhieu h6 ng c iu + 1.000 UH X o n§o cu Boumeville M£u ty ngodi mdng cung - Ti§m lO T x lp xi v6 -i 100 UH - m6 NHlEU T £ BAO + 60 UH u m£ng nao, u day than kinh, u lym pho ... U mdng n3o g6c lifem dgi nflo- lAu tiAu ndo. ____________khftng va c6 tiflm________________ - m^u luu th6 ng v&i HEMATOCRIT cao (trd em) Dj dgng dQng-tinh m ^ch kh6ng ti6m vS c6 tifim - PROTEIN nong dp tren 5 gam I lit U nh&y xoang tr^n Nang th& keo n§o thAt III o O n g m a t DQ - c h At x A m + 30 UH : nude 7 0 /100, ma 8 /100, protein 2 2 /100 c6 kha nang co ton th u o n g dong m at dp : chan doan am gia tren X Q C LD T neu n hu khong co hieu chung choan cho - C HAT t r A n g + 1 5 U H : nub'c 80/100, ma 15/100, protein 5/100 m a t d o THAP : 4 m u c - PHU " thuan tuy " ... hay phu va te b&o u - DNT ... va xuat huyet m ^ng nao khong co ege m£u dong - MCf - KHi Phu hai b3n cku sau khi ngt>ng tu4n ho^n nh£n xSm va ti&u n§o trln g g ii nh i/ m ^t d$ cao - 1.000 UHNang dang t>i kyste Oermotde) G3y t5ng tn/oc O ">& so - Thu th§p: b& day cac ISt cat tuy theo may: ti> 1 den 4 mm. B AO N H l£ u LAT C AT ? . T ^j ( ^ 0 v(^j day 4 ho5 c 5 mm - H6 sau : 16 den 20 l£t do day 4m m sat nhau - Tang tren leu : 16 den 20 lat do day 5mm T u o n g quan giai p h lu xem trang 2 0 , 21 XQCLDT sau tiem 29 Cua so -1 / Cu-a s6 " mo m&m " : 1 / 21 100 UH 60 50 40 30 2 0 con s6 thay ddi tuy theo logi m£y CCra s6 hep. a /a s6 rOng T^i tdo kiAu VRT Volume Rendering T e ctn q u t chon dung b& rpng cira so sau <36 Xcic djnh mire s^ng - 2 / Quan s£t m pt c£ch he thong, tgi ban dieu khien, toan bp cac l£t cat qua cu a s6 rpng, cua so xu o n g ... c ic thong tin doi khi co tinh chat quyet djnh + 1.000 U H /O S C ua s 6 rpng « xu o n g » + 60 UH 4 20 UH i I 000 UH KHI cu a so hpp mo mem " T a i tao nhi^u m a t phlng, r it h&u ich de xac dinh vj tri ton thirong 1/ Tai tgo ti> 30 lat cat ngang c6 be day 4mm 2/ XQCLDT nhi&u hang d6 . tai tao tu1 1 2 0 lat cat ngang be day 1mm ... c h it lu’p’ng cao hon h§n . trong tru in g hpp kh6 xac djnh vj tri t6 n thu-ong, l$p ti>c thyc hi?n chuoi lat cat thi> 2 r£t mong Xipong da : cac lat cat ngang, dp day lat cat: 0.8mm i T a i ta o d a m a t p h ln g h&u ich cua m ^y X Q C LD T trong tru o n g h ap khong c 6 may CHT thi dg : tong ke khao sat tien p h lu m ot u m ang nao cua leu tieu nao . hinh the va vj tri cua ton thu’ang . khao sat dac biet tinh thong thoang cua xoang ben sau khi tiem 1 2 0 l£ t. be day 1mm T£i tgo dCmg ngang : mode MIP 0 ^ o nghjch c^c tircrng ph£n Maximum Intensity Projection ^ ich nhl/ ^ 7 d&y 40mm Tat sq nghieng hop so bat xCrng do hien tu-pmg hoa xi/o ng va dinh khdrp som mQt ben, dong som di/ong khop vanh ben tra' hinh anh tong ke tn/a c dieu tn 32 XQCLDT mgch m£u cac d ly hinh in h tu in ty tu1 dOng m?ch c6 r6 i dOng mach n3o, d#c biet 13 da gi£c Willis - xi> ly . mode MIP : Maximum Intensity Projection . mode VRT : Volume Rendering Technique, d$c bi$t trong trucrng hp-p v6 i h6 a dOng mach - Tong ke khao sat trucrc khi dieu trj tui phinh mach . phinh mgeh dau tan cua DM than nen . hinh £nh va p h in day cua phinh mach . dOng mgeh nao sau x u it phat ti> tui phinh mach - H# dot s6 ng - than nen binh th im n g . phinh mach nho doi ben o- dpng mgeh nao sau ben phai Lat c lt nguyen thuy Tai tao theo m ode MIP XQCLDT tuoi mau Chi dinh : 1 / Lp*i ich trong viec quyet djnh ly giai huyet kh6 i, . dac biet neu khong the th u c hien CHT ngay tu c thi . the tich khao s a t : 30m m , vi vay tap trung cac lat 6- vung dong mgch n§o g iua 2 / Loi ich trong tong ke khao sat u nao : vung u hoat dpng co hinh 3nh tang tu& i mau . djnh vj sinh thiet nao . lap luan giup phan biet u nguyen bao dem va cac u khac : u lym pho . u tai phat d u p e tu-di mau nhieu hon vung hogi ti> do t£c dyng cua tia xa - Ky thuat : . XQ C LD T nhieu hang dd : 16 hang . tiem 40 cc chat tu’o ng phan iod v o i toe do 6 cc/giay, iod 300m g/lit . th u c hien chuoi lat cat c u moi 0,5 giay trong v 6 ng 40 giay - Ly g ia i: . sau khi x u ly hinh cinh : . do dac hinh 3nh : DSC : lu u lu p n g m au n3o, V SC : the tich mau n§o, TTP : thfri gian dat dinh . vung khong tu b i mau, vung giam tu o i mau, vung tipoi mau binh th u o n g , vung tang tiF tru’drng . Idm n6ng c£c m6 . c in c6 khung Faraday Gam m e radio FM kham lam s£ng: quan sat 16 17 22 tia e y e tim tia X: R oentgen tia G am m a X quang QUY UO C , chgp mach m ^u tr6n XQCLDT NHAP NHAY BO d6ng vj. PET scan 1 - CAC CHUOl CHlNH : T1 Spin Echo - . T2 Spin Echo: 1°echo = mat do proton 2° echo: "T2 thyc sy" . T2 FLAIR: fluid attenuated inversion recuperation . T2 *: echo gradient . Hinh anh khuech t3n : b1000 va ban do ADC : he so khuech tan bieu tn/ng T1 GADOLINIUM: thu thap b in g Spin Echo ho$c Echo gradient (mpr) 2 - CAC CHUOl DAC BiET: - hinh anh hpc . d$ng mach: dong d$ng mgeh TOF 3D, chyp mach b in g CHT: gado . tinh mach: dong tTnh mach TOF 2D, T1 gado . dong DNT - T 1 inversion recuperation - dp phan giai rat cao: T2 CISS - hinh anh nhanh: trong tuyen yen, hinh anh hoc trong ti> cung, . - hinh anh tu o i mciu: gadolinium - hinh bo than kinh: hinh anh si>c cang khuech tan - hinh anh hpc chirc nSng nao - phep do ph6 b ln g CHT Echo Planar Imaging EPI 1 / T Lf T R U IN G djnh hu’6 ,ng c£c proton HYDROGEN I 2 /C A C S6 N G C A O T A N : 1 /p h a tc a c s ong cao tan 2 / ngang ca c song cao tan -> 3/phfc neu tan so cac song cao tan giong vai tan so xoay cua proton H nhOng proton n^y, do cpng hirang, se tich tg n3ng I^Q-ng -C A O T A N : 3 logi CHUOl - SE Spin Echo - IR Inversion Recuperation - EG Echo Gradient moi chu&i bao gom c£c dac tinh: TR Temps de Repetition thai gian I3p Igi TE Temps d’ Echo thai gian phan hoi Tl Temps d’ Inversion thai gian dao nghjch Tan so xoay cua cac proton H tuy thuQC vao moi truang xung quanh cua chung H20 , CHOH, COOH, protein, chuyen dOng .. - C H O N G C H l D |N H C P A C Q N G HU’O’N G TLf: . 1 / C hong ch i djnh len quan ta i ti> tru a n g : . chong chi djnh tuyet doi: - m ay tao nhjp, van tim b ln g kirn loai the he cu, - lu’O’i lo c tTnh m ach chu m a i dat, stent dong m ach canh m a i d a t ... d u o i 2 tuan - clip cu tren phinh m ach, tren 15 nam - m anh kim loai trong hoc m at can phai di kham bac sT, nhCmg tru a n g h ap nay can thu’c hien X quang qui u a c so nao. - van nao tha t-p hu c m ac dieu chinh b ln g ti>, tru’ khi dung tam m ot loai d ieu chinh m a i tro ng th a i gian ng£n - bo phan cay oc tai, cac ong thong tro ng p h ira n g phap kich th ich d ien nao sau (benh P arkinso n ) - bam tiem t y dong . khong chong chi djnh: - bo phan ghep kim loai: cot song, hang, chi - bo phan ghep rang co djnh ... nhipng la y§u to g ay nhieu h in h anh - bo phan ghep dong m ach cu, lu a i loc tTnh m ach chu cu . 2 / Chong chi djnh lien quan ta i hieu u ng cao tan: hieu u'ng lam nong len theo kie u"so ng vi ba" - han che tuy theo nha san xuat cam slf dgng mot so chuoi nhat djnh a nhu nhi va tre em . 3 / Chong chi dinh lien quan ta i benh nhan: - benh nhan sa n lm trong mot hop kin. benh nhan kich dong: can dung thuoc truac? - nen thu-c hien cac chu6i co thai gian n g in , trong vong 1 phiit, b it dau b ln g cac chuoi cho nhieu thong tinrfl . 4 / Chong chi dinh lien quan ta i ch at tu a n g phan: (luu y: benh nhan khong can phai nhjn doi) - tru'ang hap rat ngoai le dj ung vai gadolinium - khong can dung thuoc tru a c tru khi ghi nhan co tien can di i>ng 36 -OAI HlNH ANH thi&n T 1.T 2: thdri gian d l c^c proton tr6 Igi th£ng b in g 2 logi hinh 3nh c6 th i thu nh$n du’O'c trong 3 logi chu6 i khac nhau Spin Echo, Inversion Recuperation, Echo Gradient AT CAT - tru-drng (FOV, Field Of View), ma trgn: 256 ?, - dO d£y (1-5 mm) - s6 Icpong l£t c it (20 - 150) - kich thu’d'c d ilm 3nh? D ilm kh6 i? dAT PHANG : m$t p hin g c it ngang, m$t phing tr£n, dung dpc HOl GIAN : 4 - 8 chu6 i trong trung binh 3 phut 512 ?, doi xtrng ?, b it doi xi>ng ? Logi may Lat c it m uc (niveau) do day truang ma tran do nghieng Ci>a so be rong m i/c (hauteur) 3 7 CAC CH U O l T R O N G CHT - it n h it 15 loai hinh 3nh - trong 3 m $t p h ln g T1 Spin Echo T 2 SE 1° E CHO m$t dO proton T2 SE 2° ECHO l ' \ V T 2 FLAIR ..r it nhi&u q uy trinh kh^o s3t t6n thuang loai u sinh th ilt: u te b&o gai it nheinh ph§n dO II T2 * E cho G radient khuech ten b 1 0 0 0 T1 SE gado b in (36 ADC f T \ ' v ^ ^ \ - u U v dOng mgch ■ tinh mgch dbng DNT trircrng hop d$c bi$t 11 IR T 1, CISS, fat sat CHT tircri m£u hinh bo th in kinh ph6 p do p h i CHT chirc n£ng -1 I 0 Q C V A LY G iA l TIN HIEU Cac ti> khoa - TIN HIE U : c u o n g d o : thap, dong, cao? b it g adolinium hay khong? tu o n g u ng v a i loai cau true giai phau: ton thim ng dac? phu? xuat huyet? m&? voi hoa? dang nang? dong c h |m ? dong nhanh? / ddng n h it 9 -1 : T1 -2 : T2 -3 : T2 -4 T2 - 5: T2 * - 6: kh u ich tein - 7 T 1 GADOLINIUM Spin Echo Spin Echo 1°echo m$t dQ proton Spin Echo 2°echo "T2 thyc" FLAIR Echo Gradient .b1000 b£n do ADC - 8: hinh 3nh d$ng m a tfi - 9: hinh anh tTnh maefi - 10:hinh £nh dong DNT -1 1 : Inversion Recuperation T1 - Vj T R I? ton th u a n g thu y tran? thu y dinh?, ... ho sau, tuyen yen? ... tu a n g u ng dung v a i cac dau hieu lam sang ? - roi loan van dpng, cam gi3c, m at tieng noi, c h u c nang cao cap, tri n h a . - cac than kinh sq van d 2 ■ P 7 T * 5 - K ■ ' v T in thuang phu: nh6 i m^u bao trong bSn ph3i: tin hi§u tr§n T1 thlp, T2 echo thu11 tSng, T2 echo thur 2 tang Spin Echo T1 SE T2 echo thi> 1 SET2 echo thir 2 T6 n thuang x u it huyet: m&u ty dr nhSn d$u ben phdi v^o ng^y thu 7: tin hieu a T1 tang. T2 echo thu-1 t£ng, T2 echo thu 2 tang vi6 n xung quanh giam tin hieu do hemosiderine. Tin hieu tin hieu cao ro ret T u a n g im g 1 S PIN ECHO giai phau I T 1 cuc m£u dong nong do protein cao | ^ SPIN ECHO T2 e cho thi> 1 mat do proton SPIN ECHO T2 e cho thi> 2 Acuc mau dong nong do protein = trln g tin hieu cao trung binh = xam sang d6 ng tin hieu = x£m v ira tin hi0 u thap trung binh = xam sam tin hieu thap m a, melanin cao gadolinium T1 phu nang it protein hogi ti> DNT phu ton thu-ang phu nang it protein hogi tCr xu’a ng ro ret = den v6 i hoa dong dong mgch mpt so dong tTnh mgch hem osidenn khi ▼ T xuong voi hoa dong dong mgch, dong tTnh mgch hem osidenn khi 39 CAC TiN Hlgu CAO tren Spin Echo T1 -1 / C y c mciu dong - 2 / N ong dQ p rotein cao: nho i m au ng&y thi> 1 0 hogi ti> v6 n§o dang I6 p nang the keo nao that III ? \ - 3 1 M onang dang bi tin hieu cao 6 dinh xu o n g d£: m a binh thub-ng cua tuy xu a n g s q ? protein? cho thay Ipi ich cua chuoi bao hoa m a T1 Fat Sat mfj - 4 / M elanin di can cua u h ie to T1 khong tiem - 5 / B enh i> dpn g ch a t dong: benh W ilson , benh lp dpn g m a n ga n: n uo i d u o n g q u a d u o n g tTnh m ach - 6 / D ong . tTnh m ach: tin hieu th a y doi tren T 1 ... tin hieu co the tang do hien tu p n g di vao lat c l . the o vj tri dpng m ach: dong dong m ach ch am ? (h ie u ipng di v a o lat c it ) ... kho ly g iai tro ng tru o n g h o p p h in h m ach don g m a ch b| h u y e t khoi m o t phan - 7 / G ad o lin iu m di can u h lc to - 2 di can thuy tran ben trai . tang tin hieu tu phat . sau khi tiem ton thuang co kich th ira c lan han b it gadolinium mot phan - 1 di can d u a i lap n: . tua n g phan r6 g iua . c h it trln g c6 tin hi$u th lp , DNT dong tin higu . ton thu a ng phii co tin higu cao . chu6 i n3y kh6 ng tao nhieu 3nh gia a ho sau nhung khong cho nhieu thong tin han chu6 i O' T2 FLAIR T2 SE echo thi> 1 T2 SE echo thi> 2 T2 FLAIR T1 T2 SE echo th u 1 T2 SE echo th u 2 T2 FLAIR T1 gado X a ci>ng r3i rac: nhieu ton thu a ng mat myelin nhieu nai mang tin hieu cao tren T2 echo th u nhat Luu y: mOt ton thu a ng d u d i npi m ac nao that ke can nga tu nao that ben ben phai mang tinh chat "dang hoat dpng" tren T 1 gado . 21 Chudi nay h uu ich de khao sat cac nhan xam trung tam / benh Parkinson: chat trln g co tin hieu thap ro rgt, nhan xam co tin hieu cao I C ua so hep co the mang lai Igi ich vi DNT co hien tua n g dong tin hieu hay tin hieu tang nhe 41 CAC TIN HIEU tren Spin Echo T2. echo thi> 2, T 2 th y c s i/' Lo-i ich - dQ phan giai khong gian r it tot chuSi da protein tren spin echo P. SOM: RADIOLOGY. 1989, 172. 515-520 T2 echo thi> 2 DNT: 0,20g/lT 1 Spin Echo T2 echo thtr 1 A . mf g j W m - 1 - 15g/l T1 T2 echo thi> 1 T2 echo thu1 2 nang cua u phu -15- 30g/l eye m£u dong CA0 nang cua u . . dOng nhieu protein -30-40 g/l nang the keo nang dgng bi m$t s6 nang nhay - tr§n 40g/l mOt s6 nang nhay u qu£i T1 Spin Echo T2 echo thi> 1 T2 echo thi> 2 ege m£u dong T1 Spin Echo nang n hly ciia dinh xi/ang d3 T 1 Spin Echo T2 echo thi> 2 43 CAC TIN HIEU tren T2 FLAIR . Fluid Attenuated Inversion Recuperation : hinh anh 12 nhi/ng cho tin hi£u DNT 'd e n ' . la chuoi cho nhieu thong tin nhat - 1 / T uong phan ro r$t g iua ton thuong co tin hi#u cao (phu) va DNT, d$c bi$t 6 nhOng p h ln \6\ cua W n c iu dai nSo * r K ^ ( * ) \ v ' - • > : 7 / « ' 12 SE echo thi> 1 12 SE echo thi> 2: t6n thi/ong ?? T2 FLAIR nhAi mau vo ndo - 2/ Luu y: nang, djch c6 n6 ng dp protein c = "it tSng tin hi$u "tr§n T2 FLAIR Sinh thiet: u te bdo sao it nhdnh dang nang dQ II T2 SE echo thi> 1 Mpt nguy c o sai s6 t tren T2 FLAIR: . Trong dien tien cua nhoi mau nao: doi khi co the g$p viec chuyen d in dan tU mpt ton thu o ng logi phu co tin hi$u cao sang mpt hoc nao, co tinh chat djch, tin hieu thap ... qua mpt giai doan djch chua protein dong tin h*6 u . Hg qua: quan s3t ky c£c chuoi tren T1 : ton thu o ng co tin hieu thap 12 FLAIR -------------------------- SE T2 FLAIR "binh thucrng" ton th i/a n g dau nhan duoi ben phai khong thay d u p e 44 CAC TIN H l£U trdn T2 * - chufii Echo G ra d ie n t: giSm tin hi$u cua md vd vi v$y c6 hien tup n g Qi^m tin hi$u cua c h it trln g , - c6 3nh gia Ii6 n quan d in c£c c lu true xuang vd s i/ hi$n di$n cua khi trong cac xoang - c6 s i/ deinh gid trQi han so v6 i th i/c t l t h i t(ch t6 n thuang n hung d3y |& chufii r it c6 y nghTa; vl n6 mang Igi nh&ng thdng tin m3 chu6 i T2 Spin Echo v3 T2 FLAIR khong cung cap dupe: hinh 2 nh hemosiderin, v6 i h6 a 1/ HEMOSIDERIN : m£u ty? x u lt huyet m3ng nao? nhoi m£u x u lt huyet? u mach hang? chan thu a ng ? ... - Vi dy: mat ngon ngu dot ngOt a mpt benh nhan thuan tay phai c3ch nay 4 ngay : . Chuoi T1 v3 T2 Spin Echo, T2 FLAIR ... khong co nhoi mau . K h u lch t£n: nhoi mau, phu nao hai thcii d ua ng chu yeu ben phcii . Chuoi T2 * chan doan . co nhoi m3u thcii d ua ng trai . nhoi mau mang tinh chat xuat huyet ... chi chuoi nay m di cho phep chan do£n d u y c nhu v§y T2 SE echo thi> 1 echo thi> 2 T2 FLAIR khuech tan b 1000 NhOng hinh anh n£y kh6ng cho th ly du’O'c ton thirong th£i duang b§n tr£i T2 * kh6i mdu ty T1 T2 SE echo thi> 1 echo thi> 2 T2 FLAIR T2 * M3u tu nho a nhan dau ben trai, khong nhgn ra d u a c nhung vi xuat huyet khac N hieu ton th u a n g gi3m tin hieu dang cham trong b$nh canh nao do cao huyet £p Thanh phan xuat huyet cua nhoi mau vung dong mach nao giua va nao trudc chi thay duac tren T2 ' T2 FLAIR 45 T1 T2 SE 2° echo T2 FLAIR T2 • V6 i h6 a nh3n duoi b£n tr3i, kh6 c h in doan tren T 1 , T2 SE, T2 FLAIR Chu6 i T2 * 13 rat goi y: . khong nhung th iy voi hoa nhan duoi tr3i . m3 c6 n th iy c3 vi voi hoa ben phai v3 giup k h in g djnh c h in do3n, loai bo mQi nghi ngdr b$nh ly u ... benh FAHR CHT: hinh anh h ADC Cac chi djnh chinh - 1 / Nhoi m3u nao : . chan do3n mQt hay nhieu vung nhoi mau mai. co the n im g iua nhOng ton th i/a n g cu ly gi3i huyet khoi? hinh anh khuyech tan xac djnh dQ lan rong cua vung phu dQC te bao khong h6 i phgc d u t/c nOa - 2 / Ly gi3i mQt ton thu a ng dgng nang: . khuech t3n han che: ap xe . khuech t3n gia tang: u hogi tu (u nguyen bao dem. di c3n) - 3 / C3c Igp lugn goi y tinh c h it cua mo: khuech t3n hgn c h i: u nhieu te bao (lymphom, u nguyen bao tuy, u d3y than kinh, u m3ng n3o) . khuech t3n gia tin g : u it te bao (u te bao dem) 46 -K9 thu$t c h u ii 2 0 lat trong vbng 30 gidy, cb t h i 2 c h u ii 2 0 lat c it t£p trung vdo vung h6 sau roi den 2 ban cau dgi nao phan giai v i mgt khdng gian k6 m/ma tr^n nho phfin g iii v i mat tin hi$u tuy$t h5o tr£n kh uich tan b 1 0 0 0 , tua n g phan "ton thuang trin g tren n in den" . tr6 n ban d i ADC, dpc kh6 han : "tin thuang den tren nen trin g " - c6 t h i do h$ s6 : c6 l|ip mOt vung t6 n thuang va mpt vung doi xung mo lanh - so sanh: khac bi$t tr§n 20% giua cac hg so khuyech ten bieu trung la co y nghTa n iu t6 n thuang khbng bao gom thanh phan voi h6 a hay x u it huyet tr£n T2* - Kit q u i : - bieu hi§n s6 do b in g 10-3mm2/giay DNT = 3 ; c h it trin g = 0,7 . (Hinh ^nh sau khi si> dung m ^t trudrng tr6 ng, b = 0 . hinh in h T2 tua n g ty nhu1 hinh in h T2* . khbng c6 ich ly i trong c h in doan; n6 giup tinh toan cho ban do ADC) . (Hinh in h sau khi su dyng mpt trubng b 500: d i khao sat nao bo, it la i ich han b1000 trong khao sat nao bd) . Hinh £nh sau khi s u dyng m it tru an g b1000: 2 logi hinh in h , bo sung cho nhau: . 1/ K h u ic h ten: hinh anh hon hop: mpt phan la hinh anh T2 (gpi la "T2 xuyen qua"), mpt p h in la hinh anh khuech ten teng tinh hi$u tr§n T2 SE hay FLAIR, tru-ang h yp thu b ng gap, se d ua den tang tin higu tren b1000 do higu i>ng cua T2 vi vay tang tin hieu tren b 1 0 0 0 khong n h it thiet dong nghTa va i khuech ten hgn che can doc ban do ADC ("khuech ten th u c s y ) : tim s y giam tin higu ro r?t ciia khuech ten hgn c h i . 21 Ban d6 ADC: "hg so khuech ten bieu trim g" c6 du-p’c b in g cach tinh ti> bO va b1000 . logi try thanh phan T2 cua hinh anh: hinh anh "th y c s y " cua khuech ten . dpc b in g cach so sanh "bang mat thirang" giua ben lin h va ben bgnh hoac c6 the do dgc DNT = 2 den 3, c h it trin g : 0,3 den 1,2; lu-u y s y so sanh b in g phan tram g iua p h in lanh va phan bgnh la c h ic c h in han cac so do tuyet doi - hinh trin g va den: ADC giam = den, do nhay gia tang: nhoi mau m ai, ... va ca mau tu r i t m ai, ap-xe ADC teng = trin g , djch chuyen dong: DNT. nang cua khoi u - hinh mau: ADC giam = xanh duang ADC tang = do KHUECH TAN trong th y c hanh - Lam sang gp-i y nhoi mau nao r i t m b -i/1 den 3 gib-: . XQCLDT va CHT binh thuang . Hinh anh k h u ic h ten g y i y nhoi mau r i t mai: - b1000: nhoi mau co tin higu cao do khuech ten / khong the nham lan v&i hi£u ung T2 chua x u it hign - b in do ADC: tin higu th ip : co the do: g iim 20 - 50% so va ben trong hoai tu tin hieu tu a n g ty nhu cua u hoai tCr) - 3 / Nhieu t l bao khuech tan b1000 48 ... k h u ic h ten gi^m T2: giam tin hieu kin dao khoang co chi>a it djch : n h ilu t l bao k h u ic h tan b 1000: tang tin higu r6 khong the giai thich bang higu u ng T2 trung binh sinh th ilt: lym phom nao T2 FLAIR: tang tin higu . k h u ic h tan b 1000 tang khfing r6 tang tin higu do higu u ng T2 hay do hgn c h i s i/ k h u ic h tan? ban d 6 ADC tin higu thap ro do hgn c h i k h u ic h tan sinh thiet: lym phom nao . Lym phom ( phan b*gt vtri u nguygn bdo dgm) U nguygn bao tuy (phan t>gt vdn u mang 6ng nfy tuy) DN ET (va khdng phai Igc chfi c h it xam) . U m ang n io U dgy th in kinh Nang dang bi Cac Igp iu3n kh6ng 06 tinh k h ln g Sinh 'g o i y d 4 n ' c ln so sanh vbi cac d lu khac | KHUECH TAN GIA TANG | djch ■ ti/ do * T2 FLAIR KHUfCH TAN b 1 000 BAN DO ADC trung t3m hogi ti> t h Ap T2 FLAIR I KHUeCHTAN b 1.000 B£n d6 ADC £ v t W ' ‘ v V ' ' Trung tSm THAP THAP thAp T1 T2 FLAIR - 1 / N u d e = DNT, h6c n io n a n g m £ n g n hgn - 2 / K h o a n g n g o a i b £o = c h £ t c h u a ben tro n g nan g r$ng c u a kh 6 i u: u te b ^ o dg m , di c3n = p h£ h u y t6 b£o: x a ci>ng r^ i r£ c to n th u a n g cu = n h 6 i m £ u cu: tS ng sin h tb dgm , h 6 c n§o - 3 / G ia ta n g d o n h a y v d i ti> tin h d a u hieu phi>c tg p tre n kh u e ch tan: h e m o s id e n n - m a u ty (b a n ca p ) - 4 / K y n u d e / m a u m a , u quai x e m tin h ie u m a d u d i da th a i d u a n g KHUECH TAN b1000 b3n d6 ADC ( ' J KHCNG KHUECH TAN- KHI - V C l HOA KHUECH TAN b1000 m - ■ K - . V ' XQCLDT v6i h6a 49 LQI ICH CUA KHUECH TAN: 9 thi dy - Nghi ngd nhA« rrteu mdn - Hinh in h khuAch ten b 1 000 tin hi$u cao bdn dA ADC tin hifcu thAp ... nhAi nteu m di vung dm n£o giua nfing vd sSu - Tr§n khuAch ten thAy nhAi m£u lan r^ng han tr6n T2 FLAIR T2 khuech tin : b 1.000 DNT c6 tin hieu th^p "nhi/ tr6n T2 FLAIR" m$t dO protons b3n do ADC DNT cd tin higu cao "nhi/ tren T2 Spin Echo * ^ 3 Sfci. T2 echo thi> 2 kho6cti tin b 1000 Nhi&u hinh dnh dgng khuyet trong v6 n§o: khuyet hay nhAi m£u ngo? t6n th u a n g mGi hay cu? c5n nguygn? K h u ic h ten cho thdy: . d£u la t6n th u a n g m ai: tin higu cao trgn b1000, t6n th u a n g cO c6 tin higu d6ng . d6 Id nhung nhoi m£u dudri v6 c h ir kh6ng phdi lA khuygt do thodi h6a lypohyalin . nhAi mdu m 6i, da phdn ngm ben trdi trgn khuech tdn: c6 thg do thuygn tdc tir dgng m gch c Luu y: cdc chuAi kinh dien T1 va T2 Spin Echo khong cho nhigu thgng tin ; ph6i h ap v6i day ban trong xu a n g trdn - Nghi ngdy nhoi mau mai: chan dodn mpt hay nhieu ton thuang m ai g iua nhung hinh khuyet nao cu T2 FLAIR: t6n th u a n g m 6i? cdi nao? tra kri ..kh u A ch td n b1000, ban dA ADC ban (36 ADC nhAi m du m o i c6 tin higu thAp T 1 T2 FLAIR Hai nhoi mau dgng khuyet ke can nhau: m ot ton th u a n g m a i7 cat nao7 50 kh u e ch ta n b1000 nhoi mau m 6 i c6 tin higu cao 5 / B$nh nhan 6 khoa h6i si>c / lam t6ng k6 tdn thuang, ti£n lupng ? . b$nh nhan h6n m§ sdu sau nh6i mau co- tim tu 6 ngay tru d c sang; kh6ng c6 tripu chung than kinh mpt ben T1 T2 SE echo thi> 1 echo thCr 2 T2 FLAIR T2 * . c h it trin g phu ne lan toa, doi xi>ng, dong tin hipu tren T1 . tin hi$u cao 6 v6 nao tren T2 FLAIR ? xoa cac ranh vo nao, sau nay xac djnh la chat xam phu ne khuech tan b1000 ban d6 ADC tSng tin hieu toan bo chat xam tren khuech tan b1000, tin hieu hon hpp cua vo nao tren ban do ADC ton thu-ong nao do giam luu lu pn g mau tram trpng va keo dai; tien lupng khong kha quan 6 / Ap xe hay u hoai tu (u nguyen bao dpm, di can) ? Ap xe khuechtan b1000 . ch i co the dpc ly giai chat ch u a ben trong nang ban do ADC U hogi tu . khong ly giai d u p e tin hieu ben trong ton th u a n g dac ... hinh anh khuech tan khong mang lai thong tin ve phan do cung n h u ve logi u te bao dem , cung n h u chan doan phan biet g iua u te bao dem va i ung th u . nhung hinh anh khuyech tan co the giup co nhung Igp luan ve tinh chat nhieu te bao, xem benh an tiep theo. khuechtan b1000 ban do ADC 51 C ic Igp lugn tren khuech tan giup tiep can c h in doan giai p h iu b$nh cac u: - 1 / Ton thu a ng nhieu te bao: lym phom , u nguy§n bao tuy, DNET. u day th in kinh, u mang nao = khuech tan han che, tin hieu cao tr£n b1000 - 2 / Ton thuang it te bao, "co tinh phu ": u te bao dem nao, di can = khuech tan binh thu&ng, dong tin hieu tren b1000 . ngoai cac yeu t6 lam sang va hinh thai. . ton thu a ng dong tin hieu T2 echo thu 2 vi vay day ia khoang c6 tinh c h it dich b« hgn c h i . k h ln g dinh tren hinh anh khuech tan: tin hi£u cao khong the g iii thich b in g hi$u ung T2 ... co kha nang ton thu a ng nhieu te bao khu & ch te n b1000 sinh thiet: lymphom nao T 1 T2 FLAIR T1 gado khuech t£n b1000 chan doan u mang nao tren T 1. T2 FLAIR (khoang co tinh chat dich yeu), va T 1 gado lap lu$n bo sung tren khuech tan: tang tin hieu b1000 do khuech tan han che, ban do ADC it co y nghTa - Ton th u a n g nam a nhan dau ben phai, b p ro. co ve ia ton th u a n g trong nao it cac dau hieu gian tiep : day nhe thung lung Sylvius ra ngoai. g in n hu ton trong bao trong va d u a n g g iua nhung day nhan dau ra tru a c : khong co phu ke can : gai y ton th u a n g ngoai nao - Khao sat cac tin hieu : giam T 1, tang T2 SE, giam T2 FLAIR, tang T2* ton th u a n g co thanh p h in mang n h ie u tinh chat d|Ch chan doan nang mang nhen khong d u p e nghT den vi hinh the va vj tri khong dien hinh c h it ch u a ben trong ton th u a n g khong dong nhat tren T1 va T2 tang tin hieu dgng vgch th in g a ngoai vi tren T1 T2 mo co nhieu protein khong b it gadolibium . tang tin hieu ro tren khuec tan b 1.000 va giam tin hieu kin dao tren ban do ADC khuech tan bi han che 1 ton th ira n g nhieu te bao, nhieu vach ngan Tom lai chan doan nang dang bieu bi (kyste epiderm oide) iu hat ngoc) ia gan n hu rat dung C h in doan khong d u p e kiem ch u n g lai. benh nhan khong mo Co the kiem tra dien tien b in g CH T th u c hien voi th o i gia"- - 52 T 1 G A D O LIN IU M - CHl D|NH Tl£M ? lu-u y H A N G RAO M AU NAO - CHT k h On g T I£ m khoang 4 0 /1 0 0 c ^ c khao sat - tai b iln m gch meiu n3o - v$n dOng b it th u d n g , Parkinson - c h in th u a n g - kh2 nSng dj dgng nao-m ^ng nao - nghi n gp viem n io do herpes - r6i logn tri n hd , sa sut tri tup - C H T C 6 T l£ M 6 0 /1 0 0 - nghi n g d u nao ... u te bao dem , lym phom , di can - &p xe - x a c u n g r£i r£c, A ID S - tai bien m ach m au nao: . chgp m gch b in g C H T (C H T-M M ) . nghi n g d viem huyet khoi tTnh m ach nao . h inh anh khong dien hinh t h iy tren cac chuoi khong tiem - lam s^n g khong ro rang ... dpng kinh, nhin doi n h u c dau: hoi benh s u cua benh nhan ; neu khong dien hinh: tiem - c£c khao sat C H T khong tiem da th u c hipn co ket qua kho ly giai Ghi chu: the o nguyen t i c an toan, m ang thai la m ot chong ch i djnh tiem gadolinium - k Et q u A CAU TR U C B lN H T H L rtl'N G khong b lit gadolinium - nao bp - dpng m ach: dong nhanh, tin hieu thap (tru khi chu6i bao hoa dong d u p e si> dung) T O N T H U m iG khong bat gadolinium - phu nao: quanh u viem nao - m ot so u te bao dem , phan do thap - nhoi m au m o i, nhoi m au cu - khoi m au tu - dj dang nao - m ang nao - u quai bat gadolinium - m ang nao - dam roi m ach m ac - tuyen yen - tTnh m ach bat gadolinium - u te bao dem : khong tu a n g u ng g iu a phan do u va do b it tu a n g phan - di can - lym phom u m ang nao. u day than kinh - m ot so nhoi m au sau 6 ngay chu vi quanh khoi m au tu - ap xe, tu m il - x a c u n g rai rac (m ang dang hoat dong) 53 T1 g a d o lin iu m : k y th u a t th u th a p -1 / T h u th ^ p T 1 S pin E cho: 20 lat c i t d a y 5 m m , c3 ch q u ^ n g 2 h ay 3 m m , tro ng 3 m $t p h ln g - tr u d c ti§ n th y c hien c h u o i tre n m a t p h ln g d u n g dQC v£ tr£ n , v£ sa u d 6 , tro n g c h u ii cuAi cu n g , trfen m £ t p h ln g ca t ngana. d iiu n £ y c h o p h e p - ta n g th d i g ia n tu lu c tie m de n kh i th u c hi$n c £ c l£t c i t n g a n g , ia t c i t n h i^ u th 6 o g bn n h it - g ia m I n h g ia o h6 s a u Ii6n q u a n td i g a d o lin iu m lu u th ftn g tro n g c i c xo a n g tTnh m g ch bAn - 3 m $t p h ln g , d $ c b i$ t Id m a t p h ln g d u n g d p c p h a i d u o c th y c h i£ n thudrng q u i ... Ip i ic h c h o p h 5 u th u £ t T 5 n g tin hi$u d o ti I? p ro te in ta n g va d o e ye h u y lt kh6i - c h u o i tru b ’c va sa u tie m g a d o lin iu m : v ln d e ve d ie u ch in h c u a so . kh i b i t tu o n g pha n yeu: ne n d u n g c u a s o n h u n h a u g iiip so sa n h c a c h in h 3 n h c6 dp tu o n g p h a n g»6ng nhau . tu y n h ie n kh i tu o n g p h £ n tru o c tie m ro ret, h o £ c khi b i t m a n h g a d o lin iu m , kh d n g t h i n a o g iu c h u n g c u a s i - 2 / T hu th g p T 1, m ode 3 D . 100 iat d a y 1,4 m m ; th u th a p tro n g m a t p h ln g d u n g d p c (e c h o g ra d ie n t), h a y 180 la t de»y 0 .9 m m ; thu th a p tro n g m a t p h ln g c i t n g a n g (T1 in v e rs io n re c u p e ra tio n ) . sa u d6 tai tg o tre n m g t p h ln g n g a n g va va m a t p h ln g tra n th a n h 20 la t d a y 5 m m - ky th u g t n a y d u p ’C s u d y n g sa u tie m g a d o lin iu m de c o d u p e c a c ch u o i tro n g 3 m a t p h ln g sa u m p t lan th u th a p , d $ c b ie t la ceic d o n g m g ch va tTnh m a ch co tin hieu c a o ro d o h ie u u n g h on h p p : d o n g + g a d o lin iu m - so sanh g iu a . 1/ h in h anh thu th a p tren spin echo, m o d e 2D thp'i gian 3 x 3 phut = 9 ptiut hinh anh t i t ve m at tin hi£u trong 3 m at p h ln g thu thap trong m £t phang cat ngang, dung dpc. tran lat cat day 5 mm 21 h in h anh thu th a p tre n T 2* m o d e 3D th in gian 1 x 4 phut ♦ tai tao . hinh ^n h khdng g ia r kem hem khi tai tao tr6n m at p h ln g tran va d-m g doc d0 phan giai v& m at bn h i& j th ip - phan bi$t c h it r t n g - gadolinium thu thap 0.9 mm trong m$t p h ln g c it ngang roi tai tao trong m at p h ln g cat ngang tran va d ung doc lat c it day 5 mm 54 chat xam - Di&m chii y : 1 / Lp'i ich quan trcpng cua ccic chu6i sau tiem de chan doan ton thuong T1 gadolinium .21 Lp’i ich cua chu6i sau tiem trong vi?c phan do u te bao dem T1 gadolinium - ton thu’O'ng tham n h ie m ke c^n nga tu nao that ben ph a i, lan d e n th e chai day len den nga tu- doi ben - b a t g a d o lin iu m k in d a o n h u n g c h ic c h in co b it , c o c a c tTnh m a c h dan luu - sin h th ie t: u te b £ o g a i it n h a n h (o lig o d e n d ro g lio m e ) d o II h a y do III: hien tuo n g oat gadolinium xep ton thuong thanh do III 55 3 / Khong nen giai han the tich khoi u chi a ton thuang co b it gadolinium - ton th u a n g co the khong dong nhat, nhat la u te bao dgm trong do m pt p h in c6 t h i thu ^c p h in dp th ip . khd>ng b it gadolinium va m pt phan khac phan do cao, b it gadolinium - co the sai sot tren X Q C LD T : khong c h in doan d u p e phan u th im nhi&m vi d6ng m $t d<> t r in X Q C LO T - cOng co the sai sot tren C H T : ly giai vung khong b it tu a n g phan n h u vung phu n io phan u ng trong khi th u c s u lai la vung u tham nhiem v a i hang rao m au-khoi u khong bi pha va. - do do sinh thiet p h ii khdo sat khong n hu ng vung b it g ad olin ium m i ca n hu ng vung I3n c£n kh6ng b it c h it tu a n g p h in C H T : T1 T1 gado T2 m it dO proton K h ln g djnh ton th u a n g thai d u a n g g iu a trong - n hu ng ton th u a n g cung lan t& i hoi hai m § va c u e t h ii d u a n g - h inh thai khong g a i y mQt phu p h in u ng , vdri t6n th u a n g th u a n g a trung tam n hu ng la mOt u te b ao d$m kh6ng d6ng nh^t - sinh thiet nhieu cho k h ln g djnh s u lan rpng cua u d in to in bO thuy thai d u a n g 56 X Q C LO T sau tiem Ton th u a n g thai d u a n g g iu a trong C Q N G H l/ d N G T L f cac 0 Q N G M A C H va T IN H M A C H C 6 va T R O N G S Q - 1 / DOng m gch c6 : - A / boc tach? T1 F at S at - B / C H T - m ach m au (C H T -M M ) - 2 / DOng m gch n io : - A / T1 va T2 - B / TO F 3D - C l C H T -M M - D I chup m gch so hoa xoa nen - 3 / K hao sat d6ng th d i dOng mgch va tTnh m g c h : M PR gado, TO F 3D sau tiem - 4 / K hao sdt cdc tTnh m gch trong sq : TO F 2D ,T 1 gado, tu o n g phan pha - 1 1 CHT CAC DQNG MACH CQ A / B 6 C TACH CAC DQNG MACH CO? T1 Fat Sat, mat p hln g ngang - LSm sang: tai biln mgch mau nao thoang qua hay <33 hinh thanh - cb th i trifbc <36 cb (3au vung co ty phat - ho$c khbi phat do chin thirang tryc tilp ho3c gian tiep: thu thu3t xoa bop CQt s6ng, xoay dau dot ngot - C ln thyc hi$n chin doan khln. d l quyet djnh d ilu trj khang dong - Khlo sat cac dbng mach c£nh trong va dpng mgch dot song: . 15 I4t trong m$t phlng c it ngang, cac iat c it ngang thi T 1 bao h6a mb’ (Fat Sat). ti> ngang dot song C5 d in nen so . 3 bflo h6a - bao h6a ma de chin doan tin hi$u cao cua eye mau dong dirai lap ngoai mac cua mach mau so vai mb vung co - bao hba dbng tTnh mach ti> tren di xuong de loai tri> nhOng hinh anh c6 th i c6 cua dbng tTnh mach binh thi/bng tang tin hi$u tren T1... hien tuang di vbo iat c it - bao h6a dbng dbng mach tu dubi di len, n lu dbng bj cham lai. co th i tang tin hi$u tren T1. . lat c it ngang khong tiem, T1 va 3 hieu i>ng bao hba: tang tin hieu "hinh liem" cua eye mau dbng dual nQi mac dbng mach canh - bao hoa md - bao hoa dong dong mach di len cac lat c it phia dudi - bao hoa dong tTnh mach di xuong cac iat cat phia tren Boc tach cac dong mach canh phai va trai . eye mau dbng co tin hieu cao "hinh liem" dbng dong mach co tin hieu thip 57 0 nh&ng b$nh nhan tre, nen tim boc tach dOng mgch tr£n T1 Fat Sat c it ngang m$t c ic h thuang qui . dau vung c6 khong thuang xu yln . cdc d lu hi£u hep dpng mach thay tr§n CHT-MM c6 th i r it it ho$c khPng c6 . p h li th y c hien chuoi T1 Fat Sat truOc khi l£m CHT-MM vPi gadolinium T 1 Fat Sat: boc tach duPi npi mac dpng mgch dot song ben phai ... b6c t£ch ty phat, phat hien nhP dau nh6i mau trong vung tu6 i cua dpng mgch tilu ndo sau duPi b6n phdi CHT-MM: d$ng mgch dot song ben phgi c6 k h lu kinh hep v£ khong deu ... c h in do£n boc tach dong mgch khong the c6 dupe neu khong thyc hi$n chu6i T 1 Fgt Sat cat ngang T 1 Fat Sat: b6c t£ch duPi n$i mgc dOng mgch c£nh trong bdn phli (luu y: x6a dbng tinh mgch chu-g dgt y§u c£u) CHT-MM: dpng mgch cgnh trong c6 k h lu kinh g in nhu binh thud-ng c h in do£n b6c tech dpng mgch khong the cb dupe nlu khong c6 chu6i T 1 Fgt Sgt c it nggng C6 the su dgng gnten be m$t vung co: dp phgn giai khong gian va do phan giai tin hieu tot nhat Mgc dich: . 1 / th iy dupe ege mdu dong cug boc tach dpng mgch . 2 / thay dupe cau true mang xa vua : mdng xa? lipit? ege mau dong nho? voi hoa nho hay lan? Anten be mat vung co H Ngu6n X Lederc 58 B / CHT-MM cAc DQNG MACH VUNG CO iat c it theo mat p h ln g tran sau khi tiem gadolinium - 50 d6n 70 Idt / d$ ddy: 0.7 -1 m m / m $t p h ln g tr£n - tifim g adolinium , d£nh m 6c th d i gian khi c h it tu a n g phan den quai dong m gch chu - thdri gian th i/c hi$n ch ufii 34 giSy - xCr ly h inh 3nh: xo£ n&n, MIP, tgo vi&n cAc dogn dong m ach dang chu y, tgo h inh xoay chinh tam: lat cat sau cung n£m m$t iat cat ch6ng 50 iat cat I6n nhau dr sau cung sau cua d6t d§i chong 50 lat c it len nhau tren mode MIP . sau do tao vien true dong mach canh ben phai trong mat p h ln g tran va dung doc. . loai bo cac doan dong mach khong y nghTa loan san co sai: . dong mach to va dai n g o ln ngoeo . cac tiii phinh mach di chung cua boc tach . nguy co thuyen tac va nhoi mau nao . dieu tri khang dong CHT-mach mau kiem tra khi nao ngung dieu tn khang dong7 59 X a vua dQng mgch c ln h : hep? huyet khoi? mang xa vua loet? ao dessus de la sienose T f V Mang xo vfra lodt Hinh 3nh d£nh gi£ hep qu3 mire so vOi thi/c tl: . hinh 3nh gi£ tic dpng mgch do khdng c6 tin hi^u li§n quan tdri tSng cao t6c dO ddng, tin tai ddng dpng mgch 6 phia trfen . tin hi£u thip ben trong c3c d$ng mach c3nh chung vd canh trong do cung hi$n tuang dpng nhanh - hep dQng mach canh trong do x a vua - do be mat c it ngang dQng mach sau khi tai tao theo m$t p h ln g c it ngang t£r kit qua thu thap cua mat p h ln g tran d u d i cho hep tai cho hep tren cho hep 1030 mm2 560 mm2 840 mm2 - lai ich cua viec do n&y? tren thuc hanh, danh gia mire dQ hep b3ng m it Khong co q u y lt djnh dieu trj n&o c6 t h i dua tren khao sat duy nhat ia CHT-mach m£u co bem gado Quyet dinh phai dua tren s i/ tong hap giua dau hiQu lam sang: am thoi? thieu sdt than kjnh? k it qua khao sat Doppler? . m uc dQ hep: tren 70/100? | Co th i dieu tri ngoai khoa? Nong gian qua dudng nQi mach? 60 Sieu 3m doppler - 2 I C A C D Q N G M A C H N A O : 2 k9 thu$t khfing tidm gadolinium, 2 ky thu$t c6 tifim gadolinium - A / O q c c ic chufii kinh d iln T1 v i T2 dQng mgch kh6ng c6 tin hiQu do dong chay nhanh - B / Khdng tifim gadolinium TOF 3D, hinh Snh ddng, 60 lit tren m$t p h ln g c it ngang, d iy 0,8 mm - C / Tifim gadolinium • D / Tifim gadolinium echo gradient / 50 lit c it tr§n m$t p h ln g trin , d iy 1 mm gi6ng nhu chyp mgch c ic dQng mgch vung co ... tic h bigt dong mgch n io ra DSA: Digital Substraction Angiography (chyp mgch so h6a x6a n&n) A / O pc c*ic chufii kinh kiem chung tren T 1 gado va CHT-mgch mau: huyet khoi hoan toan DM canh trong ben phai 61 B I Khong tiem gadolinium : hinh anh dong dpng m ach: TOF 3D - 50 - 100 iat c it ngang, day 0,7 -1 mm, thbi gian thu th$p: 5 d&n 7 phut - "hOp" kh£o sat bj gi6*i hgn vbi be day 50 den 70 mm ; toan b$ tuin ho3n DM nao cb the khao sat trong 2 chuoi libn tiip nhau ... 6 phut - thu thap trong m$t phing c it ngang, thing goc vbi tryc DM c3nh v£ than n&n - hinh £nh ho3n h3o d6i vb i cac DM co dong chay nhanh - hinh anh doan xa cua cac D l^cb the dupe c3i thi$n neu trubc db cb tibm dii chi "mpt gipt gadolinium " - nhu-ng . hinh 3nh cb the thay doi b cac DM cb dbng ch^y trung binh va ch|m ... c£c nhanh xa cua DM nao giOa? cb th& hinh £nh khbng ro b mat sau cac xiphong dpng mach c3nh ... bb sbt tui phinh mach kich thi/bc dirbi 2 mm chyp mach m3u quy u-bc v in ia c in thi&t trong tong ke khiio sat cbc tnrbng h<7p xu it huyit mang ndo . eye mau dbng cb tin hieu cao trbn T1 iam c3n trb vi^c ly giai c3c tiii phinh mach . ki&m tra sau khi iam thuybn tic : cb the cb anh giei liSn quan den coil chbng cac iat cat: mode MIP 1 trong so 50 lat c it ngang bbc tach 2 xiphong DM canh cue mbu dbng dubi npi mac DM cbnh ben phai tbi tao trbn m$t phing trdn h uyit kh6i DM nao giCra b6n ph^i do thuydn tic b it s3n DM nao tnfbc b6n ph3i C I CHT-mgch mau: chyp mgch m£u bing cpng huang ti> c3c iat c it tr6n m$t phlng tran k6o dai 30 giay dupe thyc hiQn 20 giay sau khi tiem gadolinium . ky thu$t tuang ty nhu- chyp mach mau cac DM vung co t^ch biet cac DM nflo ra, sau 66 xu ly hinh anh. - l/u dilm : k9 thu$t nhanh, khdng bj chlng hinh anh cac tTnh mgch nao ■ Khuylt d ilm khao sat bj hgn c h i trong mQt dQ day 50 mm tr6n mat phlng tran . doan xa cua DM trong nao it tuang phan va sau d6 khdng thiy du’p’c nOa . bQnh nhan c6 than hinh dai: kh6 bao trum tru’d-ng khao sat ti> quai DM chu cho d in toan th i sq nao I f Xlp ly h inh anh X6a cac doan DM khdng y nghTa sau d6 khao sat cac DM nao duPi r ~ '■ f > i t nhilu chilu vj tri khac nhau . thuyfin tic ti> tim dr mQt tr£ bj liQt nCra ngi/iri trai dQt ngQt . vung khao sat: cac DM nao . tai tao hinh anh trong m$t phlng c it ngang tic gan nhi/ hoan toan DM nao giOa bSn phai { \ . thu thap . chQng 50 lat c it len nhau l I3t c it theo mp tran . tach biQt cac DM nao bing cach xoa bo cac DM vung co m .tai tgo / xoay mpi hucrng - Chit lupng hinh anh DM dang duac cai thiQn nhung hiQn nay chua du de c6 the thay the chyp mach mau quy ucrc hay XQCLOT-mach mau trong tong kfe x u lt h uylt mang nao. - Ngoai ra. bj han che boi mot "hop "co do day 50 d in 70 mm: khong the khao sat toan bo he thong DM trong so • Chit lupng khi§m t6n ho$c khong thiy dupe cac nhanh DM xa. 63 CHT - DSA : Digital Substraction Angiography 0/ ti§m 6 cc gadolinium trong vong 4 giSy + 20 cc djch d in g truang chuoi r it nhanh, 16 pha, 1 gi3y 1 iat c it: d&y 8 cm, 2 thu thap xi> ly sau: 20 phut chi djnh: iam t6ng ke / k iim tra dj dgng dpng-tmh mgch IRW DSA NguAn: JY GAUVRfT t chyp m^ch mdu quy i/6c Luu y CHT c6 t h i tot han chyp mgch m3u quy u 6 c trong vi$c k iim tra theo ddi c3c dj dgng dOng-tTnh mgcti sau khi da 1dm thuyf t ic v3/ ho$c xg trj, dgc bi^t khi dbng chay r it ch$m: ... hinh the "binh thud-ng" tr§n chyp mgch m3u vi d<> tu a n g ph3n y iu v£ c h it tu a n g ph£n i6t d in tri ... hinh 3nh b it th u ic t r i c£c tTnh mgch tr§n T1 gadolinium CHT-MM c6 thay t h i ky thugt chyp mgch m3u d i k iim tra theo d6i - 3 / K H A O S A T D Q N G T H O I c a c D Q N G M A C H va T IN H M A C H : A I TOF 3D sau tie m : thu th^p dupe trong m$t phSng cSt ngang / lat cSt 2mm . Lpi ich cua k9 thu$t n&y khi 13m s£ng khong nghi den chi djnh k h io s3t c3c dQng mgch hay c3c tTnh mgch . Luu y: kheio Scit toan bO tuan hoan nao dong mach v£i tTnh mgch, tu l6 c h im Idn d in dinh v6m sq 100 lat cat ngang dp d£y 2 mm ma tr|in 154 - 256 4 phut 30 giay tai tgo trong cac "hop" day 60 mm trong 3 mgt p h in g 64 B / H inh Anh h y c ddn g dQng m gch TOF 3D c6 ti§m gadolinium T O F 3D khOng tifim x T O F 3D co tiem th u o c trong d png m ach va tTnh m ach - Lpi ich trong tong ke dj dang dQng-tm h mgch v d i m gc d ich djnh ranh g id i nhan dj dang - TOF 3D khdng tifim dbng d$ng mgch ch6ng nhau 20 iat cat X ■L 65 - TOF 3D sau ti§m, 1 iat cat dbng OM+ thu6c trong nhan va tTnh mgch - TOF 3D sau.tiSm, 20 iat cat d6ng DM + thuoc tu o n g phan trong nhan va tTnh mach co the tai tao trong 3 mat p h in g ^ C I MPR gad o : 120 Idt c it 1 mm - Mat p hln g thu th£p: - thuang Id mat p hin g dirng dQC r6i tdi tgo trong m$t phing trdn vd m ^t p h in g di/ng phdi qua trdi, ti> tren xuong dudi - dQ phdn gidi kh6ng gian tuy^t hdo - iQi ich: khdo s^t mQt b§n xoang hang, dudng giCra, ton thu’O'ng dinh sq... _ f . ; > s y 9T7 ’I t , ' * ' ■ \ : > J - y • ^ P .fJ a • S ' ~- , * « * * * • ' • : • • - \ ' - 4 / CHT cdc TTNH MACH NAO 2 myc dich: - A / chin doan huyAt khAi tTnh mgch nao - B / khao sat trudc phSu thu$t tinh thdng thoang cua cac xoang tTnh mgch k6 can v6i mQt u mang nSo - A / ChAn doan huyAt khAl tTnh m ?ch ngo I xem thSm chu-ong nay - A 1 / C hu5i T 1, khdng ti6m : . cac tTnh mgch binh thuang c6 th& tin hieu cao tu phat tren T 1: hien tupng di vao lat cat nhung mOt tin hi$u cao rd r§t, d6ng nhdt, 6- xoang tTnh mgch la benh ly: eye mau dong tin hieu cao: eye mdu dong di kdm dj dgng xoang tTnh mgch - tang tin hieu xoang b£n - huyet khoi tTnh mgch nao :3Vv r v ' V it > 1 I r \I V ' h i Tang tin hi$u do ddng binh thuong hay do cuc mdu dong? T1 khdng y nghTa ... dQC hinh anh T2 v . ' Tang tin hieu tren T2 SE echo thu 2 va T2 FLAIR: gp'i y huyet khoi xoang tTnh mgch dpc trdn A 2 / Chu5i T2: chuoi kinh dien T2 Spin Echo 6 echo thu 2, hay T2 FLAIR cdc chuoi ndy cung cho thong tin nhu cac chuoi dong tTnh mgch hay cac chuoi co tiem gadolinium binh thuong f t - f V \ / / _ \ t V k ( m , T2 SE T2 FLAIR binh thudng = xoang doc tren co tin hieu thap huyet khoi tTnh mach T2 SE T2 FLAIR huyet khoi tTnh mach nao = xoang co tin hieu cao 2 ly do: khong co dong chay . cue mau dong 67 - A 3 / Hinh anh dong tTnh m ach khong tiem g adolinium : TO F 2D . hinh anh he thong tTnh mach co c h it lupng . nhung co nguy co sai s6t: khi xoang tTnh mach nam trong m$t p h in g lat cdt, thi du m$t p hin g cdt ngang. r>6 cd thA dAng tin hi$u ... khong thay doi lat c it = dong tTnh mgch khbng phdt hi$n dupe ... so sdnh voi hinh dnh sau tiem Id cdn thiAt ho$c thu thgp m$t chuoi theo mgt p h in g trdn rAi tdi tgo dung doc T1 gado ho$c tot hon, thu thdp mOt chuAi 120 Idt c it ddy 2mm theo mdt p h in g ngang vd dung doc rAi tdi tgo theo cdc mdt p h in g khde TOF 2D T1 gado TOF 2D: hinh anh nhim lin vbi huyAt kh6i tTnh mgch xoang t>6n b6n trti T1 gado: xoang ben bbn tr£i c6 d6 d iy thu6c, dudng kinh nh6 nhung thdng thoAng TOF 2D: hinh Snh nhim l5n vbn huyAt khAi tTnh mgch xoang b6n b6n trdi T1 gado: xoang b§n b6n tr£i c6 dA ddy thuAc - 1 / Hinh anh dong: "khong thay" xoang ben ben trai 2 / Chuoi T 1 gadolinium thu thdp trong mdt phdng dung dQC bat san? huyet khoi tTnh mgch nao? 100 Idt c it, tai tgo trong mdt phdng tran xoang ben ben trai gidm sdn, nhung con hoat ddng ca 2 chuoi, dbng tTnh mgch va T1 gadolinium MPR, phai dupe thuc hien mot cach thuong qui trong truong hpp nghi ngo huyet khAi tTnh mgch ndo TOF 2D: dong tTnh mgch - Huyet khoi tTnh mgch nao xoang tTnh mgch doc tren xoang ben ben phai - Dan luu tTnh mgch nao qua cdc tTnh mach vo ndo vdnh dai tTnh mach d u o*-’'— sytvius cdc tTnh mach vung e ra '-