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TCE
Lesões
Primárias
Lesões de movimento
Lesões (inerciais)
Lesões Focais
Secundárias Lesões
Multifocais
Lesões de impacto
Lesões (contato)
Difusas
Lesões
Terciárias
-Lesões
Lesões Isquêmicas;
- Difusas;
Terciárias “cascata - Focais (compressões e
isquêmica’’ lesões vasculares);
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Lesões Multifocais
- Descolamento do encéfalo;
Linear
- Lesões de contragolpe;
Lesões de
movimento
(inerciais)
-Diversas energias – cisalhamento
cisalhamento;;
Angular -Força centrífuga – estiramento
axonal;
Mecanismo
-Lesões difusas;
-Graus (energia) :
Lesões de Lesão axonal difusa (LAD)
impacto - Impacto Disfunção axonal difusa (DAD)
(contato)
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Lesões
Primárias
Lesões
Secundárias
LAD Figure 6. Proposed mechanisms of
calcium entry into stretch
stretch--injured axons
axons..
Lesões 1, Strain on the axonal membrane
Difusas inducing an abnormal influx of Na Na1
1
through mechanosensitive sodium
channels.. 2, In response, reversal of
channels
Movimento axonal NaNa11–Ca
Ca21
21 exchangers (a) and
Angular activation of voltage
voltage--gated calcium
channels (b), collectively contributing to
a pathological influx of Ca Ca1212 into the
axons..
axons
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Key points
Comum
Menos Comum
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TC RM
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GRE/FFE T2*
sinal
Gradiente Avaliação da LAD na fase aguda e crônica
crônica;;
de retorno
de fase Maior sensibilidade na identificação de
microsangramentos;;
microsangramentos
TE
TR
FIG 5. Images of a 39-year-old woman who fell off a horse in July 1996. Traumatic
microbleeds are shown in the left rostral brain stem (superior cerebellar peduncle),
which is a preferential site for diffuse axonal injury. The nearly symmetrical
additional larger dark areas are artifacts from the petrous bone. Left, T2- weighted
image; right, T2*-weighted image. GCS score, 14; GOS score, 6.
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FIG. 3. An axial view section on the level of the basal forebrain demonstrates the increased susceptibility to artifacts from
air of sinuses and temporal bone of the 3 Tesla images (B) as compared to the 1.5 Tesla images (A).
1.5T 3T 1.5T
Artefato
3T
Conclusion: T2*- weighted gradient
Conclusion: gradient--echo MRI at 3 T is superior
as compared to MRI at 1.5 T for the detection of TMBs TMBs..
Nevertheless, in clinical practice, MRI at 1.5 T seems to be
sufficient for this purpose
purpose.. MRI at 3 T may be appropriate if
there is a strong clinical suspicion of DAI, despite unremarkable
FIG. 2. Illustrative comparison of 1.5 (A) and 3 Tesla (B) images of one
FIG.
routine MRI, and possibly also if evidence of DAI is sought after patient.. Note the higher sensitivity for traumatic microbleeds (TMBs) of
patient
a long interval from trauma
trauma.. the 3 Tesla images in several anatomic locations
locations..
GRE/FFE T2*
Sistemas 1.5 T e 3.0 T;
Plano axial, orientação AC
AC--PC
PC;;
Espessura de corte 4-5 mm, gap 0.4-0.5 mm
mm;;
FOV 22
22..9/22
22..9 cm, matrix 256
256x
x256
256,, TR 570
msec,, TE 18
msec 18..4 msec
msec,, flip angle 20
20°°;
FOV 19
19..2/19
19..2 cm, matrix 256
256x
x256
256,, TR 700
msec,, TE 15 msec
msec msec,, flip angle 25
25°°).
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3D--TOF + MTC
3D
FIG 3. A, Detail of an MT-weighted image overlaid with contours corresponding to 2 SD below normal white matter MTR. The image in the
axial plane shows the region of the splenium in a healthy volunteer. B, MT contour map of a patient with TBI shows a region of MTR lowered in
excess of 2 SD below normal (arrow). This patient had a pattern of cognitive weakness and impairments consistent with TBI, including
fluctuating auditory attention and impaired sustained attention and visual concentration. C, MT contour map of a different patient with TBI
shows multiple regions (arrows) of abnormality. This patient had impairments consistent with TBI, including deficits in executive function and
delayed short-term memory.
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Sistema 1.5 T ;
3D-gradiente eco, plano axial (AC-PC), steady
state (106/5/1), flip angle 128° - minimizar os efeitos
das ponderaçõesT1 e T2 (MTR = (M0 - Ms) / M0 X
100%);
Pulso de saturação MT off-resonance 19ms TR=
1200Hz RF;
Espessura de corte 5mm e gap 0.0;
Software de processamento (Ex: Sun Sparc
station 330 (Sun Microsystems, Palo Alto, CA))
H 2O
DWI: Movimento das moléculas de água no tecido;
H 2O
DTI: Determinação do tensor permite a plena realização
3-D, verdadeira natureza da difusão. Medição rotacional (valores não
são regidos pela orientação da estrutura em relação ao scanner).
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GRE SWI
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OBRIGADO!
Email: thiago_fedele@yahoo.com.br
Skype:: thiago_fedele
Skype
www.imagenologiabiomedica.com.br
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