卒中患者脑微出血的MRI特点及其临床意义VIP专享VIP免费

·72·实用医学影像杂志2008年第9卷第2期JPMI，2008，Vo1．9，No．2卒中患者脑微出血的MRI特点及其临床意义王金月‘，杨筠，刘振兴，王荣仁(1．天津医科大学研究生院，天津300070；2．天津市人民医院影像学部)【摘要】目的探讨卒中患者脑微出血(CMBs)的MRI特点及其临床意义，并比较MRI不同扫描序列检出CMBs的能力。方法卒中患者6O例，分为脑缺血组(34例)和脑出血组(26例)，以同期查体的60岁以上健康老年人为对照组(30例)。采用常规MRI(包括sETlwI和FSEr：wI)、扩散加权成像(DWI)、梯度回波T2加权成像(GRE一r：wI)和平面回波成像(EPI)检查，分别统计各组CMBs、腔隙性梗死、脑白质稀疏情况，同时记录卒中患者的高血压、糖尿病、卒中病史，比较不同扫描序列检出CMBs的差异。结果CMBs在缺血组、出血组和对照组的发生率分别为29．4％，61．5％和6．7％。CMBs最常见于基底节／丘脑区。CMBs与高血压、卒中病史相关(P<0．01)，而与糖尿病无关(P>0．05)。CMBs的数目与腔隙性脑梗死的数目和脑白质的改变程度成正相关(P<0．01)。常规MRI和DWl均不能显示CMBs，EPI与GRE—T2wI检出CMBs的差异无统计学意义(P>0．05)。结论脑卒中患者多发性CMBs的存在提示微血管病变的严重程度和出血倾向，对于临床治疗决策具有重要的指导意义。GRE—T2WI是检测CMBs的首选方法，EPI可作为GRE—T2WI的补充手段。【关键词】脑微出血；磁共振成像；卒中【中图分类号1a445．2；R743．34【文献标识码】A【文章编号]1009—6817(2008)02—0072—05M砌featuresandclinicalsignificanceofcerebralmicro—bleedinginpatientswithstrokeWangJinyue,，lgJun,IduZhenxing,WangRongren．GraduateSchoolofTianjinMedicalUniversity,Tianjin300070,China【Abstract】ObjectiveToinvestigatetheMRIfeaturesandclinicalsignificanceofcerebralmicmbleeds(CMBs)inpatientswithstroke．andtocomparethedetectabilityofCMBsondifferentMRIsequences．Methodssixtypatientswithacutestrokeweredividedinto2groups：ischemicgroup(n：34)andhemorrhagicgroup(n=26)，andcomparedwithacohortofhealthyindividualswhowereolderthan60years(n=30)．Thefrequency，numberandlocationofCMBswereexaminedbyusingconventionalMRIsequences(SET1wIandFSET2wI)，diffusion—weightedimaging(DWI)，gradient—echoT2一weightedimaging(GRE—T2wI)andechoplannerimaging(EPI)，la—cunarinfarctionandleukoaraiosiswerealsoevaluated．Meanwhile，hype~ension，diabetesandpreviousstrokewererecordedforstrokepatients．andthedifferencesinthenumberofCMBsondiferentMRIsequenceswerecompared．ResultsThefrequencyofCMBswas29．4％inischemicgroup．61．5％inintracerebralhemorhagegroupand6．7％incontrolgroup．ThenumberofCMBswassignificantlyhigherinthebasalganglia／thalamusregionthaninanyoftheotherregions．CMBsweremoreprevalentinpatientswithhypertensionandpreviousstroke(P<0．01)．TherewasnosignificantrelationshipbetweenCMBsanddiabetes(P>0．05)．TherewasapositivecorrelationbetweenthenumberofCMBsandlacunarinfarctsorseverityofwhitematterchanges(P<0．01)．CMBswerenotrevealedonSETIWI．FSET2wIandDWI．ComparingwithGRE一r2WI．thenumberofCMBsonEP1wasnosignificantlyhigherthanthatontheformer(P>0．05)．ConclusionTheexistenceofmultipleCMBswasallindicatorofthesevedtyofmicroangiopathyandanincreasedriskforbleeding，ithadclinicalsig—nificanceintreatmentandmanagementforpatientswithstroke．GRE—WIcouldbethefirstchoiceofMRIsequencesindetectingCMBsinstrokepatients，withEPIasasupplementarymeans．【KeywordsJCerebralmicrebleeds；Magneticresonanceimaging；Stroke近年来，随着梯度回波T2加权成像(gradient—e．choT2一weightedimaging，GRE—T2WI)技术的临床应用，脑微出血(cerebmlmicrobleeds，CMBs)己成为目前脑血管病的研究热点之一。研究证实，CMBs的出现与脑出血(Intracerebmlhemorrh...