微出血与不同类型脑卒中的关系
The Relationship between CMBs and Different Types of Stroke

作者: 郭兴华 , 张崇杰 , 王俊波 :运城市中心医院影像科,运城 山西;

关键词: 脑微出血卒中类型SWICMBs Stroke Type SWI

摘要: 目的:探讨胰腺神经内分泌肿瘤的影像学特征,以提高对其诊断水平。方法:回顾性分析24例经病理证实的胰腺神经内分泌肿瘤患者的影像资料,并与病理结果进行对照分析。结果:8例功能性胰腺神经内分泌肿瘤平均大小为2.1 cm × 2.6 cm,平扫7例呈均匀的等或稍低密度,1例呈稍长T1、稍长T2信号,1例胰头肿瘤侵及十二指肠;目的:通过微出血在卒中史及不同卒中类型病人中的分布,探讨微出血和脑卒中的关系。方法:收集2010.5~2014.9在我院住院的最终诊断为脑卒中,影像检查资料完整的病例共796例。脑卒中诊断均符合中华医学会第四届全国脑血管病学术会议诊断标准,包括多发腔隙性脑梗死、大面积脑梗死、脑出血。微出血诊断符合文献标准(SWI显示为脑内 <5 mm的小的圆形低信号病灶,除外海绵状血管瘤、小钙化灶、小静脉、外伤后弥漫性轴索损伤等)。记录观察病例的性别、年龄、脑卒中情况、CMBs分布部位及数量(分为三度,轻度1~5个,中度6~15个,重度 ≥ 16个)。检查方法:采用西门子1.5T超导型磁共振扫描仪,头颅8通道阵列线圈,全部患者进行SWI序列、DWI和常规MRI扫描,常规MR及DWI层厚6 mm,间隔7 mm,SWI层厚2 mm,TR 50 ms,TE 40 ms。结果:符合条件病例共796例,男481例,女315例,年龄40~80岁,平均61.9岁,高血压病史0~30年,平均12.6年。有脑卒中病史的(≥2次) 107例,占14.69%,脑出血病人42例,合并微出血最多,22例,达52.38%,复合病例(脑梗死、脑出血同时合并多发腔隙性脑梗死的病例) 252例,合并微出血的84例,占到33.33%,单纯脑梗死98例,合并微出血29例,占29.59%,出血性脑梗死53例,10例合并微出血,占18.86%,腔隙性脑梗死病人最多,共351例,合并微出血者仅39例,约占11.11%。共发现微出血184例,合计总数1399个微出血灶,其分布为单发、局部多发、多区多发,相互之间重叠较多。按文献方法计数分度,在不同类型卒中病人中均是以中度(6~15个)为多,平均占51%。以基底节区–丘脑(DGM区)病例数及CMBs总数最多。DGM区(308例,1530个) > CSC区(幕下区,219例,600个) > IA区(皮层及皮层下区,134例,570个)。结论:磁敏感成像对于检出CMBs有较高的敏感性和特异性,在不同类型脑卒中病人CMBs的发生存在明显差异,以出血性脑卒中为多,以基底节–丘脑区为多。

Abstract: Purpose: To research the relationship between CMBS and the different types of stroke according to the distribution of CMBS among the history of strokes. Methods: 796 cases from 2010.5-2014.9 were collected in this group, including multiage lacunar infarction, massive cerebral infarction and cerebral hemorrhage. Stroke, according to the 4th CMA national cerebral meeting, include multiage lacunar infarction, massive cerebral infarction and cerebral hemorrhage. Whereas CMBs, according to the standards of conferences, appear as low density lesion small than 5 mm, and exclude cavernous hemangioma, venues, calcification, and diffuse axonal injury. The age, gender, type, number and distribution of stroke of patients were observed and recorded. The extent of stroke includes 3 degrees (mile, 1 - 5 lesions; moderate, 6 - 15 lesions; severe, more than 16 lesions). Methods of examinations include MRI, DWI and SWI (slice thickness 6 mm, interval 7 mm, TR = 50 ms, TE = 40 ms) on all patients with Siemens 1.5 T MRI system. Results: 796 cases were collected in this group, including 481 male cases and 315 female cases, aging from 40 - 80 years with an average of 61.9 years. Their history of hypertension is varying from 0 to 30 years with an average of 12.6 years. 107 cases (about 14.69%) underwent a stroke history more than 2 times; 42 cases were cerebral hemorrhage with 22 CMBS (52.38%); 252 cases were complex cases (infarction and hemorrhage and lacunar infarction) with 84 CMBS (about 33.33%); 98 cases were infarction with 29 CMBS (about 29.59%); 53 cases were hemorrhagic cerebral infarction with 10 CMBs (18.86%); and lacunar infarction were the biggest group, which include 351 cases with 39 CMBs (11.11%). 1399 CMBs were observed in 184 patients, which appears as single lesion, local multi-lesions or global multi-lesions. Among the three degrees, the “moderate” has the largest number, about 51% of the total cases, and mostly distributed in the DGM area. The number in DGM area (1530) was more than those in CSC area (600) and IA area (570). Conclusion: There was an apparent difference of CMBs’ numbers between the different types of stroke, the major group is hemorrhagic cerebral stroke and the major distribution is in the DGM area. 

文章引用: 郭兴华 , 张崇杰 , 王俊波 (2016) 微出血与不同类型脑卒中的关系。 医学诊断, 6, 68-72. doi: 10.12677/MD.2016.63012

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