高血压性脑出血与脑微出血的相关影像研究

摘要

目的 利用磁敏感加权成像的影像特征分析,探讨高血压性脑出血与脑微出血发病的相关性.方法 2016年6月～2017年6月深圳市南山区人民医院神经外科收治的高血压脑出血患者95例,选择首次入院且病情较轻行逆向影像分析患者51例,行头颅MRI(T1WI,T2 WI,T2液体衰竭反转恢复)、磁敏感加权成像、磁共振血管造影(MRA)检查.结果 51例患者均在本次发病的出血区域外发现脑内多发的微出血灶和小血管异常增生等病理结构.按照影像特点分别为:颅内脑底节区、丘脑、脑干和小脑区域见到＞2个的微出血灶40例(78.4％),脑底部小血管增生和间隙扩大11例(21.6％).MRA显示,15例患者大脑中动脉和基底动脉呈不同程度硬化表现,其他均无发现明显夹层、狭窄、动脉瘤和血管畸形等异常改变.结论 高血压性脑出血发生时均存在脑血管结构病理性改变的影像基础,包括脑微出血、局部脑小血管增生、血管间隙扩大等.%Objective To study the relationship between hypertensive cerebral hemorrhage and microbleeds by analyzing the characteristics of magetic susceptibility-weighted imaging.Methods Fifty-one patients with mild hypertensive cerebral hemorrhage admitted to Shenzhen Nanshan District No.6 People's Hospital for MRI (T1WI,T2WI and T2FLAIR),susceptibility-weighted imaging,and magnetic resonance angiography from June 2016 to June 2017 were included in this study.Their MRI data were analyzed.Results Multiple foci of microbleeds and small vessel hyperplasia were detected in hemorrhage regions of the 51 patients included in this study,including ＞2 foci of microbleeds in intracranial basal area,thalamus,brain stem and cerebellar area of 40 patients (78.4％),and cerebral small vessel hyperplasia and VR space enlargement in 11 patients (21.6 ％).Magnetic resonance angiography showed cerebral middle artery and basal artery atheroclerosis in 15 patients but no vascular dissection,stenosis,aneurysm and vascular malformation in the other patients.Conclusion MRI can show the pathological changes in cerebral blood vessels of hypertensive hemorrhage patients,including cerebral microbleeds,cerebral small vessel hyperplasia and VR space enlargement.