CT、MRI、3D-CTA、DSA诊断妊娠及产褥期出血性脑卒中7例分析

摘要

Objective To investigate the diagnostic value of the brain CT, MRI, 3D-CTA and DSA features of heraor-rhagic stroke during pregnancy and puerperium (HSPP). Methods Retrospective analysis of 7 cases of HSPP with the clinical findings and imaging data. After the onset in 7 patients, 7 cases underwent CT, 1 case underwent MRI, 2 cases underwent 3D-CTA, 4 cases underwent DSA. Results 6 cases of CT showed the local high-density video in the basal ganglia or lobe, and 1 case showed a small number of high-density video filling in the bilateral fissures. 1 case of MRI showed iso or high mixed signal on T1WI, and low mixed signal on T2WI. One 3D-CTA of two cases showed left parietal lobe high-density irregular vascular group, another one showed normal performance. DSA of four cases confirmed three cases with cerebral vascular AVM, and one case with normal performance. The two 3D-CTA findings were matched to the DSA findings. Cerebral imaging investigations showed 1 case with subaraohnuid hemorrhage (SAH), 2 cases with basilar ganglia hemorrhage, and 4 cases with lobar hemorrhage. There were 4 cases whose etiology was because of ruptured AVM,the diagnosis of 3 cases based on DSA, and 1 case based on CT and past history. Conclusion The brain CT and MRI were the preferred diagnosis means of HSPP, 3D-CTA and DSA examination could help to find etiology.%目的 探讨妊娠及产褥期出血性脑卒中(hemorrhagic stroke during pregnancy and the puerperium,HSPP)的头部电子计算机体层扫描(CT)、磁共振成像(MRI)、三维计算机断层扫描血管造影(3D-CTA)、数字减影血管造影(DSA)表现的诊断价值.方法 2004年6月至2007年7月中国医科大学附属盛京医院收治7例HSPP,回顾性分析其临床及影像学资料.7例患者发病后均行CT检查,行MRI检查1例,3D-CTA检查2例,DSA检查4例.结果 CT表现基底节或脑叶局部高密度影6例,双侧外侧裂少量高密度充填影1例.1例MRI表现T1WI等高混杂信号、T2WI低混杂信号；1例3D-CTA呈现左顶高密度不规则血管团,另1例3D-CTA正常.4例DSA证实3例脑血管动静脉畸形( arteriovenous malformation,AVM)、1例正常.3D-CTA检查结果与DSA相符.头部影像学检查提示蛛网膜下腔出血( subarachnoid hemorrhage,SAH)1例,基底节区脑出血2例,脑叶出血4例；病因为AVM破裂出血4例,依据DSA诊断3例,依据CT表现及既往病史诊断1例.结论 头部CT及MRI是诊断HSPP的首选手段,3D-CTA及DSA有助于病因判断.