脑淀粉样血管病的影像学标志物及临床相关性研究进展

摘要

Cerebral amyloid angiopathy (CAA) is a common form of cerebral small vessel disease among elderly persons. It is different with hypertensive cerebral small vessel disease, which mainly cause deep brain vascular disease, that CAA mainly affects the small cortical and leptomeningeal arteries and arterioles. Multiple lobar microbleeds are the radiologic hallmark of CAA and have been considered as a potential cause of intracranial hemorrhage and cognitive impairment. With further researches on radiologic markers of cerebral small vessel disease, convexity subarachnoid hemorrhage and cortical superifcial siderosis have been regarded as relatively speciifc radiologic ifndings of CAA. Besides, white matter hyperintensities and small infarcts have been found in CAA commonly, which indicates ischemic injuries are as important as hemorrhagic lesions of CAA.%脑淀粉样血管病（cerebral amyloid angiopathy，CAA）是一种多见于老年人群中的脑小血管病，不同于高血压导致的脑小血管病易累及脑深部区域，CAA多累及皮层及软脑膜小血管。多发脑叶微出血是CAA患者常见的影像学表现，研究认为其与症状性脑叶出血及进行性认知功能下降相关。随着近年来对脑小血管病影像学表现的深入研究，发现皮层蛛网膜下腔出血与皮层表面含铁血黄素沉积是CAA相对特异的影像学表现，并且与短暂性局灶性神经系统症状发作相关。此外，脑白质高信号、小梗死灶等脑小血管病影像学标志均在CAA患者中出现，提示除外临床较关注的出血性改变，CAA患者的缺血性损伤也是导致临床症状的重要因素。