大面积脑梗死后出血性转化的CT诊断新认识

New insight of CT diagnosis in hemorrhagic transformation after massive cerebral infarction

目的 提高对大面积脑梗死后出血性转化的CT诊断水平及新认识.方法 对60例大面积脑梗死后出血性转化的CT资料进行回顾性分析.结果 大面积脑梗死后复查头部CT,常规扫描37例,薄层扫描23例.出血性转化在梗死后1d检出3例,2～3 d检出16例,4～7 d检出9例,8～14 d检出32例.CT表现分3型：中心型（13例）、边缘型（21例）、混合型（26例）.结论“出血性转化”已代替“出血性脑梗死”和“梗死后出血”,大面积脑梗死最易发生出血性转化,影像学检查是诊断出血性转化的金标准,CT为首选的主要检查方法,薄层扫描更利于病变早期检出,对指导临床选择治疗方案及预后判断具有重要意义.

Objective To evaluate the value of CT in the diagnosis of hemorrhagic transformantion after massive cerebral infarction. Methods CT findings of hemorrhagic transformation of massive cerebral infarction were studied in 60 cases retrospectively. Results Of 60 cases, 37 were performed conventional CT scan and 23 were performed thin layer scan. Hemorrhagic transformation were detected after massive cerebral infarction were found in 3 cases at 1 days,16 cases at 2-3 days, 9 cases at 4--7 days, 32 cases at 8-14 days. CT findings of hemorrhage in 60 cases were 3 patterns： 13 cases were central, 21 cases were peripheral, 26 cases were mixed. Conclusion ＂Hemor- rhagic infarction＂ and ＂bleeding after infarction＂ has been replaced by ＂hemorrhagic transformation＂. Massive cere- bral infarction is the most prone to produce hemorrhagic transformation. Imaging examination has been believed a golded standard in diagnosis of hemorrhagic transformation. CT is the first choice in checking and diagnosing of hem- orrhagic transformation. Thin layer scanning may help to find early lesions, and therefore plays an important role in choice of treatment program and prognosis.