MRI预测急性脑梗死后出血的价值

MRI in predication of early hemorrhagic transformation after acute stroke

目的探讨急性脑梗死患者 MR 早期增强 T_1WI 中脑实质强化及大脑中动脉高信号(HMCA)征与继发性脑出血(HT)的关系。方法回顾性分析24例发病6.0 h 内[平均(4.3±1.4)h]的急性脑梗死患者首次 T_1WI 及随后1周内复查的 MRI和(或)CT 资料,了解首次增强 T_1WI脑实质强化和 HMCA 征与 HT 的关系。早期脑实质强化为脑梗死6.0 h 内缺血的脑组织区域在增强T_1WI 出现高信号;HMCA 征为增强 T_1WI 上大脑中动脉增粗(与对侧相比)、出现边缘模糊的高信号。结果 24例患者中10例发展为 HT(出血组),其中6例首次 T_1WI 可见脑实质强化,5例出现 HMCA征;14例未出现 HT(无出血组),均未发现脑实质强化和(或)HMCA 征。2组相比,T_1WI 脑实质强化、HMCA 征出现率差异均有统计学意义(P 值均<0.01)。结论 T_1WI 早期脑实质强化和 HMCA征有可能预测急性脑梗死后 HT。

Objective To investigate the relationship among early parenchymal enhancement, post-gadolinium （Gd） hyperintense middle cerebral artery （HMCA）, and subsequent hemorrhagic transformation （HT） in patients with hyperacute ischemic stroke. Methods Twenty-four consecutive patients with ischemic stroke who underwent MRI within 6 h [ （ 4. 3 ± 1.4 ） h ] of symptom onset were retrospectively reviewed. All of these patients underwent at least one follow-up MRI or non-enhanced CT study at 2 to 7 days. Post-Gd T1WI were analyzed for parenchymal enhancement and hyperintense MCA. Gradient echo MRI and CT were used for assessment of HT. Results Ten patients developed HT on follow-up imaging （hemorrhagic group）. Early parenchymal enhancement was found in 6 patients with HT （P 〈0. 01 ）. The HMCA was in 5 patients with HT （ P 〈 0. 01 ）. In the fourteen patients without HT （ nonhemorrhagic group）, none showed early parenchymal enhancement and/or hyperintense MCA. Conclusions Early parenchymal enhancement and HMCA on T1WI after Gd-DTPA administration are independent predictors of subsequent HT.