脑微出血的临床及影像学特征分析

Clinical analysis and imaging characteristics of cerebral microbleeds

目的探讨脑微出血（cerebral microbleeds,CMB）患者的临床特点及其影像学特征。方法回顾性分析12例脑微出血患者的临床资料及影像学表现。结果12例患者中,11例为卒中患者,其中有高血压病史者9例,高脂血症5例,糖尿病3例;临床上缺乏与脑微出血相关的神经系统症状与体征。②CMB患者的简易智能状态量表（mini-mental state examination,MMSE）分值为21.47±2.45,Barthel指数（BI）分值为64.68±16.21,表明均有认知功能障碍并影响日常生活活动能力。③在磁共振中的磁敏感加权成像（susceptibility-weighted imaging,SWI）上CMB的分布：皮质-皮质下区的CMB病灶平均为9.45个;基底核区平均为5.34个;丘脑平均为4.67个;脑干平均为4.78个;小脑的CMB平均为3.45个。皮质-皮质下区CMB病灶的数量最多。差异均有统计学意义（P〈0.02）。④CMB在磁共振成像（magnetie resonance imaging,MRI）中的SWI上均呈低信号。CMB在T1、T2加权像及SWI上均表现为斑点状、圆形或椭圆形的、性质均一的直径为2~5mm的低信号灶,边界清晰,周围无水肿带。结论CMB患者多数有高血压病和高脂血症,多为卒中发展而来;SWI作为一种新兴的MRI技术,能很好地显示CMB的存在,有助于指导临床CMB患者治疗计划的实施。

Objective To investigate the clinical features and imaging characteristics in patients with cerebral microbleeds （CMBs）. Methods The clinical data and imaging findings of 12 patients with CMBs were analyzed retrospectively. Results ①Eleven of the 12 patients had stroke, among them 9 had previous hypertension, 5 had hyperlipemia, and 3 had diabetes mellitus. There were lack of neurologic symptoms and signs associated with CMBs in clinical practice. ②The mini-mental state examination （MMSE） score in patients with CMBs was 21.47 ±2. 45, and their Barthel index （BI） score was 64. 68 ± 16. 21. This showed that they all had cognitive impairment and had influenced activities of daily living. ③The distribution of CMBs on susceptibility-weighted imaging （SWI） ： The foci of CMBs in cortical/subcortical region, basal ganglia region, thalamus, and brain stem were 9. 45, 5. 43, 4. 67 respectively, and 4. 78 in average. The numbers of CMBs in cerebellum were the least, and they were 3.45 in average. The numbers of CMBs in cortical/subcortical region were the most. There were significant differences between them （P 〈 0. 02）. ④All the CMBs presented hypointense on SWI of magnetic resonance imaging （MRI）. CMBs on T2WI, T1WI, and SWI all presented spot-like, circular or oval in shap, and uniform hypointens- es. Their diameters were 2 to 5 mm, with clear margin, and no peripheral edema. Conclusions Most of the patients with CMBs have hypertension and hyperlipemia, mostly developed from stroke, and have corresponding clinical manifestations. As a newly developed MRI technique, SWI may clearly reveal the presence of CBMs. It helps guide the therapeutic plan in clinical practice.