卒中患者脑微出血的MRI特点及其临床意义

MRI features and clinical significance of cerebral micro-bleeding in patients with stroke

目的探讨卒中患者脑微出血(CMBs)的MRI特点及其临床意义,并比较MRI不同扫描序列检出CMBs的能力。方法卒中患者60例,分为脑缺血组(34例)和脑出血组(26例),以同期查体的60岁以上健康老年人为对照组(30例)。采用常规MRI(包括SET1WI和FSET2WI)、扩散加权成像(DWI)、梯度回波T2加权成像(GRE-T2WI)和平面回波成像(EPI)检查,分别统计各组CMBs、腔隙性梗死、脑白质稀疏情况,同时记录卒中患者的高血压、糖尿病、卒中病史,比较不同扫描序列检出CMBs的差异。结果CMBs在缺血组、出血组和对照组的发生率分别为29.4%,61.5%和6.7%。CMBs最常见于基底节/丘脑区。CMBs与高血压、卒中病史相关(P<0.01),而与糖尿病无关(P>0.05)。CMBs的数目与腔隙性脑梗死的数目和脑白质的改变程度成正相关(P<0.01)。常规MRI和DWI均不能显示CMBs,EPI与GRE-T2WI检出CMBs的差异无统计学意义(P>0.05)。结论脑卒中患者多发性CMBs的存在提示微血管病变的严重程度和出血倾向,对于临床治疗决策具有重要的指导意义。GRE-T2WI是检测CMBs的首选方法,EPI可作为GRE-T2WI的补充手段。

Objective To investigate the MRI features and clinical significance of cerebral microbleeds （CMBs） in patients with stroke, and to compare the detectability of CMBs on different MRI sequences. Methods sixty patients with acute stroke were divided into 2 groups： ischemic group （ n = 34） and hemorrhagic group （ n = 26）, and compared with a cohort of healthy individuals who were older than 60 years （ n = 30）. The frequency, number and location of CMBs were examined by using conventional MRI sequences （SE T1WI and FSE T2WI）, diffusion - weighted imaging （DWI）, gradient-echo T2 - weighted imaging （GRE - T2WI ） and echo planner imaging （EPI）, lacunar infarction and leukoaraiosis were also evaluated. Meanwhile, hypertension, diabetes and previous stroke were recorded for stroke patients, and the differences in the number of CMBs on different MRI sequences were compared. Results The frequency of CMBs was 29.4% in ischemic group, 61.5% in intracerebral hemorrhage group and 6.7% in control group. The number of CMBs was significantly higher in the basal ganglia / thalamus region than in any of the other regions. CMBs were more prevalent in patients with hypertension and previous stroke（ P 〈 0.01 ）. There was no significant relationship between CMBs and diabetes（ P 〉 0.05 ）. There was a positive correlation between the number of CMBs and lacunar infarcts or severity of white matter changes（ P 〈 0.01）. CMBs were not revealed on SE T;WI, FSE T2WI and DWI. Comparing with GRE-T2WI, the number of CMBs on EPI was no significantly higher than that on the former（ P 〉 0. 05）. Conclusion The existence of multiple CMBs was an indicator of the severity of microangiopathy and an increased risk for bleeding, it had clinical significance in treatment and management for patients with stroke. GRE-T2WI could be the first choice of MRI sequences in detecting CMBs in stroke patients, with EPI as a supplementary means.