脑出血后迟发性脑水肿的磁共振波谱分析

Magnetic Resonance Spectroscopy of Delayed Edema After Intracerebral Hemorrhage

目的:了解脑出血后迟发性脑水肿的磁共振波谱特点,探讨其可能的发生机制。方法:对12例脑出血14d后发生迟发性脑水肿患者的MRS检查,观察血肿周围迟发性脑水肿组织的MRS谱线,与脑出血后1周水肿的谱线进行对照研究,定量分析相关代谢物峰值的变化。结果:9例患者获得满意谱线,14d时血肿周围水肿区N-乙酰天门冬氨酸/肌酸(NAA/Cr)较7d时显著降低[(13.7±3.2)%对(18.3±4.4)%,P<0.05]。7例检测到乳酸峰,8例患者检测到甘露醇峰。结论:脑出血后迟发性水肿区MRS的NAA/Cr降低和乳酸峰的出现表明水肿区神经元受损或缺血,迟发性水肿区甘露醇峰的存在在迟发性脑水肿中起着重要作用,提示局部血脑屏障破坏。

Objective： To observe the magnetic resonance spectroscopy （MRS） characteristics of delayed edema after intracerebral hemorrhage and to investigate its possible mechanism. Methods： Twelve patients with delayed edema were examined with MRS at 14 days after intracerenal hemorrhage. MRS spectrum in the tissue of delayed edema around hematom was observed, and it compared with the spectrum at 7 days after intracerebral hemorrhage. The chan- ges of the corresponding metabolite peak were analyzed quantitatively. Results： Nine patients obtained satisfactory MRS spectrum. As compared with the MRS spectrum at day 7, the NAMCr in the edema area around hematom decreased significantly （[ 13.7 ± 3.2 ] % vs E 18.3 ± 4.4] %, P 〈0.05）. The lactic acid peak was detected in 7 patients, and the mannitol peak was detected in 8 patients. Conclusions： 1he NAA/Cr of MRS in the delayed edema area reduced after intracerebral hemorrhage and the appearance of lactic acid peak demonstrated that neuronal damage or ischemia in edema area. The existence of mannitol peak in delayed edema area played an important role in delayed edema, indicating local blood-brain barrier damaged.