485例脑白质改变的影像学与血管性因素的相关性研究

The correlation between imaging and vascular factors in 485 cases of white matter changes

目的探讨脑白质MRI高信号表现特征及相关病理机制。方法对485例连续住院患者行头颅MRI检查,并将其脑室周围高信号严重程度分级,对不同级别脑白质损害与患者年龄、性别以及相关疾病间联系进行统计学分析。结果脑白质高信号严重程度随年龄增长而加重,性别对脑白质信号没有明显影响。脑室周围脑白质高信号与脑梗死、糖尿病、高血压、心房颤动呈正相关,深部脑白质高信号与脑梗死和高血压呈正相关,差异有统计学意义。短暂性脑缺血发作、脑出血及高脂血症与脑白质高信号没有显著联系。结论脑白质高信号与脑梗死、高血压、糖尿病有密切联系,脑白质改变与脑出血不相关。脑脊液回流障碍、大血管病变以及低灌注状态可能参与脑白质高信号的形成。

Objective To explore the clinical characteristic and correlative pathogenesis of white matter MRI hyperintensity. Methods In 485 consecutive patients admitted to the neurological department, MRI was performed, including T1-weighted, T2-weighted, fluid attenuated inversion recovery and diffusion weighted imaging sequences. The white matter hyperintensity（WMH）,including periventricular hyperintensity（PVH） and deep white matter hyperintensity（DWMH）,was graded as 0（absent）, 1 （mild）, 2 （medium）, 3 （severe） with Fazekas scale. The relationships between the severity of WMH and the age, sex and relative diseases including cerebral infarction, hypertension,TIA, cerebral hemorrhage, diabetes mellitus were analyzed statistically. Results WMH was more severe in older patients while the sex had no influence on the WMH. Cerebral infarction,hypertension, diabetes mellitus and atrial fibrillation showed positive correlations with PVH,while DWMH was positively correlated to cerebral infarction and hypertension. No significant relation between leukoaraiosis and TIA, cerebral hemorrhage or hyperlipidemia was found. Conclusions WMH had close association with cerebral infarction,hypertension and diabetes reellitus. The drainage failure of cerebrospinal fluid, stenosis or occlusion of large vessels and cerebral hypoperfusion may play roles in the pathogenesis of white matter hyperintensity.