脑梗死出血性转化的时间规律及MRI分型建议

Time regularity of hemorrhagic transformation in cerebral infarction and MRI classification recommendations

目的探讨脑梗死(CI)出血性转化(HT)的时间规律及其MRI分型表现。方法对医院收治的93例HT患者进行回顾性分析,其中栓塞性脑梗死35例,血栓形成性脑梗死58例,总结分析其HT发生时间规律和MRI影像特征。结果栓塞性脑梗死多在发病后1~3 d发生HT,血栓形成性脑梗死则多为发病后4~7 d发生HT,前者发生HT时间明显早于后者(P<0.05)。HT发生部位仅位于幕上区比例为82.8%,仅位于幕下区比例为12.9%,幕上幕下区均发生比例为4.3%。HT出血形态中,脑回样、线样出血49例(主要见于脑叶),斑点样、斑片样出血39例(主要见于脑叶和基底节),血肿形成5例(主要见于脑叶)。建议脑梗死HT的MRI分型:幕上非血肿型(Ⅰ型)、幕下非血肿型(Ⅱ型)、血肿形成型(Ⅲ型)、混合(幕上+幕下)非血肿型(Ⅳ型)。结论栓塞性脑梗死HT发生时间早于血栓形成性脑梗死;本研究提出的MRI分型标准有助于了解HT的发生部位、出血形态和血肿情况,对临床诊疗具有一定指导意义。

Objective To explore the time regularity of hemorrhagic transformation （HT） in cerebral infarction （CI） and the magnetic resonance imaging （MRI） classification. MeAods A total of 93 cases of HT patients admitted to our hospital were analyzed retrospectively, including 35 cases of embolic cerebral infarction and 58 cases of thrombotic cerebral infarction. The time regularity of HT and the features of MRI images ＂were analyzed. Results Most of HTs occurred during 1-3 d after the onset of embolic cerebral infarction and during 4-7 d after the onset of thrombotic cerebral infarction, so the onset of the former was significantly earlier than that of the latter （P 〈 0.05）. The proportion of HT only in the supratentorial region was 82.8% and that only in the subtentorial region was 12.9%, while that in both supratentorial and subtentorial regions was 4.3%. In the form of HT hemorrhage, there were 49 cases of cerebral gyrus and linear hemorrhage （mainly in the lobes）, 39 cases of speckled and patch like bleeding （mainly in the lobes and basal ganglia）, and five cases of hematoma （mainly in the lobes）. The MRI classification for HT in cerebral infarction was proposed as： supratentorial non-hematoma type （type Ⅰ）, subtentorial non-hematoma type （type Ⅱ） , hematoma formation type （type Ⅲ） and mixed （supratentorial ＋subtentorial） non-hematoma type （type Ⅳ） . Conclusion The onset time of HT in thrombotic cerebral infarction is earlier than that of embolic cerebral infarction. The standard for MRI classification proposed in this study is helpful for understanding the region of HT, the form of hemorrhage and the situation of hematoma, which is of certain guiding significance for clinical diagnosis and treatment.