16例急性脑梗死出血性转化的临床及影像学分析

Clinical and radiological analysis of hemorrhagic transformation in 16 patients with acute cerebral infarction

目的探讨急性脑梗死出血性转化的(hemorrhagic transformation,HT)的临床特点及影像学诊断价值。方法回顾性分析2016年1月~2018年2月我院收治的16例HT患者的临床及影像学资料。所有患者均行CT及MRI检查。结果 HT发生于梗死后9 h^15 d,平均(8.26±0.35)d,14例发生于溶栓治疗后。出血性梗死(hemorrhagic infarction,HI)10例,脑实质内血肿(parenchyma haematoma,PH)6例。出血位于脑叶8例,基底节区6例,中线额叶-胼胝体区域1例,小脑1例。HI表现为梗死区域内点状、斑片状、条索状、脑回状出血灶;PH表现为梗死区域血肿形成,伴占位效应,主要发生于较大面积梗死灶中。结合影像学复查,本组CT及MRI均能对HT作出诊断,以MRI的DWI序列显示最佳,T2WI序列其次。结论大面积脑梗死、脑叶部位的梗死溶栓治疗2周内更易并发HT;CT及MRI随访尤其是MRI DWI序列可明确HT。

Objective To investigate the clinical characteristics and radiological diagnostic value of hemorrhagic trans- formation （HT） in acute cerebral infarction. Methods The clinical and imaging data of 16 HT patients admitted to our hospital from January 2016 to February 2018 were retrospectively analyzed. All patients were given CT and MRI ex- aminations. Results HT occurred 9 h to 15 d after infarction, mean value was（8.26±0.35）d. 14 cases occurred after thrombolytic therapy. Hemorrhagic infarction（HI） was seen in 10 cases, and parenchyma haematoma（PH） was seen in 6 cases. Bleeding was found in the lobe in 8 cases and in basal ganglia in 6 cases. 1 case was in the midline frontal corpus callosum area, and 1 case was in cerebellum. HI manifested as dotted, patchy, cord-like, gyrus-like bleeding foci in the infarcted area; PH manifested as hematoma formation in the infarcted area, complicated with mass effect. It mainly occurred in larger area of infarction foci. Combined with imaging review, this group of CT and MRI could make a diagnosis of HT. The MRI showed the best DWI sequence, followed by the T2WI sequence. Conclusion Infarct thrombolysis in the large area of cerebral infarction and lobular area is easier to be complicated with HT within 2 weeks of treatment. CT and MRI follow-up, especially DWI sequence in MRI, can provide a clear diagnosis of HT.