磁共振成像对老年人脑内腔隙灶、脱髓鞘和血管周围间隙的鉴别诊断

Differential diagnosis of lacunas, demyelination and perivessel space in the brain of the elderly

目的 探讨磁共振成像 (MRI)对老年人脑内腔隙灶、脱髓鞘和血管周围间隙的鉴别诊断能力。 方法 回顾性分析 10 0例无痴呆症状的老年人在GE 1 5T扫描机上完成的T1加权像(T1WI)和T2加权像 (T2WI) ,其中 6例包括有弥散成像 (DWI)。 结果 同一患者脑内病灶可多处分布。10 0例中 ,6 1例有腔隙性脑梗死 ,共 110个腔隙灶 ,分别位于桥脑 (17个 )、小脑 (14个 )、豆状核 (14个 )、内囊 (10个 )、丘脑 (12个 )、室旁和尾状核 (2 6个 )、半卵圆中心 (7个 ) ,这些病灶呈圆形、卵圆形、三角形、弧线形和不规则形 ;71例有脱髓鞘改变 ,累及室旁和半卵圆中心 ,但有 7例位于桥脑 ;95例有血管周围间隙 ,可数出的共 12 5个 ,分布在基底节 (84个 )、室旁和半卵圆中心 (41个 )。 结论 腔隙灶、脱髓鞘和血管周围间隙需要从信号变化、病灶形态、部位和扫描序列 4个方面进行鉴别诊断。

Objective To explore the differential diagnosis among lacunas, demyelination and perivessel space in the aging brain. Methods T1 and T2 weighted image for 100 aging brains were analyzed retrospectively. All examinations were performed using GE 1.5 T scanner. Results In 100 subjects, 61 had multiloci of infarction and constituted a total of 110 loci. They located at pontine(17), cerebellum(14), lentiform nucleus(24), internal capsal(10), thalamus(12), periventricular and head of caudate nucleus (26), semioval centrum (7). They were round, elliptic, triangle, curve and irregular in shape, respectively. Ninety-five patients had 125 countable perivessel spaces. They located at ganglia (84) and semioval centrum (41). Demyelination was seen in 71 subjects and involved pontine and semioval centrum. Conclusions Most of lacuna, demyelination and perivessel space is distinguishable based on their signal, shape and location.