脑微出血的数量和位置分布与脑小血管病的影像学相关性研究

The correlation between the number and location distribution of cerebral microbleeds andimaging of cerebral small vessel disease

目的 基于磁敏感加权成像(susceptibility-weighted imaging, SWI)分析脑微出血(cerebral microbleeds,CMBs)的数量和位置分布,并确定其与脑小血管疾病(cerebral small vessel disease, CSVD)严重程度之间的相关性。材料与方法 394名经临床及影像学表现确诊为CSVD的患者的临床资料被纳入研究,评估其CSVD影像学标志物,包括腔隙(lacunar infarcts, LI)、脑白质高信号(white matter hyperintensities, WMH)、CMBs、血管周围间隙(perivascular spaces, PVS)、近期皮质下小梗死(recent small subcortical infarct, RSSI)和脑萎缩。应用CSVD总负荷评分评估CSVD的总体影响。应用脑微出血解剖评估量表(Microbleed Anatomical Rating Scale, MARS)评估CMBs的位置及数量。分析CMBs的严重程度、位置分布特点与CSVD影像学特征之间的相关性。结果 CMBs严重程度在年龄、WMH、脑萎缩和CSVD总负荷评分方面差异具有统计学意义(P=0.005;P<0.001;P=0.005;P<0.001)。在调整年龄因素后,CMBs的严重程度与CSVD总负荷评分和WMH相关(r=0.441, P<0.001;r=0.380, P<0.001)。CMBs的位置分布与WMH相关,混合型CMBs组的改良Fazekas评分显著高于单纯脑叶型、单纯深部型和单纯幕下型(P=0.011;P=0.034;P=0.023)。结论 CMBs的严重程度和位置分布与WMH相关,CMBs的严重程度与CSVD总负荷评分相关。

Objective:To evaluate the number and location distribution of cerebral microbleeds(CMBs)based on susceptibility weighted imaging(SWI),and analyze the correlation with the severity of cerebral small vessel disease(CSVD).Materials and Methods:Three hundred and ninety four patients who diagnosed with CSVD by clinical and imaging features were enrolled in this study.Evaluating the imaging markers of CSVD,including lacunar lacunae(LI),white matter hyperintensities(WMH),CMBs,recent small subcortical infarct(RSSI),perivascular spaces(PVS)and cerebral atrophy.The total CSVD score was calculated to evaluate the severity of CSVD.The Microhemorrhage Anatomical Rating Scale(MARS)were used to evaluate the distribution and severity of CMBs.The correlation between the severity and location distribution of CMBs and the imaging characteristics of CSVD was analyzed.Results:There were statistical differences in the severity of CMBs in terms of age,WMH,brain atrophy and the total CSVD score(P=0.005;P<0.001;P=0.005;P<0.001).After adjusting for age,the severity of CMBs was correlated with the total CSVD score and WMH(r=0.441,P<0.001;r=0.380,P<0.001).The location distribution of CMBs was correlated with WMH.The modified Fazekas scores of mixed CMBs group was significantly higher than that of simple lobar type,simple deep type and simple subtentorial type(P=0.011;P=0.034;P=0.023).Conclusions:The severity and distribution of CMBs are related to WMH and the severity of CMBs is related to the total CSVD score.