急性脑梗死SWI低信号与血脑屏障完整性对于出血性转化的早期判断  

The SWI low intensity and BBB integrity for early diagnosis of hemorrhagic transformation in acute cerebral infarction

作　　者：霍晓婷 王雪杰[1,2,3] 刘国萍[1,4] 汪志云[1,4] 倪红艳[1,2,3] 张顺[5] 朱文珍[5] 尹建忠[1,2,3] 

机构地区：[1]天津医科大学一中心临床学院 [2]天津市第一中心医院放射科 [3]天津市影像医学研究所,天津300192 [4]天津市第一中心医院神经内科,天津300192 [5]华中科技大学同济医学院附属同济医院放射科,湖北武汉430030

出　　处：《中风与神经疾病杂志》2014年第11期1020-1023,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家"十二五"科技支撑计划项目资助(2011BAI08B10)

摘　　要：目的 研究急性脑梗死病例磁敏感加权成像（susceptibility weighted imaging,SWI）低信号与对比增强磁共振成像（contrast-enhanced MRI,CE-MRI）之间的关系,判断其性质及发生机制,比较两者评价脑出血的能力。方法 分析2012年8月~2013年11月我院收治的86例急性脑梗死患者的影像资料,统计梗死区内SWI低信号与CE-MRI强化的病灶数目,评价其信号表现特点。结果 SWI与CE-MRI检出脑出血的敏感度均为100%,特异度分别为86.17%、87.10%。SWI低信号除为出血外（17个）,还可能为脑微出血（8个）、梗死灶的引流静脉（3个）及陈旧性出血灶（2个）。CE-MRI出现强化的病灶共29个,其中17个为出血灶。结论 SWI与CE-MRI对急性脑梗死后出血的敏感度都很高,特异度也相当,但两者对其诊断能力不同。SWI会出现假阳性现象;而CE-MRI对脑出血的提示早于SWI,可于出血发生前判断血脑屏障的完整性,甚至预测出血性转化的发生,两者结合可更准确地判断梗死后出血。Objective To investigate the relationship between susceptibility weighted imaging（SWI） low intensities and contrast-enhanced MRI,CE-MRI, compare their capacity to evaluate hemorrhagic transformation. Methods The MR data of 86 cases diagnosed as acute cerebral infarction in our hospital from August 2012 to November 2013 were analyzed. The number of lesions in SWI and CE-MRI were calculated,their imaging characteristics were recorded. Results The sensitivities to detect hemorrhage of SWI and CE-MRI were both 100% , specificities were 86.17% and 87.10% , respectively. Except for hemorrhage, SWI low intensities may be CBMs, infarct draining vein and old hemorrhage. Total lesions in CE-MRI were 29,including 17 hemorrhages. Conclusion The sensitivities of SWI and CE-MRI to detect cerebral hemorrhage after acute cerebral infarction were both high, specificities were also similar. However, their diagnostic capabilities were uneven. False positive signs may appear in SWI, CE-MRI may assess the BBB integrity before hemorrhage, and even predict the occurrence of hemorrhagic transformation, combination of both can diagnose infarct hemorrhage more accurately.

关 键 词：急性脑梗死 磁敏感成像 对比增强MRI 脑出血 血脑屏障 

分 类 号：R743.3[医药卫生—神经病学与精神病学]