老年出血性脑梗死的头CT、MRI诊断及临床治疗  

Study on the Value of Head CT and MRI in the Diagnosis of Hemorrhagic Infarction among Elderly Patients and Related Clinical Treatment

作　　者：胡川[1] 杨溢[1] 陆秀红[1] 刘伟[1] 何静[1] 张圭[1] 

机构地区：[1]武警广东省总队医院高干科,广州510507

出　　处：《医学综述》2015年第3期573-574,576,共3页Medical Recapitulate

摘　　要：目的探讨CT、磁共振成像(MRI)在老年出血性脑梗死患者诊断中的价值及其临床治疗方法。方法选择武警广东省总队医院2010年1月至2013年3月收治的65例老年出血性脑梗死患者作为研究对象,所有患者均进行头CT、MRI检查,且所有患者均行数字减影血管造影(DSA)检查,并作为出血性脑梗死的诊断金标准,将CT和MRI检查结果与DSA检查结果进行对照分析,比较两种诊断方法的灵敏度。结果 65例患者经超声血管造影检查分期结果为:急性期18例,亚急性期34例,慢性期13例,CT检查共诊断出58例出血性脑梗死,3例误诊为其他疾病,诊断灵敏度为89.2%;MRI检查共诊断出61例出血性脑梗死,2例误诊为其他疾病,诊断灵敏度为93.8%。MRI检查对出血性脑梗死的诊断灵敏度显著高于CT检查。老年出血性脑梗死患者CT主要表现为在原来低密度灶内出现点状、条索状或斑片状混合密度影,MRI主要表现为T1WI可见小片状高信号病灶,而T2WI可见等、高信号病灶。经过治疗后,9例(13.8%)基本痊愈,49例(75.4%)患者好转,2例(3.1%)患者因病情加重而处于昏迷状态,5例(7.7%)患者死亡。结论头颅CT与MRI检查是诊断出血性脑梗死的重要手段,对于不同时期的出血性脑梗死两种检查方法各有优势。及早诊断出血性脑梗死并予以对症治疗,可获得较好的治疗效果。Objective To investigate the value of CT and magnetic resonance imaging（ MRI） in the diagnosis of hemorrhagic infarction in elderly patients and the clinical treatment for the disease. Methods A total of 65 elderly patients with hemorrhagic infarction admitted in Guangdong Corps Hospital of Chinese Armed Police Forces from Jan. 2010 to Mar. 2013 were selected as research objects. All the patients underwent head CT,MRI examination,and digital subtraction angiography（ DSA） examination. Results of DSA were used as the gold diagnostic standard of hemorrhagic infarction,and results of CT and MRI were compared with the results of DSA,and then the diagnostic accuracy of CT and MRI was comparatively analyzed. Results The staging results of ultrasound angiography for the 65 cases were： 18 cases of acute stage,34 cases of sub-acute phase,13 cases of chronic phase. While CT examination found 58 cases of hemorrhagic infarction,with three cases misdiagnosed as other diseases,the diagnostic sensitivity was 89. 2%; and MRI examination found 61 cases of hemorrhagic infarction,with 2 cases misdiagnosed as other diseases,the diagnostic sensitivity was 93. 8%. The sensitivity of MRI examination in the diagnosis of hemorrhagic infarction was significantly higher than the sensitivity of CT examination（ P〈0. 05）. CT imaging features of hemorrhagic infarction in elderly patients mainly included punctate,stripy or patchy mixed density appeared in the original foci of low density,while MRI imaging features mainly included small pieces of high intensity signal lesions appeared in T1 WI,while isointensity and high intensity signal lesions visible in T2 WI. After treatment,9 cases（ 13. 8%） recovered,49 cases（ 75. 4%） got improved,2 cases（ 3. 1%） went into coma due to exacerbations,5 cases（ 7. 69%） died. Conclusion Head CT and MRI are important diagnostic means of hemorrhagic infarction,the two methods have their own advantages in diagnosing hemorrhagic infarction of different stages. Early diagnosis of hemorr

关 键 词：出血性脑梗死 计算机X线断层扫描 磁共振成像 诊断 治疗 

分 类 号：R445[医药卫生—影像医学与核医学]