常规MRI和DWI在鉴别老年淀粉样脑血管病相关炎症中的意义  

The value of MRI and DWI in the diagnosis of cerebral amyloid angiopathy-related inflammation in the elderly

作　　者：刘伯儒 张玉萍 孔晓琴 任建平 顾祯 LIU Boru;ZHANG Yuping;KONG Xiaoqin;REN Jianping;GU Zhen(Radiology Dept,Peopleundefineds Hospital of Shandan County,Shandan 734100,China;Five Sense Organs,Peopleundefineds Hospital of Shandan County,Shandan 734100,China)

机构地区：[1]甘肃省山丹县人民医院放射科,甘肃山丹734100 [2]甘肃省山丹县人民医院五官科,甘肃山丹734100

出　　处：《国外医学（医学地理分册）》2019年第4期425-428,共4页Foreign Medical Sciences：Section of Medgeography

摘　　要：目的探究常规MRI和扩散加权成像在鉴别老年脑淀粉样血管病(cerebral amyloid angiopathy,CAA)中发生相关炎症患者中的意义和价值。方法选择2018年1月—2018年12月甘肃省山丹县人民医院收治的脑淀粉样血管病81例以及淀粉样血管相关炎症患者17例作为研究对象,所有患者年龄均>60岁。所有患者入院均进行T2加权成像核磁共振检查,纳入研究后择期进行磁共振扩散加权成像检查、脑脊液生物标志物检查,比较患者的颅内出血特征(出血人数以及出血灶数)、脑出血、皮质表面铁沉积以及脑脊液(cerebrospinal fluid,CSF)生物标志物水平及其诊断价值。结果与CAA患者相比,CAA相关炎症患者脑微出血(cerebral microbleeds,CMB)比例显著提高[17(100%)vs.36(44.4%)]且CMB数量较多[(13.7±2.3)vs.(6.4±1.6)],存在DWI病灶的人数比例显著提高[10(58.8%)vs.16(19.8%)];CAA相关炎症患者各项炎症指标均大于CAA患者,但是差异不具有统计学意义;Aβ42水平显著低于CAA组患者[(307±116)pg/mL vs.(431±125)pg/mL],tau水平显著高于CAA组患者[(472±132)pg/mL vs.(364±117)pg/mL]。结论CAA患者中存在CMB且数量较多、DWI病灶、CSF中Aβ42水平较低、tau水平较高可能提示患者合并有相关炎症,可及时进行相应的临床治疗以提高患者的生命质量。Objective To investigate the value of MRI and DWI in the diagnosis of cerebral amyloid angiopathy-related inflammation in the elderly.Methods From January to February 2018,81 patients diagnosed with cerebral amyloid angiopathy and 17 patients with cerebral amyloid angiopathy-related inflammation who were older than 60 years were enrolled in this study.All patients underwent T2-weighted imaging MRI initially,and during the recruitment period,all patients underwent diffusion-weighted imaging and lumbar puncture for CSF biomarkers analyses.The characteristics of intracranial hemorrhage(number and hemorrhage),cerebral microbleeds,and cortical superficial siderosis were compared betwwen the two groups,and the diagnostic value of CSF biomarkers were investigated.Results The presence of CMB in patients with CAA-related inflammation was significantly more than in CAA patients[17(100%)vs.36(44.4%)]and the number of CMBs were higher[(13.7±2.3)vs.(6.4±1.6)];The proportion of DWI lesions was significantly increased in patients with CAA-related inflammation[10(58.8%)vs.16(19.8%)];The level of the inflammatory marker in patients with CAA-related inflammation was greater than in CAA patients,but the difference was not statistically significant;the levels of Aβ42 in patients with CAA-related inflammation were significantly lower[(307±116)pg/mL vs.(431±125)pg/mL],and the level of tau were significantly higher than patients with CAA[(472±132)pg/mL vs.(364±117)pg/mL].Conclusion The presence of CMB and DWI lesions,low levels of Aβ42 and high levels of tau in CAA patients may indicate the related inflammation,timely treatment can be performed to improve the quality of patients life.

关 键 词：淀粉样脑血管病 相关炎症 核磁共振成像 扩散加权成像 

分 类 号：R737[医药卫生—肿瘤]