脑静脉窦血栓形成的影像学表现及脑实质病变预测  

Clinical and imaging features of cerebral venous sinus thrombosis and prediction of cerebral parenchymal lesions

作　　者：张守华[1] 樊红光[1] 常琼[1] 宁培刚[1] 齐广昌 李永丽[1] ZHANG Shouhua;FAN Honggua;CHANG Qiong;NING Peigang;QI Guangchang;LI Yongli(Department of Imaging,Henan Provincial People's Hospital,Zhengzhou 450003,China;Tongji Cerebrovascular Hospital,Huaxian 456400,China)

机构地区：[1]河南省人民医院影像科,河南郑州450003 [2]滑县同济脑血管医院,河南滑县456400

出　　处：《中国实用神经疾病杂志》2020年第1期45-49,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的总结脑静脉窦血栓形成(CVST)患者的临床和MRI表现特征并探讨继发脑实质病变的预测因素。方法回顾57例CVST患者的临床及头颅MRI资料,分析患者MRI表现特征,并对临床及影像学指标进行对比分析。结果57例患者中男22例,女35例,年龄15~72岁(平均35岁)。临床症状头痛29例,癫痫发作11例,感觉变化8例,局灶性神经功能缺损9例;头颅MRI示静脉窦血栓形成部位上矢状窦9例,横窦2例,乙状窦1例,直窦1例,其中同时累及2个或2个以上静脉窦44例。静脉窦血栓伴发脑实质病变36例,其中出血性静脉梗死20例,非出血性静脉梗死12例,脑实质内出血4例。对伴和不伴脑实质病变2组患者的对比分析显示,伴脑实质病变组女性比例明显高于不伴脑实质病变组;伴脑实质病变组癫痫、感觉异常及局部神经功能缺损症状发生率均明显高于不伴脑实质病变组;伴脑实质病变组直窦血栓的发生率明显高于不伴脑实质病变组(P<0.05)。结论MRI可清楚显示CVST的直接及间接征象,通过分析CVST患者的临床和静脉窦血栓表现特征还可帮助预测严重的脑实质病变发生风险。Objective To summarize the clinical and MRI features of patients with cerebral venous sinus thrombosis(CVST)and to explore the predictive factors of secondary cerebral parenchymal lesions.Methods The clinical and MRI data of 57 patients with CVST were reviewed,the MRI features of patients were analyzed,and the clinical and imaging indicators were compared.Results 57 patients with CVST(22 male,35 female;mean age,35 years,range,15-72 years)were enrolled in this study,including 29 cases of clinical symptoms,11 cases of seizures,8 cases of sensory changes,9 cases of focal neurological deficits.MRI showed 9 cases of superior sagittal sinus thrombosis,2 cases of transverse sinus,1 case of sigmoid sinus,and 1 case of straight sinus,among which 44 cases involved two or more venous sinuses simultaneously.Venous sinus thrombosis was associated with cerebral parenchymal lesions in 36 cases,including 20 cases of hemorrhagic venous infarction,12 cases of non-hemorrhagic venous infarction,and 4 cases of intracerebral hemorrhage.Comparative analysis of the two groups of patients with and without brain parenchymal lesions showed that the proportion of women with brain parenchymal lesions was significantly higher than that of patients without brain parenchymal lesions;the incidence of epilepsy,paresthesia and local neurological deficits in patients with brain parenchymal lesions.The incidence of sinus thrombosis was significantly higher in the group with brain parenchymal lesions than in those without brain parenchymal disease(P<0.05).Conclusion MRI can clearly show the direct and indirect signs of CVST,and can be use of predicting the risk of severe brain parenchymal lesions by analyzing the clinical and sinus thrombosis features of patients with CVST.

关 键 词：磁共振成像 脑静脉窦血栓 脑实质病变 预测 

分 类 号：R743[医药卫生—神经病学与精神病学]