磁共振成像常规检查序列对计算机断层扫描阴性的不典型蛛网膜下腔出血的诊断价值  

Diagnostic Value of Routine Magnetic Resonance Imaging Sequences in Atypical Subarachnoid Hemorrhage with Negative on Computerized Tomography

作　　者：汪敬业[1] 陈露露 汪凯[1] WANG Jing-Ye;CHEN Lu-Lu;WANG Kai(Department of Neurology,The First Affiliated Hospital,Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022

出　　处：《中国卒中杂志》2020年第7期766-770,共5页Chinese Journal of Stroke

基　　金：国家自然科学基金(81870918)。

摘　　要：目的分析总结常规M RI序列(T1WI、T2W I、F L A I R、D W I)对C T阴性的不典型蛛网膜下腔出血(subarachnoid hemorrhage,SAH)的诊断价值。方法回顾性分析2016年1月1日-2019年10月30日于安徽医科大学第一附属医院神经内科住院治疗,CT结果为阴性但腰椎穿刺证实为SAH,且进行了头颅MRI辅助诊断患者的临床资料。结果本研究共入组5例患者,男性3例(60.0%),年龄范围14~53岁。基于临床表现,最初诊断高度怀疑SAH 1例(20.0%),不除外出血3例(60.0%),怀疑非出血性疾病1例(20.0%)。MRI假阴性1例(20.0%)、误报转移瘤1例(20.0%);在FLAI R、DWI、T2WI、T1WI序列上显示SAH阳性的例数分别为4例(80.0%)、1例(20.0%)、0例、0例。出血病因分析中感染性心内膜炎1例(20.0%),不明原因型4例(80.0%),5例患者出院时均预后良好(mRS评分≤2分)。结论常规MRI检查在CT阴性的不典型SAH中有良好的显示率,其中FLAIR序列阳性率最高。神经科或影像科医师需要重视MRI在SAH中的诊断价值,并能正确识别其异常信号。Objective To evaluate the diagnostic value of routine MRI sequences(T1WI,T2WI,FLAIR,DWI)in atypical subarachnoid hemorrhage(SAH)with negative on CT.Methods A retrospective analysis of in-hospital patients diagnosed with SAH in Department of Neurology,the First Affiliated Hospital of Anhui Medical University From January 1,2016 to October 30,2019 was performed.All enrolled patients showing negative on CT were confirmed with SAH by lumbar puncture,and also underwent MRI examination.Results A total of 5 patients were included,with 3 males(60.0%)and a mean age of 33.8 years(range:14-53 years).Based on the initial symptoms,SAH was highly suspected in 1 case(20%),bleeding cannot be excluded in 3 cases(60%)and suspected non-bleeding diseases in 1 case(20%).1 case(20%)showed false negative on MRI,and 1 case(20%)was misdiagnosed as metastasis by MRI.4 cases(80.0%),1 case(20.0%),0 case and 0 case showed SAH signals on FLAIR,DWI,T2 and T1 weighed imaging,respectively.In the analysis of bleeding causes for 5 patients,1 case(20%)was infective endocarditis,4 cases(80.0%)were unidentified.All cases had good prognosis(mRS≤2).Conclusions Routine MRI sequences have a good auxiliary diagnostic value for atypical SAH patients with negative on CT,of which FLAIR sequence is the most sensitive.

关 键 词：头痛 蛛网膜下腔出血 计算机断层扫描 核磁共振 液体衰减反转恢复序列 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.35[医药卫生—诊断学]