慢性扩展性脑内血肿影像学表现及病理基础  

Chronic expanding intracerebral hematoma:a comparative study of imaging feature with pathology

作　　者：莫信 金军 汤小俐 王玉理[2] 张亚明 陈义波 曹晋博 徐丙仁 谭利华[3] MO Xin;JIN Jun;TANG Xiaoli;WANG Yuli;ZHANG Yaming;CHEN Yibo;CAO Jinbo;XU Bingren;TAN Lihua(Department of Radiology,Shekou People's Hospital,Shenzhen,Guangdong Province 518067,China;Department of Imaging,the Second People's Hospital of Shenzhen,Shenzhen,Guangdong Province 518000,China;Department of Radiology,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]深圳市南山区蛇口人民医院放射科,广东深圳518067 [2]深圳市第二人民医院医学影像科,广东深圳518000 [3]中南大学湘雅二医院放射科,湖南长沙410011

出　　处：《实用放射学杂志》2021年第3期365-368,共4页Journal of Practical Radiology

摘　　要：目的探讨慢性扩展性脑内血肿(CEICH)的影像学表现与病理联系。方法回顾性分析11例经临床及手术病理证实的CEICH临床及影像学表现,探讨形成影像学表现的病理基础。结果本组大部分病例位于大脑半球,形态多为圆形或类圆形。CT平扫10例混杂密度,4例见“分层征”。MRI平扫10例T1WI、T2WI为混杂信号,5例见“铁环征”。CT、MRI增强扫描病变周围可见轻中度环形强化。术中见血肿包膜厚薄不一,质地坚韧,内见红色、褐色、酱油样液体及血凝块。镜下血肿包膜含胶原组织、肉芽组织、含铁血环素沉积,4例见微小血管畸形。结论CEICH的影像学表现源于血肿内部不同时期出血并存及其刺激引起局部脑组织炎性反应及胶质增生,影像上的“铁环征”、环形强化征具有一定特征性,有助于CEICH的诊断及鉴别诊断。Objective To probe the relationship between the imaging features and the pathology of chronic expanding intracerebral hematoma(CEICH).Methods The imaging features and pathological manifestations of 11 CEICH confirmed by clinic and pathology were analyzed and compared retrospectively.Results Most of the lesions occurred in hemicerebrum brain,which were round or elliptical in shape.There were 10 lesions presented mixed density,in which 4 lesions had"layer sign"on CT images.MRI showed 10 lesions with mixed signals in the center of the lesions on both T1WI and T2WI,in which 5 lesions had"hoop like"appearance.Enhanced CT and MRI showed mild to moderate ring enhancement.Intraoperative findings revealed all hematoma capsules had different thickness with red,brown or soy sauce like liquid as well as blood clots.Microscopically,the capsule contained collagen tissue,granulation tissue and hemosiderin deposition.Microvascular malformations were seen in 4 lesions.Conclusion The imaging features of CEICH result from coexistence of hematomas in different stages and the following local inflammatory response and gliosis caused by the repeatitive stumulation..The"hoop-like"sign and ring enhancement appearance can be useful for the diagnosis and differentiation of CEICH.

关 键 词：慢性扩展性脑内血肿 计算机体层成像 磁共振成像 病理学 

分 类 号：R651.15[医药卫生—外科学] R814.42[医药卫生—临床医学]