颅内血管内治疗术后迟发性非缺血性脑增强病变临床特征分析并文献复习  

Analysis of clinical features of delayed non-ischemic cerebral enhancing after endovascular therapy and literature review

作　　者：梁骊 范雪怡 于瑾[3] 李华[3] 王晓辉[3] 张舒凤 钱海蓉[1,2] Liang Li;Fan Xueyi;Yu Jin;Li Hua;Wang Xiaohui;Zhang Shufeng;Qian Hairong(Navy Clinical College,the Fifth School of Clinical Medicine,Anhui Medical University,Hefei,Anhui 230032,China)

机构地区：[1]安徽医科大学第五临床医学院海军临床学院,合肥230032 [2]解放军总医院第六医学中心神经内科 [3]解放军总医院第三医学中心神经内科

出　　处：《中国脑血管病杂志》2023年第3期186-194,204,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：首都卫生发展科研专项(首发2020-2-5115)。

摘　　要：目的探讨颅内血管内治疗(EVT)术后迟发性非缺血性脑增强(NICE)病变的临床特征。方法回顾性连续纳入2015年1月至2022年12月解放军总医院第三医学中心神经内科因脑梗死或颅内动脉瘤疾病行EVT术后出现NICE病变患者的病历资料。设定主题词,在中国知网、万方医学和PubMed数据库中进行文献检索,检索日期自2008年1月1日至2022年12月1日。分析所诊病例及文献病例的基线资料(年龄、性别)、临床资料[临床症状、发病时间、治疗方法(药物、使用方法)、遗留症状、EVT原因]、影像学资料[T1加权成像(T1WI)、T2加权成像(T2WI)序列、液体衰减反转恢复(FLAIR)序列、扩散加权成像(DWI)序列、表观扩散系数序列、增强后T1WI、磁敏感加权成像(SWI)、T2^(*)WI序列]、预后及随访资料(随访时间、随访方式及随访结果)等,评估病变分布范围、病变位置T2WI及FLAIR信号改变、病变部位弥散是否受限、是否有病灶周围水肿带,记录增强扫描强化病灶的部位、形状以及SWI或T2^(*)WI是否存在低信号等。结果纳入文献病例42例,解放军总医院第三医学中心所诊患者1例,共43例NICE病变患者。43例患者中,男5例,女38例,男∶女为1∶7.6;年龄33~71岁,平均(52.1±1.5)岁;5例为机械取栓术后,38例为动脉瘤EVT术后;EVT术后发生NICE症状的中位天数为35(21,56)d;前、后循环发病患者分别为33、10例,前循环与后循环发病比例为3.3∶1;最常见的症状为偏瘫(16/43)、头痛(12/43)、失语(8/43)和癫痫样发作(7/43),另有6例无症状患者。43例NICE病变患者影像学表现:NICE病变均位于EVT治疗血管的同侧,43例患者颅内均有不同程度白质血管源性水肿区,白质病变分布范围位于EVT治疗血管的供血区域内占比为35/43,多发强化病灶以结节状强化最为常见(38/43),SWI或T2*WI序列病变区可见边界清晰的点状或结节状低信号者占比为4/43,周围无明显水肿带,NICE的�Objective To investigate the clinical features of delayed non-ischemic cerebral enhancing(NICE)after endovascular therapy(EVT).Methods Medical records were retrospectively collected from January 2015 to December 2022 from patients who developed NICE after EVT for cerebral infarction or intracranial aneurysm at the Department of Neurology,the Third Medical Center of Chinese People′s Liberation Army(PLA)General Hospital.A systematic research was conducted by using Medical Subject Headings(MeSH)in the China National Knowledge Infrastructure(CNKI),Wanfang and PubMed databases from January 1,2008 to December 1,2022.Baseline data(age,gender),clinical data(clinical symptoms,time of onset,treatment[drugs,usage],residual symptoms,cause of EVT),imaging data(T1 weighted imaging[T1WI],T2 weighted imaging[T2WI],fluid attented inversion recovery[FLAIR],diffusion weighted imaging[DWI],apparent diffusion coefficient[ADC],T1WI after enhancement,susceptibility-weighted imaging[SWI],T2^(*)WI),prognostic and follow-up information(follow-up time,methods and results)were gathered.The extent of lesion distribution,T2WI and FLAIR signal changes at the lesion location were accessed.Whether the diffusion was limited at the lesion site and whether there was a perifocal edema zone were identified.The site and shape of the enhanced lesion on enhanced scan and the presence of low signal on SWI or T2^(*)WI were also accessed.Results Forty-two patients were included from the literature,and 1 patient from the Third Medical Center of the PLA General Hospital.A total of 43 patients with NICE lesions were reported.Of the 43 patients,there were 5 males and 38 females,with a ratio of 1∶7.6 for males and females.The age ranged from 33 to 71 years,with the average(52.1±1.5)years.There were 5 patients after mechanical thrombectomy and 38 patients after aneurysm EVT.The median onset date was 35(21,56)days after EVT.There were 33 and 10 patients with anterior circulation and posterior circulation,respectively,and the ratio of anterior circulation to

关 键 词：迟发性非缺血性脑增强 血管内治疗 机械取栓 颅内动脉瘤 

分 类 号：R743.3[医药卫生—神经病学与精神病学]