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磁共振T 2 flair、 DWI序列在各期脑出 血诊断价值分析*

作者:南晓东1 张 俊1 吴连强1 裴晓红1 强孔俊1 骆 宾1 张 焱2 程敬亮2

所属单位:1.河南科技大学附属黄河三门峡医 院CT、MRI科 (河南 三门峡 472000) 2.郑州大学第一附属医院MRI科 (河南 郑州 450052)

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摘要

目的 探讨磁共振T2flair、DWI 序列在各期脑出血诊断价值及信号演变 特征,以提高对本病的进一步认识。方 法 回顾性分析经临床确诊的65例脑出血 患者MRI影像资料。结果 65例中,超急 性早期(6h内)3例,T2flair为稍低信号, DWI为低信号,周围无水肿;超急性晚期 (6-24h)7例,T2flair为稍低信号,DWI为 低信号,周围轻度水肿;急性期(1-3d)8 例,T2flair为极低信号,DWI为极低信 号,周围中度水肿;亚急性早期(4-7d)7 例,T2flair为低信号,DWI为低信号,周 围重度水肿;亚急性中期(8-15d)11例, T2flair为外高中低信号,DWI为外高中低 信号,周围中度水肿;亚急性晚期(16- 30d)7例,T2flair为高信号,DWI为高信 号,周围轻微水肿;慢性期(1-2m)7例, T2flair为高信号,周围有黑环,DWI为高 信号,周围有黑环,病变周围无水肿; 残腔期(3m以上)15例,T2flair为低信 号,DWI为低信号,病变周围无水肿。 结 论 不同期别脑出血的T2flair、DWI表现 具有特征性,有助于该病的诊断及鉴别诊 断,从而指导制定治疗方案。

Objective To study diagnosis value of Magnetic Resonance T2flair, DWI sequence in different phases of cerebral hemorrhage analyze characteristics of signal evolution, and to improve the understanding of its imaging findings. Methods In the 65 cases of cerebral hemorrhage proved by clinical diagnosis were retrospectively analyzed in MRI imaging. Results Among the 65 cases, 3 cases were super acute early (6h), T2flair is slightly low signal, DWI is low signa, no edema around, 7 cases were super acute late (6-24h), T2flair is slightly low signal, DWI is low signa, mild edema around. 8 cases were acute period (1-3d), T2flair is extremely low signal, DWI is extremely low signal, moderate edema around. Early subacute(4-7d) in 7 cases, T2flair is low signal, DWI is low signal, severe edema around. Mid subacute(8-15d) in 11 cases, T2flair and DWI is too, moderate edema around. Subacute late (16-30d) in 7 cases, T2flair and DWI is too, mild edema around. Chronic phase (1-2m) in 7 cases, T2flair and DWI is high signal, surrounded by black ring, no edema around the lesion. Residual cavity(more than 3m) in 15 cases, T2flair and DWI is low signal, can no edema around the lesion. Conclusion It has the characteristic of T2flair, DWI manifestation for different period cerebral hemorrhage, which is helpful for differential diagnosis and guiding clinical treatment.

【关键词】脑出血;信号;磁共振成像

【中图分类号】R722.15+1

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.10.004

前言

脑出血和脑梗死在中枢神经系统血管性疾病中最为常见,影像及 临床医师对脑梗死的MRI诊断掌握较好,而对脑出血的MRI诊断,特别 是超急性、急性脑出血的MRI诊断信心不足,有一定误诊率[1],而随着 高场磁共振T2flair、DWI序列的应用,显著提高了各期脑出血诊断准 确性。笔者搜集了65例经临床证实的脑出血病例,回顾性分析其MRI表 现,特别是T2flair、DWI信号变化,以进一步提高对脑出血的MRI诊断 水平。