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CT、MRI检测早期腔隙性脑梗死的价值研究*

作者:刘玉涛 许予明 高 远 杨 靖 史长河 王燕琳

所属单位:郑州大学第一附属医院神经内科(河南 郑州 450052)

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摘要

目的探讨CT、MRI在检测早期腔 隙性脑梗死的临床价值。方法 分别应用 CT、MRI检测我院2015年1月-2017年6月 收治250例LAC患者。结果 共250例患者 经CT检测后共发现451枚病灶,呈现低密 度或等密度改变。MRI检测后共发现1048 枚病灶。MRI组的检出率显著高于CT组 (P<0.05)。CT组病灶检出直径5-18mm,平 均直径(10.59±1.58)mm,≤5mm的病灶检 出6枚,5-10mm的病灶检出184枚,≥10mm 的病灶261枚。MRI组病灶直径2-18mm, 平均直径(4.59±1.48)mm,≤5mm的病灶 检出489枚,5-10mm的病灶检出290枚, ≥10mm的病灶269枚。MRI组的≤5mm病灶 检出率显著高于CT组(P<0.05)。CT结果显 示LAC患者发生新发病灶位于基底节区、 无症状性梗死、扩大血管周围间隙、颅内 粥样硬化白质病变轻度比例显著高于重度 患者(P<0.05)。MRI结果显示LAC患者发生 新发病灶位于基底节区、无症状性梗死、 扩大血管周围间隙、颅内粥样硬化白质病 变重度比例显著高于轻度患者(P<0.05)。 CT组平均检测时间、检测费用显著低于 MRI组(P<0.05)。结论 CT及MRI均能检出 早期腔隙性脑梗死病灶,MRI能显著提高 微小病灶检出率,判断白质病变程度。

Objective To investigate the clinical diagnostic value of CT and MRI in early lacunar infarction (LAC). Methods A total of 250 LAC patients treated in our hospital from January 2015 to June 2017 were given CT and MRI examination. Results A total of 451 lesions were found in 250 patients through CT examination demonstrated as hypodensity or isodensity, while a total of 1048 lesions were found through MRI detection. The detection rate in MRI group was significantly higher than that in CT group (P<0.05). The lesion diameter of CT group was 5-18mm, the mean diameter was (10.59±1.58) mm, including 6 lesions size ≤ 5mm, 184 lesions size between 5mm to 10mmm and 261 lesions size ≥10mm. The lesion diameter of MRI group was 2-18mm, the mean diameter was (4.59±1.48) mm, including 489 lesions size ≤ 5mm, 290 lesions size between 5mm to 10mmm and 269 lesions size ≥10mm. The≤ 5mm lesions detection rate in MRI group was significantly higher than that in CT group (P<0.05). CT results showed that the incidence of new lesions in basal ganglia, asymptomatic infarction, enlarged perivascular space and intracranial atheromatous white matter lesions in LAC patients were significantly higher than those in severe patients (P<0.05). While the MRI results showed that the incidence of above disease in LAC patients were higher than that in the mild patients (P<0.05). The average detection time and cost of CT group were significantly lower than those of MRI group (P<0.05). Conclusion LAC can be detected by both CT and MRI examinations. The MRI has the advantages of higher small lesions detection rate and determining the degree of white matter disease.

【关键词】CT;MRI;早期腔隙性脑梗死;微小病灶

【中图分类号】R445.2;R814.42

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.07.019

前言

早期腔隙性脑梗死(Lacunar infarction,LAC)是一种脑小血 管病,主要是指脑部小穿支动脉及毛细血管病变引发的脑白质及灰 质的缺血或出血性损害,可引发患者认知改变、肢体功能障碍[1]。 常规CT不能清晰观察患者脑小血管,无法有效鉴别无症状性脑梗死 (Asymptomatic cerebral infarction,AC)。有报道认为[2],小血管病 变表现越多,患者脑部病变程度越严重,脑部病变范围越大。LAC好发 于丘脑、脑干部位,腔隙直径<15mm,主要包括新鲜及陈旧性深部小 梗死。本文回顾性分析我院2015年1月-2017年6月收治LAC患者,分别 应用CT及MRI检测,现将具体研究数据及结果报道如下。