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基底节区脑出血MRI影像学表现及其与CT对比分析

作者:黄景玉

所属单位:山东省聊城市中医医院放射科(山东 聊城 252000)

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摘要

目的分析基底节区脑出血磁共 振成像(Magnetic Resonance Imaging, MRI)影像学表现及其与计算机断层扫描 (computed tomography,CT)的对比。方 法 选取我院收治的50例基底节区脑出 血患者纳入观察,并取同期50例急性脑 梗死患者纳入对照组,均行MRI与CT检 查,观察2组MRI影像学表现特点,并与 CT对比。结果 观察组病灶周围DWI高信 号水肿带30例(60.00%),显著多于对照 组6例(12.00%);观察组病灶DWI低信号 与混杂信号所占比例明显高于对照组(P <0.05),高信号所占比例明显低于对照 组(P<0.05);MRI示,2组点状、胼胝体 所占比例比较无明显差异(P>0.05),观 察组类圆形病变所占比例明显高于对照组 (P<0.05),不规则形病变所占比例明显 低于对照组(P<0.05);CT示观察组:CT 值:(60-90)HU,病灶密度:不均匀增加 或者呈均匀一致,水肿情况:血肿周围产 生低密度水肿,病灶形态:主要为肾形, 占位效应:3-5d逐渐产生占位效应;对照 组:CT值:(60-80)HU,病灶密度:密度 减低,水肿情况:局部产生脑水肿,病灶 形态:主要为椭圆形或者圆形,占位效 应:3~10d产生明显占位效。结论 MRI与 CT均能准确诊断基底节区脑出血,MRI主 要鉴别病灶形态、DWI序列信号;CT主要 鉴别病灶密度与形态、CT值变化、水肿情 况与占位效应。

Objective To analyze the magnetic resonance imaging (MRI) findings of cerebral hemorrhage in basal ganglia and comparison with computed tomography (CT). Methods A total of 50 patients with cerebral hemorrhage in basal ganglia were included in the observation group and 50 patients with acute cerebral infarction were included in the control group. All of them were examined with MRI and CT. MRI findings of both groups were observed and compared with CT. Results There were 30 cases (60.00%) with DWI high signal edema zone in the observation group, significantly more than those in the control group [6 cases (12.00%)]. The proportions of DWI low signal and mixed signal in the observation group were significantly higher than those in the control group (P<0.05), and the proportion of high signal was significantly lower than that in the control group (P<0.05). MRI showed that there was no significant difference between the two groups in punctiform or corpus callosum (P>0.05). The proportion of quasi-circular shape in the observation group was significantly higher than that in the control group (P<0.05), while the proportion of irregular shape was significantly lower than that in the control group (P<0.05). CT showed that the CT value in observation group was (60- 90) HU, the density of lesions was uneven increase or uniform, there was low-density edema around the hematoma, the morphology of lesions mainly was kidney-shaped, and mass effect gradually occurred at 3-5 days. The CT value of control group was (60 ~ 80) HU, the density of lesions decreased, there was local cerebral edema, the morphology of lesions mainly was elliptical or round, and obvious mass effect occurred at 3 to 10 days. Conclusion MRI and CT can accurately diagnose cerebral hemorrhage in basal ganglia. MRI mainly distinguishes the morphology and DWI sequence signal of lesions while CT mainly identifies the density, morphology, CT value change, edema and mass effect of lesions.

【关键词】基底节区脑出血;磁共振成像;计算机断层扫描;影像学表现

【中图分类号】R722.15+1

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.12.006

前言

神经外科常见危急重症之一为脑出血,相关调查发现,脑出血患 者半年内死亡率高达30%~50%,严重威胁到生命[1-2]。脑出血好发于 基底节区,该部位动脉血管直径相对较小,同时和大脑中动脉呈垂直 关系,如果产生血压过高现象,小动脉可能纤维坏死,导致脑出血。 基底节区脑出血患者易出现偏瘫等后遗症,故其诊治已得到临床广 泛重视。临床实践证实,急性脑梗死与基底节区脑出血临床表现较 为相似,容易出现误诊事件,最终延误最佳治疗时机[3]。故准确鉴别 对诊断基底节区脑出血具有重要意义。在颅内磁共振成像(Magnetic Resonance Imaging,MRI)与计算机断层扫描(computed tomography, CT)技术不断发展背景下,影像学表现已经逐渐成为确定基底节区脑出 血患者治疗方案及预后评估非常重要的依据[4-5]。本文以基底节区脑出 血与急性脑梗死患者各50例为研究对象,探讨其MRI影像学表现及其与 CT进行对比。