高血压脑出血血肿周围组织脑血流量的磁共振灌注成像研究

doi:10.3877/cma.j.issn.1673-9248.2014.02.002

目的

应用磁共振灌注加权成像研究高血压脑出血急性期和亚急性期血肿周围组织脑血流量的改变。

方法

连续入组2011年10月至2013年9月期间在南通大学附属医院神经内科住院治疗的高血压脑出血（hypertensive intracerebral hemorrhage，HICH）患者24例。所有患者于发病第3天、14天进行MRI检查，应用灌注加权成像（perfusion weighted imaging，PWI）测定并计算血肿周围1 cm区域、血肿周围损伤区域和血肿远隔区域的相对脑血流量（relative cerebral blood flow，rCBF ）。

结果

发病第3天、 14天时，血肿周围1 cm区域、血肿周围损伤区域的rCBF均显著低于血肿远隔区域。与发病第3天相比，发病第14天时血肿周围1 cm区域、血肿周围损伤区域的rCBF均显著下降。

结论

高血压脑出血的急性期和亚急性期，血肿周围组织存在明显的低灌注，亚急性期比急性期更严重。磁共振灌注加权成像能清晰显示血肿周围组织的脑血流量改变，有一定的临床实用价值。

关键词: 脑出血, 血肿周围组织, 磁共振, 灌注加权成像

Objective

To study alterations of cerebral blood flow in perihematomal tissue in acute and subacute hypertensive intracerebral hemorrhage with MRI perfusion weighted imaging.

Methods

24 consecutive patients with hypertensive intracerebral hemorrhage (HICH) admitted to the department of neurology of the affiliated hospital of Nantong university from October 2011 to September 2013 were recruited in the study. All patients underwent magnetic resonance imaging at days 3 and 14 after symptom onset. The relative cerebral blood flow (rCBF) was measured and calculated using perfusion weighted imaging (PWI) in the 1 cm-wide area around the hematoma, as well as in the damaged area around the hematoma and the ipsilateral remote area.

Results

The values of rCBF in the 1 cm-wide area around the hematoma and in the damaged area around the hematoma were significantly lower than in the ipsilateral remote area at days 3 and 14 after symptom onset. Compared with day 3 after symptom onset, the values of rCBF in the 1 cm-wide area around the hematoma and in the damaged area around the hematoma were significantly decreased at day 14 after symptom onset.

Conclusions

There exits pronounced hypoperfusion in the tissue around the hematoma during the phases of acute and subacute hypertensive intracerebral hemorrhage. MRI perfusion weighted imaging may contribute to display the alteration of cerebral blood flow of perihematomal tissue, and be with certain clinical applicatin value.

Key words: Intracerebral hemorrhage, Perihematomal tissue, MRI, Perfusion weighted imaging

图1 图像传到工作站进行后处理。A图示：T2 FLAIR图像，红色线条区域为血肿周围损伤区域及其对侧镜像区域；B图示：PWI原始图像；C图示：软件处理后的CBF图像；D图示：CBF-T2 FLAIR融合图像，将T2 FLAIR图像上绘制的感兴趣区转移至CBF图像，获得CBF值。

表1 高血压脑出血患者发病第3天、14天血肿周围不同区域的rCBF

时间	?	血肿周围1 cm区域	血肿周围损伤区域	血肿远隔区域	H值	P值
3天	rCBF	0.77(0.70,0.88)	0.79(0.66,0.85)	0.94(0.81,1.15)	14.760	0.001
14天	rCBF	0.63(0.57,0.75)	0.59(0.52,0.65)	0.89(0.76,0.99)	30.420	0.000

表1 高血压脑出血患者发病第3天、14天血肿周围不同区域的rCBF

时间	?	血肿周围1 cm区域	血肿周围损伤区域	血肿远隔区域	H值	P值
3天	rCBF	0.77(0.70,0.88)	0.79(0.66,0.85)	0.94(0.81,1.15)	14.760	0.001
14天	rCBF	0.63(0.57,0.75)	0.59(0.52,0.65)	0.89(0.76,0.99)	30.420	0.000

图2 发病第3天时血肿周围不同区域rCBF的比较

图3 发病第14天时血肿周围不同区域rCBF的比较

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Study on cerebral blood flow of perihematomal tissue in hypertensive intracerebral hemorrhage with MRI perfusion weighted imaging

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Study on cerebral blood flow of perihematomal tissue in hypertensive intracerebral hemorrhage with MRI perfusion weighted imaging