切换至 "中华医学电子期刊资源库"
高级检索
中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2014, Vol. 08 ›› Issue (02) : 4 -8. doi: 10.3877/cma.j.issn.1673-9248.2014.02.002

所属专题： 文献；

论著

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
严晓铭1, 牛牧1, 柯开富1,†()   
  1. 1. 226001　南通大学附属医院神经内科
  • 出版日期:2014-04-01
  • 通信作者: 柯开富

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

Xiaoming Yan1, Mu Niu1, Kaifu Ke1,†()   

  1. 1. Department of Neurology, the Affiliated Hospital of Nantong University, Nantong 226001, China
  • Published:2014-04-01
  • Corresponding author: Kaifu Ke
  • About author:
    Corresponding author: Ke Kaifu, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

严晓铭, 牛牧, 柯开富. 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[J/OL]. 中华脑血管病杂志(电子版), 2014, 08(02): 4-8.

Xiaoming Yan, Mu Niu, Kaifu Ke. Study on cerebral blood flow of perihematomal tissue in hypertensive intracerebral hemorrhage with MRI perfusion weighted imaging[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2014, 08(02): 4-8.

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
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
1
Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets[J]. Lancet Neurol, 2012, 11(8): 720-731.
2
Babu R, Bagley JH, Di C, et al. Thrombin and hemin as central factors in the mechanisms of intracerebral hemorrhage–induced secondary brain injury and as potential targets for intervention[J]. Neurosurg Focus, 2012, 32(4): E8.
3
Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage[J]. Lancet Neurol, 2006, 5(1): 53-63.
4
Zazulia AR, Diringer MN, Videen TO, et al. Acute intracerebral hemorrhage does not produce peri-clot cerebral ischemia[J]. Neurology, 2000, 54: A261-A262.
5
Venkatasubramanian C, Mlynash M, Finley-Caulfield A, et al. Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging[J]. Stroke, 2011, 42(1): 73-80.
6
孙祥荣，郭富强，陶克言，等．脑出血患者CT灌注成像的研究[J]．中华神经医学杂志, 2009, 8(3): 295-301.
7
Zhou J, Zhang H, Gao P, et al. Assessment of perihematomal hypoperfusion injury in subacute and chronic intracerebral hemorrhage by CT perfusion imaging[J]. Neurol Res, 2010, 32(6): 642-649.
8
Zhao X, Wang Y, Wang C, et al. Quantitative evaluation for secondary injury to perihematoma of hypertensive cerebral hemorrhage by functional MR and correlation analysis with ischemic factors[J]. Neurol Res, 2006, 28(1): 66-70.
9
马春，余聪，赵建农，等. CT灌注成像对脑血肿周围组织灌注的动态观察[J]．中国医学计算机成像杂志, 2008, 14(1): 6-10.
10
刘群，田晶，朱辉，等．脑出血血肿周边局部脑血流量经时动态变化及Xe-CT的改变[J]．中华神经科杂志, 2007, 40(4): 257-259.
11
Yonezawa T, Hashimoto H, Sakaki T. Serial change of cerebral blood flow after collagenase induced intracerebral hemorrhage in rats[J]. No Shinkei Geka, 1999, 27(5): 419-425.
12
Cao M, Ke K, Sun H, et al. Effects of prostaglandin E1 on perihematomal tissue after hypertensive intracerebral hemorrhage[J]. Acta Neurol Taiwan, 2011, 20(3): 172-181.
13
Jordan LC, Kleinman JT, Hillis AE. Intracerebral hemorrhage volume predicts poor neurologic outcome in children[J]. Stroke, 2009, 40(5): 1666-1671.
14
Lindsberg PJ, Strbian D, Karjalainen-Lindsberg ML. Mast cells as early responders in the regulation of acute blood-brain barrier changes after cerebral ischemia and hemorrhage[J]. J Cereb Blood Flow Metab, 2010, 30(4): 689-702.
15
Xue M, Del Bigio MR. Injections of blood, thrombin, and plasminogen more severely damage neonatal mouse brain than mature mouse brain[J]. Brain Pathol, 2005.15(4): 273-280.
16
Diedler J, Sykora M, Rupp A, et al. Impaired cerebral vasomotor activity in spontaneous intracerebral hemorrhage[J]. Stroke, 2009, 40(3): 815-819.
[1] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(05): 470-476.
[2] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[3] 吴少敏, 张世豪, 刘炳光, 李婵, 尹嘉敏, 郑昌业, 黄素然. 胎儿巨大蛛网膜囊肿并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 390-397.
[4] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[5] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[6] 杨勇军, 曾一鸣, 贺显雅, 卢强, 李远伟. ASA分级≥Ⅲ级患者局麻经会阴前列腺多模态影像融合穿刺的安全性和有效性[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 441-447.
[7] 刘明辉, 葛方明. MRI 对腹股沟疝修补术后患者早期并发症的评估价值研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 579-583.
[8] 臧书芹, 陈巧玲, 江思源, 朱晓明, 沈浮, 王颢, 张卫, 邵成伟. 基于直肠高分辨MRI的直肠侧系膜分析及其临床价值的研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 312-320.
[9] 王永楠, 汤畅通, 殷杰, 谭溢涛. 微创钻孔引流术与神经内镜血肿清除术治疗临界量基底节脑出血的效果对比分析[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 286-292.
[10] 张志超, 李陈, 韩惠, 周夏, 洪家康. 经额平行白质纤维束立体定向血肿穿刺引流术与神经内镜下血肿清除术治疗基底节脑出血的临床对比分析[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 299-303.
[11] 刘国龙, 王鹏, 谭超, 杨辉, 彭菊红. 神经外科机器人辅助双通道颅内血肿清除术治疗高血压性脑出血[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 254-256.
[12] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
[13] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[14] 穆巴拉克·伊力哈, 徐霁华, 鲁明. 急性轻型卒中微量脑出血误诊病例的临床特点及影像学表现分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 441-445.
[15] 金安松, 邹玉松, 刘玖涛, 薛凤麟, 庞爱兰. 孤立性颅内浆细胞瘤一例及相关文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 495-500.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号