目的:研究静脉栓塞继发脑梗死的MRI影像诊断及其临床应用价值。方法:对14例经脑血管造影及临床治疗有效证实的静脉栓塞继发脑梗死的MRI影像进行了回顾性分析。男6例,女8例,年龄21~65岁,平均43岁。全部行头颅MRI平扫检查,其中10例行磁共振静脉血管造影(MRV)检查,5例行Gd-DTPA增强扫描。结果:14例中脑梗死发生于额叶6例,顶叶4例,颞叶3例,岛叶1例,小脑1例,发生于基底节、丘脑累及中脑、胼胝体1例。脑梗死发生于双侧脑内的8例,单侧6例。静脉栓塞部位14例中10例为上矢状窦(其中6例同时合并横窦或乙状窦或直窦栓塞),1例直窦及左横窦,1例左侧横窦及乙状窦,2例皮层大脑浅静脉,其中梗死内伴出血10例。5例静脉注射Gd-DTPA后增强扫描,3例无强化,2例病灶内出现不规则类环形强化,其中有大脑镰、小脑幕脑膜增厚强化的2例。10例MRV均显示栓塞的静脉血流信号丢失或缺损,以及周围异常静脉侧支和其他引流静脉异常扩张。结论:静脉栓塞继发脑梗死的MRI影像表现具有一定的特征性,对静脉栓塞的诊断和治疗非常重要,其继发的脑梗死又是评估静脉栓塞的脑实质病变严重程度和观察临床治疗效果的一项重要指标。
Abstract
Objective: To evaluate MRI features of venous embolism and cerebral infarction and its clinical value. Methods: MRI features of venous embolism and cerebral infarction in 14 cases(male 6 cases, female 8 cases) were reviewed retrospectively, age ranged from 21 to 65 years old, the average age was 43 years old, all have been proved by cerebral angiography and effective clinical therapy were given. All cases underwent MRI cerebral conventional examination, 10 of them had MR venous angiography(MRV), 5 cases underwent enhanced MRI scan. Result: In 14 cases, venous cerebral embolism and infarction located in lobus frontalis in 6 cases, lobus parietalis in 4, lobus temporalis in 3, insula in 1 and cerebella in 1. In another case, the position is in basal ganglion, thalamus and thalamencephal(with diencephalon and corpus callosum involved). Bilateral cerebrum involved were found in 8 cases and unilateral in 6 cases. Venous infarction was found in 14 cases, in 10 cases infarction was located in superior sagittal sinus(with transverse sinus, sigmoid sinus or straight sinus thrombosis), 1 case in straight sinus and left transverse sinus, 1 case in left transverse sinus and sigmoid sinus, 2 cases in cortical superficial vein. In these cases, there were 10 cases of hemorrhagic infarction. In 5 cases which underwent enhanced scan by Gd-DTPA, the lesions were nonenhanced in 3 cases and the lesion appeared irregular annular enhancement in 2 cases. There were 2 cases which appeared enhancement of falx cerebri and tentorium cerebelli. MRV images showed lack of flow void from the blocked venous channels and formation of collaterials or presence of emissary veins. Conclusion: Venous embolism and cerebral infarction have characteristic MRI image, it is important for diagnosis and therapy of venous embolism. Cerebral infarction is also an important index for evaluating the severity of lesion and the effect of clinical therapy.
关键词
脑梗塞 /
颅内栓塞 /
磁共振成像
Key words
brain infarction /
intracranial embolism /
magnetic resonance imaging
