脑中动脉瘤破裂伴脑内血肿与脑内血肿：初始和随访影像特征

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology Pub Date : 2025-05-09 DOI:10.1016/j.crad.2025.106951

J.I. Hwang , D.Y. Yoon , E.S. Kim , H.J. Jeon , J.Y. Lee , Y.L. Seo , E.J. Yun

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引用次数: 0

摘要

目的：本研究的目的是评估和比较大脑中动脉（MCA）动脉瘤破裂引起的脑内血肿（ISH）和脑内血肿（ICH）的初始和随访影像学特征。材料与方法我们回顾性评价并比较了24例中动脉动脉瘤破裂并发ISH和46例颅内出血的影像学特征。初步ct、ct血管造影、磁共振（MR）影像学表现如下：血肿密度（Hounsfield单位）及边缘，血肿周围低密度，动脉瘤形态参数，早期M1、M2段严重血管痉挛，再出血活跃，MR弥散加权成像（DWI）血肿周围b1000信号强度高，表观扩散系数（ADC）低。此外，我们在随访影像学检查中评估了迟发性严重血管痉挛和脑软化的分布。结果与ICH组相比，ISH组血肿边缘呈锯齿状（100% vs . 21.7%， P=0.000），血肿周围无厚度或均匀的低密度（75.0% vs . 15.2%， P=0.000），早期严重血管痉挛M1和M2节段（83.3% vs . 41.3%， P=0.001）， MR DWI上血肿周围厚（> 5mm）高b1000信号强度和低ADC (100% vs . 27.8%， P=0.001)，严重血管痉挛在第7天（±1）延迟（100% vs . 61.5%， P= 0.05）。3 ~ 12个月时发生脑软化（71.4% vs 0%， P=0.000）。结论早期和随访的影像学特征有助于区分缺血性脑卒中和脑出血合并MCA动脉瘤破裂，有助于在病程中进行适当的治疗。

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Intra-Sylvian versus intracerebral haematoma associated with ruptured middle cerebral artery aneurysm: initial and follow-up imaging features

AIM

The aim of this study was to evaluate and compare the initial and follow-up imaging features of intra-Sylvian haematoma (ISH) and intracerebral haematoma (ICH) from a ruptured middle cerebral artery (MCA) aneurysm.

MATERIALS AND METHODS

We retrospectively evaluated and compared the imaging features of 24 patients with ISH and 46 with ICH from ruptured MCA aneurysms. The following features in initial computed tomography, computed tomography angiography, and magnetic resonance (MR) imaging were investigated: density (Hounsfield unit) and margin of the haematoma, low density surrounding the haematoma, morphological parameters of the aneurysm, early severe vasospasm of M1 and M2 segments, active rebleeding, and high b1000 signal intensity and low apparent diffusion coefficient (ADC) surrounding the haematoma on MR diffusion-weighted imaging (DWI). Additionally, we assessed delayed severe vasospasm and the distribution of cerebromalacia on follow-up imaging examinations.

RESULTS

Compared to the ICH group, the ISH group showed a more frequent haematoma with serrated margins (100% vs 21.7%, P=0.000), absent or uniform thickness low density surrounding the haematoma (75.0% vs 15.2%, P=0.000), early severe vasospasm of M1 and M2 segments (83.3% vs 41.3%, P=0.001), thick (>5 mm) high b1000 signal intensity and low ADC surrounding the haematoma on MR DWI (100% vs 27.8%, P=0.001), delayed severe vasospasm at days 7 (±1) (100% vs 61.5%, P<0.05), and cerebromalacia involving brain surrounding the Sylvian fissure at 3 to 12 months (71.4% vs 0%, P=0.000).

CONCLUSION

Initial and follow-up imaging features can help differentiate between ISH and ICH associated with ruptured MCA aneurysm, facilitating appropriate treatment in the course of the disease.

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来源期刊

Clinical radiology 医学-核医学

CiteScore

4.70

自引率

3.80%

发文量

528

审稿时长

76 days

期刊介绍： Clinical Radiology is published by Elsevier on behalf of The Royal College of Radiologists. Clinical Radiology is an International Journal bringing you original research, editorials and review articles on all aspects of diagnostic imaging, including: • Computed tomography • Magnetic resonance imaging • Ultrasonography • Digital radiology • Interventional radiology • Radiography • Nuclear medicine Papers on radiological protection, quality assurance, audit in radiology and matters relating to radiological training and education are also included. In addition, each issue contains correspondence, book reviews and notices of forthcoming events.