MR ESWAN序列对高血压患者脑微出血的定量诊断价值
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摘要
目的探讨MR ESWAN序列对高血压患者脑微出血(CMBs)的定量诊断价值。方法搜集122例有CMBs的高血压患者作为研究组;纳入年龄、性别与研究组患者相匹配的健康志愿者50名作为对照组。分别测量皮质、白质、内囊/外囊、基底节、丘脑、脑干、小脑七个脑区的相位(PV)值。对比分析CMBs PV值与其多个影响因素的相关性,并采用统计学方法进行检验。结果 122例共发现385个CMBs病灶,其平均PV值为-1.39±0.38。CMBs组的七个脑区的平均PV值明显低于健康对照组(红核与黑质)(PV=-1.39±0.38～-0.31±0.14,P<0.05);基底节CMBs的平均PV值显著低于内/外囊区CMBs的平均PV值(P=0.02);皮层下白质CMBs的平均PV值显著低于脑干、内/外囊等区域CMBs的平均PV值(PV=-1.48±0.44～-1.24±0.31);小脑CMBs的平均PV值显著高于除了脑干之外的其他五个区CMBs的平均PV值(PV=-1.02±0.27～-1.48±0.44)。服用阿司匹林、伴发腔隙性脑梗死严重程度的增加、年龄增长、脑白质变性程度加重均可导致CMBs的平均PV值趋于降低。结论基于磁共振ESWAN序列相位图的PV值测量可为CMBs提供定量诊断信息;CMBs的影像学定量测值可成为高血压患者伴发出血和梗死的一个参考指标。
Objective To investigate the value of MR ESWAN sequence in the quantitative diagnosis of brain microbleeds(CMBs) in patients with hypertension.Methods A total of 122 patients with hypertension with CMBs were enrolled in the study group.50 healthy volunteers matched with age and gender were included as control group.The phase(PV) values of the seven brain regions of the cortex,white matter,inner capsule/outer sac,basal ganglia,thalamus,brainstem,and cerebellum were measured.The correlation between the PV value of CMBs and its multiple influencing factors was compared and analyzed by statistical methods.Results A total of 385 CMBs were found in 122 patients,and the average PV value was-1.39 ± 0.38.The average PV values of the seven brain regions of the CMBs group were significantly lower than those of the healthy controls(red nuclei and substantia nigra)(PV=-1.39 ± 0.38 ～-0.31 ± 0.14,P<0.05);the mean PV values of basal ganglia CMBs were significant.The average PV value of CMBs in the inner/outer sac area was lower(P=0.02);the average PV value of subcortical white matter CMBs was significantly lower than the average PV value of CMBs in the brainstem and inner/outer sac(PV=-1.48 ± 0.44).～-1.24 ± 0.31);the mean PV value of cerebellar CMBs was significantly higher than the average PV values ?? of five other CMBs except the brainstem(PV=-1.02 ± 0.27 ～-1.48 ± 0.44).The use of aspirin,increased severity of lacunar infarction,increased age,and increased white matter degeneration can lead to a decrease in the mean PV value of CMBs.Conclusion PV value measurement based on phase map of magnetic resonance ESWAN sequence can provide quantitative diagnostic information for CMBs;imaging quantitative measurement of CMBs can be a reference indicator for blood and infarction in patients with hypertension.
Objective To investigate the value of MR ESWAN sequence in the quantitative diagnosis of brain microbleeds(CMBs) in patients with hypertension.Methods A total of 122 patients with hypertension with CMBs were enrolled in the study group.50 healthy volunteers matched with age and gender were included as control group.The phase(PV) values of the seven brain regions of the cortex,white matter,inner capsule/outer sac,basal ganglia,thalamus,brainstem,and cerebellum were measured.The correlation between the PV value of CMBs and its multiple influencing factors was compared and analyzed by statistical methods.Results A total of 385 CMBs were found in 122 patients,and the average PV value was-1.39 ± 0.38.The average PV values of the seven brain regions of the CMBs group were significantly lower than those of the healthy controls(red nuclei and substantia nigra)(PV=-1.39 ± 0.38 ～-0.31 ± 0.14,P<0.05);the mean PV values of basal ganglia CMBs were significant.The average PV value of CMBs in the inner/outer sac area was lower(P=0.02);the average PV value of subcortical white matter CMBs was significantly lower than the average PV value of CMBs in the brainstem and inner/outer sac(PV=-1.48 ± 0.44).～-1.24 ± 0.31);the mean PV value of cerebellar CMBs was significantly higher than the average PV values ?? of five other CMBs except the brainstem(PV=-1.02 ± 0.27 ～-1.48 ± 0.44).The use of aspirin,increased severity of lacunar infarction,increased age,and increased white matter degeneration can lead to a decrease in the mean PV value of CMBs.Conclusion PV value measurement based on phase map of magnetic resonance ESWAN sequence can provide quantitative diagnostic information for CMBs;imaging quantitative measurement of CMBs can be a reference indicator for blood and infarction in patients with hypertension.
引文
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6 Nakata-Kudo Y,Mizuno T,Yamada K,et al.Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascu-lar disease[J].Dement Geriatr Cogn Disord,2006,22:8-14.
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9 Koennecke HC.Cerebral microbleeds on MRI Prevalence,association,and potential clinical implications[J].Neurology,2006,66:165-171.
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11 Horita Y,Imaizumi T,Niwa J,et al.Analysis of dot-like hemosiderin spots using brain dock system[J].No Shinkei Geka,2003,31:263-267.
12 Bokura H,Saika R,Yamaguchi T,et al.Microbleeds are associated with subsequent hemor-rhagic and ischemic stroke in healthy elderly individuals[J].Stroke,2011,42:1867-1871.
13 Harder SL,Hopp KM,Ward H,et al.Mineralization of the deep gray matter with age:a retrospective review with susceptibility-weighted MR imaging[J].AJNR Am J Neurora-diol.2008;29:176-183.
14 Haacke EM,Ayaz M,Khan A,et al.Establishing a baseline phase behavior in mag-netic resonance imaging to determine normal vs.abnormal iron content in the brain[J].J Magn Reson Imaging,2007,26:256-264.
15 Haacke EM,Cheng NY,House MJ,et al.imaging iron stores in the brain using magnetic resonance imaging[J].Magn Reson Imaging,2005,23:1-25.
16 de Rochefort L,Liu T,Kressler B,et al.Quantitative susceptibility map reconstruction from MR phase data using bayesian regularization:validation and applica-tion to brain imaging[J].Magn Reson Med,2010,63:194-206.
17 Barnes SR,Haacke EM,Ayaz M,et al.Semiautomated detection of cerebral microbleeds in magnetic resonance images[J].Magn Reson Imaging,2011,29:844-852.
18 Fan YH,Mok VC,Lam WW,et al.Cerebral microbleeds and white matter changes in patients hospitalized with lacunar infarcts[J].JNeurol,2004,251:537-541.
2 Fazekas F,Kleinert R,Roob G,et al.Histopathologie analysis of foci of signal losson gradient-echo T2*-weighted MR Images in patients with spontaneous intraeerebral hemorrhage:evidence of mieroangiopathy-related cerebral microbleeds[J].AJNR,1999,20:637-642.
3 Wahlund LO,Barkhof F,Fazekas F,et al.A new rating scale for age-related white matter changes applicable to MRI and CT[J].Stroke,2001,32:1318-1322.
4 Fazekas F,Kleinert R,Roob G,et al.Histopathologic Analysis of Foci of Signal Loss on Gradient-Echo T2*-Weighted MR Images in Patients with Spontaneous Intracerebral Hemorrhage:Evidence of Microangiopathy-Related Microbleeds[J].Am J Neuroradiol,1999,20:637-642.
5 Tanaka A,Ueno Y,Nakayama Y,et al.Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas[J].Stroke,1999,30:1637-1642.
6 Nakata-Kudo Y,Mizuno T,Yamada K,et al.Microbleeds in Alzheimer disease are more related to cerebral amyloid angiopathy than cerebrovascu-lar disease[J].Dement Geriatr Cogn Disord,2006,22:8-14.
7 Derex L,Nighoghossian N,Hermier M,et al.Thrombolysis for ischernic stroke in patients wim old microbleeds pretreatment MRI[J].Cerebrovasc Dis,2004,17:238-241.
8 Tsushima Y,Tanizaki Y,Aoki J,et al.MR detection of microhemorrhages in neurologically healthy adults[J].Neuroradiology,2002,44:31-36.
9 Koennecke HC.Cerebral microbleeds on MRI Prevalence,association,and potential clinical implications[J].Neurology,2006,66:165-171.
10 Kato H,Izumiyama M,Izumiyama K,et al.Silent cerebral microbleeds on T2*-weighted MRI:correlation with stroke subtype,stroke recurrence,and leukoaraiosis[J].Stroke,2002,33:1536-1540.
11 Horita Y,Imaizumi T,Niwa J,et al.Analysis of dot-like hemosiderin spots using brain dock system[J].No Shinkei Geka,2003,31:263-267.
12 Bokura H,Saika R,Yamaguchi T,et al.Microbleeds are associated with subsequent hemor-rhagic and ischemic stroke in healthy elderly individuals[J].Stroke,2011,42:1867-1871.
13 Harder SL,Hopp KM,Ward H,et al.Mineralization of the deep gray matter with age:a retrospective review with susceptibility-weighted MR imaging[J].AJNR Am J Neurora-diol.2008;29:176-183.
14 Haacke EM,Ayaz M,Khan A,et al.Establishing a baseline phase behavior in mag-netic resonance imaging to determine normal vs.abnormal iron content in the brain[J].J Magn Reson Imaging,2007,26:256-264.
15 Haacke EM,Cheng NY,House MJ,et al.imaging iron stores in the brain using magnetic resonance imaging[J].Magn Reson Imaging,2005,23:1-25.
16 de Rochefort L,Liu T,Kressler B,et al.Quantitative susceptibility map reconstruction from MR phase data using bayesian regularization:validation and applica-tion to brain imaging[J].Magn Reson Med,2010,63:194-206.
17 Barnes SR,Haacke EM,Ayaz M,et al.Semiautomated detection of cerebral microbleeds in magnetic resonance images[J].Magn Reson Imaging,2011,29:844-852.
18 Fan YH,Mok VC,Lam WW,et al.Cerebral microbleeds and white matter changes in patients hospitalized with lacunar infarcts[J].JNeurol,2004,251:537-541.