CT、MRI、3D-CTA、DSA诊断妊娠及产褥期出血性脑卒中7例分析

目的探讨妊娠及产褥期出血性脑卒中(hemorrhagic stroke during pregnancy and the puerperium,HSPP)的头部电子计算机体层扫描(CT)、磁共振成像(MRI)、三维计算机断层扫描血管造影(3D-CTA)、数字减影血管造影(DSA)表现的诊断价值。方法 2004年6月至2007年7月中国医科大学附属盛京医院收治7例HSPP,回顾性分析其临床及影像学资料。7例患者发病后均行CT检查,行MRI检查1例,3D-CTA检查2例,DSA检查4例。结果 CT表现基底节或脑叶局部高密度影6例,双侧外侧裂少量高密度充填影1例。1例MRI表现T1WI等高混杂信号、T2WI低混杂信号;1例3D-CTA呈现左顶高密度不规则血管团,另1例3D-CTA正常。4例DSA证实3例脑血管动静脉畸形(arteriovenous malformation,AVM)、1例正常。3D-CTA检查结果与DSA相符。头部影像学检查提示蛛网膜下腔出血(subarachnoid hemorrhage,SAH)1例,基底节区脑出血2例,脑叶出血4例;病因为AVM破裂出血4例,依据DSA诊断3例,依据CT表现及既往病史诊断1例。结论头部CT及MRI是诊断HSPP的首选手段,3D-CTA及DSA有助于病因判断。

The Diagnosis of CT,MRI,3D-CTA and DSA in Hemorrhagic Stroke during Pregnancy and Puerperium

Objective To investigate the diagnostic value of the brain CT,MRI,3D-CTA and DSA features of hemorrhagic stroke during pregnancy and puerperium(HSPP).Methods Retrospective analysis of 7 cases of HSPP with the clinical findings and imaging data.After the onset in 7 patients,7 cases underwent CT,1 case underwent MRI,2 cases underwent 3D-CTA,4 cases underwent DSA.Results 6 cases of CT showed the local high-density video in the basal ganglia or lobe,and 1 case showed a small number of high-density video filling in the bilateral fissures.1 case of MRI showed iso or high mixed signal on T1WI,and low mixed signal on T2WI.One 3D-CTA of two cases showed left parietal lobe high-density irregular vascular group,another one showed normal performance.DSA of four cases confirmed three cases with cerebral vascular AVM,and one case with normal performance.The two 3D-CTA findings were matched to the DSA findings.Cerebral imaging investigations showed 1 case with subarachnoid hemorrhage(SAH),2 cases with basilar ganglia hemorrhage,and 4 cases with lobar hemorrhage.There were 4 cases whose etiology was because of ruptured AVM,the diagnosis of 3 cases based on DSA,and 1 case based on CT and past history.Conclusion The brain CT and MRI were the preferred diagnosis means of HSPP,3D-CTA and DSA examination could help to find etiology.