磁敏感加权成像对脑肿瘤出血和非肿瘤性脑出血的鉴别诊断价值

发布时间：2018-02-24 00:17

本文关键词： 磁敏感加权成像脑肿瘤出血非肿瘤性脑出血鉴别诊断　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨脑肿瘤出血和非肿瘤性脑出血的磁敏感加权成像(susceptibility weighted imaging, SWI)表现特点；比较磁共振增强扫描(contrast-enhanced magnetic resonance imaging, CE·MR)、SWI及二者联合应用对脑肿瘤出血和脑内非肿瘤性出血的鉴别诊断价值。方法收集山西医科大学第一临床医院2011年12月至2013年12月间经手术病理或临床随访证实的脑肿瘤出血病例26例和非肿瘤性脑出血病例26例,分别行MR平扫、CE-MR、SWI检查,其中脑肿瘤出血组包括星形细胞瘤12例、转移瘤11例、少突胶质细胞瘤3例；非肿瘤性脑出血组包括高血压性脑出血10例,单纯性脑出血3例,血管畸形出血13例(海绵状血管瘤出血5例,动静脉畸形出血3例,静脉畸形出血2例,混合性血管畸形出血3例)。对CE-MR、SWI及CE-MR与SWI联合应用对脑出血病因诊断的正确率进行比较。结果(1)脑出血形态分为灶样出血型和结节肿块型,脑肿瘤出血病例组中,21例病灶未出血部位可见不同程度强化；5例出血基本覆盖肿瘤,增强扫描边缘可见不规则强化。非肿瘤性脑出血病例组中,10例高血压脑出血和3例单纯性脑出血病例可见轻度强化,强化形态与血肿形态相似。(2)脑肿瘤出血病例血肿信号多不均匀；非肿瘤性脑出血组中,10例高血压脑出血和3例单纯性脑出血信号与脑肿瘤出血相比较均匀。3例动静脉畸形出血可见流空血管信号；5例海绵状血管瘤出血可见“爆米花征”、“铁环征”；2例静脉血管畸形出血可见粗大的引流静脉和多发髓静脉,其中1例呈典型的“海蛇头”征象；1例混合型血管畸形出血,兼具“爆米花征”、“铁环征”和增粗引流静脉显影。(3)SWI扫描示脑肿瘤出血病例组中,23例于病灶内或病灶周围可见低信号肿瘤相关静脉；3例未见明显肿瘤相关静脉。(4)CE-MR、SWI及CE-MR与SWI联合应用对脑肿瘤出血和非肿瘤性脑出血的鉴别诊断正确率进行两两比较,CE-MR与SWI联合应用确诊率高,优于CE-MR和SWI方法单独应用。结论(1)SWI能够显示肿瘤相关静脉,有助于对脑肿瘤出血的诊断；(2)在MR平扫的基础上,联合应用CE-MR与SWI能够提高脑肿瘤出血和非肿瘤性脑出血的鉴别诊断准确率。
[Abstract]:Objective to investigate the features of magnetic sensitivity weighted weighted imaging (SWI) in cerebral tumor hemorrhage and non-tumor intracerebral hemorrhage. To compare the value of contrast-enhanced magnetic resonance imaging, CE 路magnetic resonance imaging and their combination in the differential diagnosis of cerebral tumor hemorrhage and intracerebral non-neoplastic hemorrhage. Methods from December 2011 to December 2013, 26 cases of brain tumor hemorrhage and 26 cases of non-neoplastic intracerebral hemorrhage confirmed by surgery, pathology or clinical follow-up were collected and examined by CE-MR-SWI. There were 12 cases of astrocytoma, 11 cases of metastatic tumor, 3 cases of oligodendrocytoma, 10 cases of hypertensive intracerebral hemorrhage and 3 cases of simple intracerebral hemorrhage in non-tumor intracerebral hemorrhage group, which included 12 cases of astrocytoma, 11 cases of metastatic tumor and 3 cases of oligodendrocytoma. 13 cases of vascular malformation hemorrhage (5 cases of cavernous hemangioma hemorrhage, 3 cases of arteriovenous malformation hemorrhage, 2 cases of venous malformation hemorrhage), Three cases of mixed vascular malformation hemorrhage were compared with the correct rate of CE-MRN SWI combined with CE-MR and SWI in the etiological diagnosis of intracerebral hemorrhage. Results 1) the morphology of cerebral hemorrhage was divided into focal hemorrhage type and nodular mass type. Irregular enhancement was observed at the edge of contrast enhancement. Mild enhancement was observed in 10 hypertensive intracerebral hemorrhage cases and 3 simple intracerebral hemorrhage cases in non-neoplastic intracerebral hemorrhage group. The enhancement morphology was similar to that of hematoma. (2) the signal intensity of hematoma was not uniform in patients with hemorrhage of brain tumor. Comparison of 10 hypertensive intracerebral Hemorrhage and 3 simple intracerebral Hemorrhage in Non-neoplastic intracerebral Hemorrhage Group. "Rice flower sign", "iron ring sign", 2 cases of venous vascular malformation bleeding can be seen thick drainage vein and multiple medullary vein, Among them, 1 case presented typical "sea snake head" sign and 1 case had mixed vascular malformation hemorrhage. Both "popcorn sign", "iron ring sign" and thickening drainage vein. SWI scan showed that in 23 patients with hemorrhage of brain tumor, hypointensity tumor associated vein was found in or around the lesion in 3 cases, and there was no obvious tumor-associated vein. CE-MR-MRI was found in 3 cases; and. The diagnostic accuracy of CE-MR combined with SWI in the differential diagnosis of cerebral tumor hemorrhage and non-tumor intracerebral hemorrhage was higher than that of CE-MR combined with SWI. It is better than CE-MR and SWI alone. Conclusion the combined use of CE-MR and SWI can improve the accuracy of differential diagnosis of cerebral tumor hemorrhage and non-neoplastic intracerebral hemorrhage on the basis of Mr plain scan.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34;R445.2

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