脑梗死后皮质性出血CT、MRI及病理学变化

目的研究脑梗死后皮质出血(cortical hemorrhagic infarction,CHI)的CT及MRI影像学特点及病理学基础。方法分析21例影像组CT、MRI影像学特征;HE染色研究6例病理组CHI人脑标本在大体和显微镜下特点。结果影像组中12例CT在低密度灶周边皮质表面有蜿蜒走行的高密度影,MRI上T1WI相应区蚓线形高信号。9例CT未见高密度影而MRI见T1高信号。病理组大体见软化灶周边沿皮质走行弥散的点状或条索状出血。镜下软化灶周边皮质区毛细血管增多充血,小静脉扩张充血,周围见红细胞。结论MRI对CHI的诊断较CT敏感,阳性率高,有较大的临床价值;CHI梗死区脑皮质经历了出血过程,系大面积脑梗死自然病程中可经历的良性病理生理现象,预后尚好。

The CT and MR imaging and pathologic changes in cortical hemorrhagic infarction(CHI)

Objective To investigate changes of CT and MR imaging in patients with cortical hemorrhagic infarction(CHI) and discuss the related pathological foundations.Methods A total of 21 CHI cases were respectively selected who were divided into image group and pathologic one.Analyse the characteristic of CT and MR imaging in the image group and study the changes of the brain tissue both in general and in microscope by using HE dying.Results 12cases of the image group showed high density image wandering around the low density area on CT scans.The MRI examination also showed curving high signal in the related area.9 cases showed no high density image while the T1-weighted MR image showed high signals.The pathologic changes generally involved dispersive spotted or funicular shaped bleeding spots distributing along the cortex in the peripheral area of the cortex.The microscope manifestation included cortical veinlet and capillary vessel dilatation around the transforming focus.Small bleedings and increased amounts of capillary are seen in peripheral area with lots of red cells around them.Conclusion MR imaging is more sensible than CT scan and is of great value for the clinical diagnosis of CHI.The infarction cortex of CHI experienced bleeding course.Perhaps it is a benign pathophysiologic phenomenon in the natural course of extensive cerebral infarction and may have good prognosis.