脑小血管病多样化临床表现的影像学基础

脑小血管病（ small vessel disease,SVD）指主要累及颅内小动脉或微动脉的疾病,其临床表现多种多样,除可引起纯运动性偏瘫、单纯感觉障碍等各种腔隙性综合征外,还可导致头晕、认知障碍、血管性痴呆、步态异常、帕金森样症状、排尿障碍等多种非特异性症状,严重影响患者生命质量.但是目前大多数临床医师对这些非特异性的症状认识不足且常常忽视SVD的危害,从而导致SVD患者不能得到早期诊断、治疗.影像学表现为诊断SVD提供了重要依据,主要包括腔隙性脑梗死（lacunar infarct,LI）、脑白质病变（white matter lesions,WMLs）、扩大的血管周围间隙（enlarged perivascular spaces,EPVS）和微出血（cerebral microbleeds,CMBs）.笔者总结国内外文献报道的与SVD相关的影像学及临床表现,以加深临床医师对SVD及其危害的认识,提高SVD的识别率,有助于延缓疾病进展,提高患者生活质量.

Imaging features of diverse clinical syndrome of cerebral small vessel disease

The term small vessel disease （SVD） encompasses all pathological processes that affect the small vessels of brain, including small arteries, arterioles, capillaries and small veins. Most often, SVD is used to refer only to the arterial vessels. Clinical features range from none specific symptoms, to discrete focal neurological symptoms （e. g., lacunar stroke ）, and insidious global neurological dysfunction such as vascular cognitive impairment and dementia, gait disturbances, mild parkinsonian signs and so on. However, SVD is neglected by many clinicians, although it compromise patient＇s quality of life seriously. The imaging features of SVD on MRI play an important role for diagnosis, these features include acute lacunar infarcts, lacunes, white matter lesions, enlarged perivascular spaces and microbleeds. Here, we summarize the neuroimaging and clinical features of SVD for the purpose of early recognition and management of SVD.