Fazekas F, Kleinert R, Roob G, Kleinert G, Kapeller P, Schmidt R, Hartung H P
Department of Neurology, and MR Institute, Karl-Franzens University, Graz, Austria.
AJNR Am J Neuroradiol. 1999 Apr;20(4):637-42.
Patients with spontaneous intracerebral hemorrhage (ICH) frequently have small areas of signal loss on gradient-echo T2*-weighted MR images, which have been suggested to represent remnants of previous microbleeds. Our aim was to provide histopathologic support for this assumption and to clarify whether the presence and location of microbleeds were associated with microangiopathy.
We performed MR imaging and correlative histopathologic examination in 11 formalin-fixed brains of patients who had died of an ICH (age range, 45-90 years).
Focal areas of signal loss on MR images were noted in seven brains. They were seen in a corticosubcortical location in six brains, in the basal ganglia/thalami in five, and infratentorially in three specimens. Histopathologic examination showed focal hemosiderin deposition in 21 of 34 areas of MR signal loss. No other corresponding abnormalities were found; however, hemosiderin deposits were noted without MR signal changes in two brains. All specimens with MR foci of signal loss showed moderate to severe fibrohyalinosis, and there was additional evidence of amyloid angiopathy in two of those brains.
Small areas of signal loss on gradient echo T2*-weighted images indicate previous extravasation of blood and are related to bleeding-prone microangiopathy of different origins.
自发性脑出血（ICH）患者在梯度回波T2*加权磁共振成像（MR图像）上常出现小面积信号缺失，提示可能为既往微出血的残留。我们的目的是为这一假设提供组织病理学支持，并阐明微出血的存在和位置是否与微血管病相关。
我们对11例死于ICH的患者（年龄范围45 - 90岁）的福尔马林固定脑标本进行了磁共振成像及相关组织病理学检查。
7例脑标本在MR图像上发现局灶性信号缺失区域。其中6例位于皮质下皮质区域，5例位于基底节/丘脑，3例位于幕下。组织病理学检查显示，在34个MR信号缺失区域中的21个区域有局灶性含铁血黄素沉积。未发现其他相应异常；然而，在2例脑标本中发现了含铁血黄素沉积但无MR信号改变。所有有MR信号缺失灶的标本均显示中度至重度纤维玻璃样变性，其中2例脑标本有淀粉样血管病的额外证据。
梯度回波T2*加权图像上的小面积信号缺失提示既往有血液外渗，且与不同起源的易出血性微血管病相关。
