Nighoghossian N, Hermier M, Adeleine P, Blanc-Lasserre K, Derex L, Honnorat J, Philippeau F, Dugor J F, Froment J C, Trouillas P
Cerebrovascular Disease Center, and CREATIS UMR CNRS 5515, Lyon, France.
Stroke. 2002 Mar;33(3):735-42. doi: 10.1161/hs0302.104615.
T2*-weighted gradient-echo MRI is known to detect old microbleeds (MBs), considered indicative of microangiopathy. MBs might be a potential risk factor for early cerebral bleeding (CB) after ischemic stroke. Therefore, we assessed the impact of MBs on the occurrence of CB after cerebral infarction.
We included prospectively stroke patients who had documented ischemic damage. The imaging protocol involved baseline CT scan, T2*-weighted gradient-echo MRI, diffusion-weighted imaging, T2-weighted imaging, and magnetic resonance angiography and had to be performed within 24 hours after symptom onset. The assessment of CB with T2*-weighted gradient-echo sequence necessitated a focal area of signal loss either within the ischemic area revealed by diffusion-weighted imaging or remote from it. Old MBs were defined on T2*-weighted images as homogeneous rounded areas of signal loss without surrounding edema. CT scan was systematically repeated within the first week to verify CB as diagnosed by the T2* weighted sequence.
One hundred patients (mean age, 60 +/- 13 years; range, 19 to 83 years; 58 men, 42 women) met the inclusion criteria. MBs were seen in 20 patients on T2*-weighted imaging. Multivariate logistic regression analysis revealed that age, diabetes, previous use of antithrombotic drugs, evidence of an atherothrombotic source of stroke, and lacunar infarct were significantly associated with MBs (P<0.0001). CB was diagnosed in 26 patients: at the acute stage by T2*-gradient echo sequence in 18 patients and with CT scan performed within the first week in 8 patients. Multivariate logistic regression analysis showed that baseline National Institutes of Health Stroke Scale score, diabetes, and MBs were considered significant and independent predictors of CB (P<0.001).
Although the pathogenesis of CB after ischemic stroke is multifactorial, the increased observation of CB in patients with MBs suggests that the associated vascular vulnerability contributes to CB.
已知T2*加权梯度回波磁共振成像（MRI）可检测到陈旧性微出血（MBs），这被认为是微血管病变的指标。MBs可能是缺血性卒中后早期脑出血（CB）的潜在危险因素。因此，我们评估了MBs对脑梗死后脑出血发生的影响。
我们前瞻性纳入了有缺血性损伤记录的卒中患者。成像方案包括基线CT扫描、T2加权梯度回波MRI、扩散加权成像、T2加权成像和磁共振血管造影，且必须在症状发作后24小时内进行。使用T2加权梯度回波序列评估CB时，需要在扩散加权成像显示的缺血区域内或其外有一个局灶性信号丢失区域。在T2加权图像上，陈旧性MBs被定义为无周围水肿的均匀圆形信号丢失区域。在第一周内系统地重复CT扫描，以验证T2加权序列诊断的CB。
100例患者（平均年龄60±13岁；范围19至83岁；58例男性，42例女性）符合纳入标准。在T2加权成像上，20例患者可见MBs。多因素逻辑回归分析显示，年龄、糖尿病、既往使用抗血栓药物、动脉粥样硬化血栓形成性卒中来源的证据和腔隙性梗死与MBs显著相关（P<0.0001）。26例患者被诊断为CB：18例在急性期通过T2梯度回波序列诊断，8例在第一周内通过CT扫描诊断。多因素逻辑回归分析表明，基线美国国立卫生研究院卒中量表评分、糖尿病和MBs被认为是CB的重要且独立的预测因素（P<0.001）。
尽管缺血性卒中后CB的发病机制是多因素的，但MBs患者中CB的观察增加表明，相关的血管易损性促成了CB。
