Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany.
J Neurosurg. 2011 Apr;114(4):1003-7. doi: 10.3171/2010.6.JNS10310. Epub 2010 Jul 30.
The aim of this study was to evaluate the diagnostic value of MR imaging in perimesencephalic (PM) and nonperimesencephalic (non-PM) subarachnoid hemorrhage (SAH) of unknown origin.
The authors conducted a retrospective review of all patients with SAH (1226 patients) in their department between January 1991 and December 2008. Included in the study were cases of spontaneous SAH diagnosed using CT scans obtained within 24 hours of the initial symptoms and initially negative digital subtraction (DS) angiograms. Patients with traumatic SAH and an unknown history were excluded from the study. Patients with initially negative DS angiograms were divided into 2 groups: Group 1, a typically PM bleeding pattern (PM SAH); and Group 2, a non-PM bleeding pattern (non-PM SAH) such as hemorrhage in the sylvian or interhemispheric fissure. Cranial MR imaging including the craniocervical region was performed within 72 hours after SAH was diagnosed in all patients in Groups 1 and 2.
One thousand sixty-eight patients underwent DS angiography, and among them were 179 (16.7%) with negative angiograms--47 patients (26.3%) from Group 1 and 132 patients (73.7%) from Group 2. Magnetic resonance imaging demonstrated no bleeding sources in any case (100% negative). Thirty-four patients in Group 1 and 120 patients in Group 2 underwent a second DS angiography study. Digital subtraction angiography revealed an aneurysm as the bleeding source in 1 case in Group 1 and in 13 cases in Group 2.
Magnetic resonance imaging of the brain and craniocervical region did not produce additional benefit for the detection of a bleeding source and the therapy administered for PM SAH and non-PM SAH (100% negative). The costs of this examination exceeded the clinical value. Despite the results of this study, MR imaging should be discussed on a case-by-case basis because rare bleeding sources are periodically diagnosed in cases of non-PM SAH. A second-look DS angiogram is necessary because aneurysmal hemorrhage occasionally produces PM SAH as well as non-PM SAH. Further prospective studies are needed to verify the authors' results in the future.
本研究旨在评估磁共振成像（MRI）在不明原因的脑旁（PM）和非脑旁（非-PM）蛛网膜下腔出血（SAH）中的诊断价值。
作者对 1991 年 1 月至 2008 年 12 月期间科室所有 SAH（1226 例）患者进行了回顾性分析。本研究纳入了通过最初症状后 24 小时内获得的 CT 扫描诊断为自发性 SAH 的病例，且最初数字减影血管造影（DS）为阴性。外伤性 SAH 患者和病史不明者被排除在研究之外。最初 DS 血管造影为阴性的患者被分为 2 组：1 组为典型的 PM 出血模式（PM-SAH）；2 组为非 PM 出血模式，如外侧裂或大脑半球间裂出血。所有 1 组和 2 组患者在 SAH 确诊后 72 小时内行颅颈 MRI 检查。
1068 例行 DS 血管造影，其中 179 例（16.7%）血管造影为阴性——47 例（26.3%）来自 1 组，132 例（73.7%）来自 2 组。所有病例的 MRI 均未显示出血源（100%阴性）。1 组 34 例，2 组 120 例行第二次 DS 血管造影。DS 血管造影显示 1 例 1 组和 13 例 2 组患者的出血源为动脉瘤。
脑和颅颈区域 MRI 检查对 PM-SAH 和非-PM-SAH（100%阴性）的出血源检测和治疗无额外获益。该检查的费用超过了其临床价值。尽管本研究结果如此，MRI 检查仍应根据具体情况进行讨论，因为非 PM-SAH 患者偶尔会诊断出罕见的出血源。因为偶尔动脉瘤性出血可导致 PM-SAH 和非 PM-SAH，所以需要行第二次 DSA 检查。未来需要进一步的前瞻性研究来验证作者的结果。
