早期 MRI 在急性自发性脑出血的诊断和治疗中的应用。
Utility of early MRI in the diagnosis and management of acute spontaneous intracerebral hemorrhage.
机构信息
Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University, 701 Welch Road, Palo Alto, CA 94034, USA.
出版信息
Cerebrovasc Dis. 2010;30(5):456-63. doi: 10.1159/000316892. Epub 2010 Aug 24.
BACKGROUND
The optimal diagnostic evaluation for spontaneous intracerebral hemorrhage (ICH) remains controversial. In this retrospective study, we assessed the utility of early magnetic resonance imaging (MRI) in ICH diagnosis and management.
METHODS
Eighty-nine (72%) of 123 patients with spontaneous ICH underwent a brain CT and MRI within 30 days of ICH onset. Seventy patients with a mean age of 62 ± 15 years were included. A stroke neurologist and a general neurologist, each blinded to the final diagnosis, independently reviewed the admission data and the initial head CT and then assigned a presumed ICH cause under 1 of 9 categories. ICH cause was potentially modified after subsequent MRI review. The final 'gold standard' ICH etiology was determined after review of the complete medical record by an independent investigator. Change in diagnostic category and confidence and the potential impact on patient management were systematically recorded.
RESULTS
Mean time to MRI was 3 ± 5 days. Final ICH diagnosis was hypertension or cerebral amyloid angiopathy (CAA) in 50% of patients. After MRI review the stroke neurologist changed diagnostic category in 14%, diagnostic confidence in an additional 23% and management in 20%, and the general neurologist did so in 19, 21 and 21% of patients, respectively. MRI yield was highest in ICH secondary to ischemic stroke, CAA, vascular malformations and neoplasms, and did not differ by age, history of hypertension, hematoma location or the presence of intraventricular hemorrhage.
CONCLUSIONS
The results of this study suggest potential additive clinical benefit of early MRI in patients with spontaneous ICH.
背景
自发性脑出血（ICH）的最佳诊断评估仍存在争议。在这项回顾性研究中，我们评估了早期磁共振成像（MRI）在 ICH 诊断和管理中的作用。
方法
123 例自发性 ICH 患者中有 89 例（72%）在 ICH 发病后 30 天内进行了脑部 CT 和 MRI 检查。纳入了 70 例平均年龄为 62±15 岁的患者。一位卒中神经病学家和一位普通神经病学家，在不知道最终诊断的情况下，分别独立地审查了入院资料和初始头部 CT，并根据 9 个类别中的 1 个，为疑似 ICH 原因进行了分类。在随后的 MRI 审查后，ICH 病因可能会发生变化。通过对完整病历的独立审查，确定了最终的“金标准”ICH 病因。系统地记录了诊断类别的变化、诊断信心的变化以及对患者管理的潜在影响。
结果
MRI 的平均时间为 3±5 天。最终 ICH 的诊断为高血压或脑淀粉样血管病（CAA）占 50%。在 MRI 审查后，卒中神经病学家改变了 14%的诊断类别，另外 23%的诊断信心和 20%的管理方式；普通神经病学家分别改变了 19%、21%和 21%的诊断类别、诊断信心和管理方式。MRI 的检出率在继发于缺血性卒中、CAA、血管畸形和肿瘤的 ICH 中最高，与年龄、高血压史、血肿位置或是否存在脑室内出血无关。
结论
本研究结果表明，早期 MRI 对自发性 ICH 患者具有潜在的临床附加获益。
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