University of California, Los Angeles (UCLA) Stroke Center, Los Angeles, CA 90095, USA.
Ann Neurol. 2010 Nov;68(5):581-92. doi: 10.1002/ana.22210.
Bleeding into the brain or adjacent structures is one of the most devastating neurological conditions, incurring tremendous emotional, financial, and societal costs. Imaging is essential to differentiate variants of hemorrhage, as the clinical features may be insufficient. A comprehensive approach to hemorrhage therefore relies on imaging to disclose pathophysiology, elucidate mechanisms, and thereby open further avenues to effective treatment. Hemorrhage patterns from superficial to deep locations in the brain are surveyed in this work, noting myriad potential causes and the influential pathophysiology of arterial ischemia, venous hypertension, and microvascular dysfunction. Recent progress of imaging studies and novel techniques to evaluate hemorrhage are explored. For decades, only computed tomography was available to define a hematoma without corroborating evidence of other pathology whereas multimodal computed tomography and magnetic resonance imaging, including noninvasive imaging of brain tissue, vessels, and perfusion, have now radically altered clinical practice. Imaging of the blood-brain barrier, cerebral microbleeds, coexistent ischemia, associated vascular lesions, and markers of hemorrhage expansion is possible with routine protocols akin to diagnostic strategies for ischemic stroke. Imaging applications for hemorrhagic transformation, venous thrombosis, and microvascular disorders are considered with a perspective that balances concern for hemorrhage with prevention of ischemia as these processes are often intertwined and clinical conundrums arise. Imminent imaging advances are anticipated with increased use of detailed imaging for hemorrhage and overlap with cerebral ischemia. Numerous questions abound regarding optimal management of hemorrhage and definitive treatments are lacking, yet imaging of pivotal pathophysiology offers tremendous opportunity for future progress in combating this debilitating condition.
脑出血或邻近结构出血是最具破坏性的神经科疾病之一，给患者个人、家庭和社会带来了巨大的经济和精神负担。影像学检查对于区分不同类型的出血至关重要，因为仅凭临床特征可能无法明确诊断。因此，全面的出血评估需要依靠影像学检查来揭示病理生理学机制，从而为有效治疗开辟新的途径。本研究综述了从脑表浅部位到深部的出血模式，探讨了多种潜在病因以及动脉缺血、静脉高压和微血管功能障碍等影响病理生理学的因素。文中还探讨了近年来影像学研究的进展和新型评估技术。几十年来，只有计算机断层扫描（CT）可用于确定血肿，而无需其他病理学证据佐证，而如今，多模态 CT 和磁共振成像（MRI），包括脑实质、血管和灌注的无创成像，已经彻底改变了临床实践。目前，通过常规方案可以实现血脑屏障、脑微出血、并存的缺血、相关血管病变以及出血扩大标志物的成像，这些方案类似于缺血性脑卒中的诊断策略。文中还考虑了出血转化、静脉血栓形成和微血管病变的影像学应用，并从关注出血与预防缺血两方面来平衡利弊，因为这些过程常常相互交织，临床难题也层出不穷。随着对脑出血详细成像的广泛应用以及与脑缺血的重叠，预计未来影像学技术将会取得重大进展。尽管目前对于脑出血的最佳治疗方法仍存在许多疑问，也缺乏明确的治疗方案，但对关键病理生理学的影像学研究为攻克这一致残性疾病提供了巨大的机会。
