Martin Andrew, Tse George, Connolly Daniel James Anthony, Batty Ruth
Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Curr Med Imaging Rev. 2019;15(9):853-865. doi: 10.2174/1573405614666180528080436.
The many causes of Intracerebral Haemorrhage (IH) can be difficult to differentiate. However, there are imaging features that can provide useful clues. This paper aims to provide a pictorial review of the common causes of IH, to identify some distinguishing diagnostic features and to provide guidance on subsequent imaging and follow up. It is hoped that this review would benefit radiology and non-radiology consultants, multi-professional workers and trainees who are commonly exposed to unenhanced CT head studies but are not neuroradiology specialists.
In the absence of trauma, Spontaneous Intracerebral Haemorrhage (SIH) can be classified as idiopathic or secondary. Secondary causes of IH include hypertension and amyloid angiopathy (75-80%) and less common pathologies such as vascular malformations (arteriovenous malformations, aneurysms and cavernomas), malignancy , venous sinus thrombosis and infection. SIH causes between 10 to 15% of all strokes and has a higher mortality than ischaemic stroke. Trauma is another cause of IH with significant mortality and some of the radiological features will be reviewed.
Unenhanced CT is a mainstay of acute phase imaging due to its availability and, sensitivity and specificity for detecting acute haemorrhage. Several imaging features can be identified on CT and, along with clinical information, can provide some certainty in diagnosis. For those suitable and where diagnostic uncertainty remains CT angiogram, time-resolved CT angiography and catheter angiography can help identify underlying AVMs, aneurysms, cavernomas and vasculitides. MRI is more sensitive for the detection of subacute and chronic haemorrhage and identification of underlying mass lesions.
脑内出血（IH）的病因众多，难以鉴别。然而，有一些影像学特征可提供有用线索。本文旨在对IH的常见病因进行图像综述，识别一些有鉴别意义的诊断特征，并为后续影像学检查及随访提供指导。希望本综述能使经常接触头颅非增强CT检查但并非神经放射学专家的放射科及非放射科会诊医生、多专业工作人员和实习生受益。
在无外伤的情况下，自发性脑内出血（SIH）可分为特发性或继发性。IH的继发性病因包括高血压和淀粉样血管病（75 - 80%）以及较少见的病变，如血管畸形（动静脉畸形、动脉瘤和海绵状血管瘤）、恶性肿瘤、静脉窦血栓形成和感染。SIH占所有卒中的10%至15%，死亡率高于缺血性卒中。外伤是IH的另一个病因，死亡率较高，本文将对一些放射学特征进行综述。
非增强CT因其可用性以及对检测急性出血的敏感性和特异性，是急性期成像的主要手段。CT上可识别多种影像学特征，结合临床信息可在一定程度上明确诊断。对于合适的患者且诊断仍有疑问时，CT血管造影、时间分辨CT血管造影和导管血管造影有助于识别潜在的动静脉畸形、动脉瘤、海绵状血管瘤和血管炎。MRI对亚急性和慢性出血的检测以及潜在肿块病变的识别更敏感。
