Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
Department of Radiology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
J Clin Neurosci. 2020 Sep;79:118-122. doi: 10.1016/j.jocn.2020.07.043. Epub 2020 Aug 5.
Regarding incidentally found old hemorrhagic foci on gradient-echo magnetic resonance imaging (GRE), it is difficult to distinguish whether the foci are the consequence of hemorrhagic infarction (HI) or primary intracerebral hemorrhage (PICH). We analyzed the radiological characteristics of patients with a definite history of HI or PICH by reviewing long-term follow-up GRE. We retrospectively enrolled patients with HI or PICH, verified by clinical history and radiological findings, who had undergone follow-up GRE at least 3 months after the first imaging. The shape of the hemorrhagic lesion was classified as "cavitation" or "no cavitation." The shape of the hemosiderin rim was classified as total dark rim and partial dark rim. Hyperintense perilesional signal was determined when an obvious hyperintensity on T2-weighted image was present. Further, we compared the radiological characteristics between HI and PICH. In total, 69 patients (38 with HI and 31 with PICH) were enrolled, of whom 45 (65%) were men. The mean patient age was 65.5 ± 12.7 years. The mean time interval from the initial stroke onset to the follow-up image was 56.2 months. Hyperintense perilesional signal was observed in 38 patients; it was associated with HI (33/38 vs. 5/31, p < 0.001). Furthermore, partial dark rim was associated with HI (34/40 vs. 4/29, p < 0.001). Cavitation was more frequently observed in patients with HI than in those with PICH (36/60 vs. 2/9, p = 0.068). Presence of hyperintense perilesional signal and partially encasing dark hemosiderin rim suggest that chronic hemorrhagic foci are the sequelae of HI, not PICH.
关于梯度回波磁共振成像（GRE）偶然发现的陈旧性出血灶，难以区分病灶是出血性梗死（HI）的后果还是原发性脑出血（PICH）。我们通过回顾长期随访 GRE 分析了有明确 HI 或 PICH 病史患者的影像学特征。我们回顾性纳入了至少在首次影像学检查后 3 个月进行了随访 GRE 的 HI 或 PICH 患者，通过临床病史和影像学发现进行了验证。将出血病变的形状分为“空洞”或“无空洞”。含铁血黄素环的形状分为完全暗环和部分暗环。当 T2 加权图像上出现明显高信号时，确定病变周围高信号。进一步比较 HI 和 PICH 的影像学特征。共纳入 69 例患者（38 例 HI，31 例 PICH），其中 45 例（65%）为男性。患者平均年龄为 65.5±12.7 岁。从初始中风发作到随访图像的平均时间间隔为 56.2 个月。38 例患者出现病变周围高信号；与 HI 相关（33/38 比 5/31，p<0.001）。此外，部分暗环与 HI 相关（34/40 比 4/29，p<0.001）。与 PICH 相比，HI 患者更常出现空洞（36/60 比 2/9，p=0.068）。病变周围高信号和部分包绕的暗含铁血黄素环的存在提示慢性出血灶是 HI 的后遗症，而不是 PICH。
