Chan S, Kartha K, Yoon S S, Desmond D W, Hilal S K
Department of Radiology, Neurological Institute of New York, NY, USA.
AJNR Am J Neuroradiol. 1996 Nov-Dec;17(10):1821-7.
To investigate the basis for multifocal hypointense lesions within the brain as identified on T2*-weighted gradient-echo MR imaging in patients with no known or presumed cause of these lesions.
In the first of a two-part study design, we retrospectively reviewed a case series of 38 patients whose gradient-echo MR images showed multiple hypointense lesions within the brain parenchyma. Thirty-one cases in which the cause was known or presumed (eg, head trauma or cavernous angioma) were excluded from further review. The MR studies and clinical findings of the remaining seven cases were reexamined. In the second part, using a cohort study design with respect to hypertension, we prospectively reviewed the gradient-echo images from MR studies of 65 patients and control subjects enrolled in two ongoing clinical studies, one on "possible vascular dementia" (n = 33) and the other on "possible motor neuron disorder" (n = 32).
In the first part of the study, we found seven cases with a pattern of multiple hypointense lesions involving the deep gray matter nuclei, especially the basal ganglia (n = 6) and thalamus (n = 5). In addition, involvement of the corona radiata (n = 5), brain stem (n = 4), and cerebellum (n = 3) was seen. Clinical review revealed a history of chronic hypertension in all seven patients. In the cohort study, we found three of 65 persons who had two or more focal hypointense lesions that involved the basal ganglia or thalami. Review of the clinical data showed that all three patients were being treated for hypertension; also, all three were patients from the "possible vascular dementia" group.
The MR imaging pattern of multifocal hypointense lesions within the basal ganglia, thalamus, and other deep cerebral structures is more commonly found among patients with a history of chronic hypertension than in patients without chronic hypertension.
对于脑内多发低信号病灶，在无已知或推测病因的患者中，探讨其在T2*加权梯度回波磁共振成像上显示的基础。
在一项两部分研究设计的第一部分中，我们回顾性分析了38例患者的病例系列，这些患者的梯度回波磁共振图像显示脑实质内有多个低信号病灶。其中31例病因已知或推测明确（如头部外伤或海绵状血管瘤）的病例被排除，不再进一步分析。对其余7例患者的磁共振研究和临床发现进行重新检查。在第二部分中，采用关于高血压的队列研究设计，我们前瞻性地回顾了65例患者和对照者的磁共振梯度回波图像，这些患者和对照者参与了两项正在进行的临床研究，一项关于“可能的血管性痴呆”（n = 33），另一项关于“可能的运动神经元疾病”（n = 32）。
在研究的第一部分，我们发现7例患者有多发低信号病灶的表现，累及深部灰质核团，尤其是基底神经节（n = 6）和丘脑（n = 5）。此外，还可见到放射冠（n = 5）、脑干（n = 4）和小脑（n = 3）受累。临床检查发现所有7例患者均有慢性高血压病史。在队列研究中，我们在65人中发现3人有两个或更多累及基底神经节或丘脑的局灶性低信号病灶。临床资料回顾显示，这3例患者均正在接受高血压治疗；此外，这3例均为“可能的血管性痴呆”组的患者。
基底神经节、丘脑和其他深部脑结构内多发低信号病灶的磁共振成像表现，在有慢性高血压病史的患者中比无慢性高血压病史的患者更为常见。
