协和全面解读缺血性中风的头颅CT和MRI辨识剖析.pptVIP

Hematoma evolution from the extremely acute stage to the acute and subacute to chronic stage. While skiing, this 54-year-old woman experienced nonspecific vertigo at 5:15 pm. A few minutes later she developed rapidly progressive facial paresis, difficulty pronouncing words and a paresis of her left arm, followed by weakness of her left leg. She arrived at the emergency department by helicopter at 7:00 pm. Day 1 (7:59 pm), MRI. A, A T1-weighted spin-echo image demonstrates a round lesion in the posterior part of the right basal ganglia and the internal capsule that is isointense compared to the nearby brain parenchyma and is surrounded by a rim of hypointense signal. B, The mass is heterogeneous and hyperintense on a T2-weighted image. The linear hypointensity at the anterior border of the lesion could be early formation of deoxyhemoglobin or a flow void from an abnormal vessel. C, The gradient echo image shows a lesion isointense to brain parenchyma that is surrounded by a ring of interrupted signal loss and therefore suggests an acute hematoma. D, On diffusion-weighted image the lesion is hyperintense and enclosed in a ring of signal loss. E, The lesion does not enhance after gadolinium administration. MR angiography (not shown) was normal. Day 4 (8:32 pm), CT. F, CT scan verifies an acute hemorrhage in the posterior part of the right putamen and the adjacent internal capsule surrounded by a small rim of edema. Day 4 (9:25 pm), MRI. G and H, 3 d after the hemorrhage, T2-weighted and FLAIR images show profound signal loss, with surrounding high signal edema. I, T1-weighted spin-echo image shows intermediate signal. At the border of the hematoma T1-shortening starts to result in signal enhancement. J, On a gradient-echo image the hematoma is only moderately hypointense due to the window/level selection. K, On diffusion-weighted images the lesion is profoundly dark and surrounded by a small rim of hyperintense signal that likely represents ischemic pressure damage of