磁敏感加权成像SWI的临床应用年会.ppt

* * Hypertensive microbleeds: FLAIR axial image (a) shows hyperintense signal in the periventricular white matter and the corona radiata, suggestive of small-vessel ischemic disease. Many more lesions (microbleeds) are visualized on SWI (b) which are not seen on FLAIR * 红核、黑质致密部 黑质网状部 大脑脚 内侧膝状体 * 含铁血黄素、营养不良性钙化、脱氧血红蛋白等导致SWI低信号 * Figure 2 Hemorrhagic transformation of acute infarct. (a) Axial CT image shows well-defined hypodensity in the left basal ganglia suggesting an acute infarct. Note the absence of acute bleed into the infarct. (b) Axial SWI MRI sequence taken soon after the CT examination shows multiple punctate hypointensities secondary to infarct. * * 左侧大脑中动脉心源性血栓栓塞，脑卒中后两小时。MRA (A) 示左侧大脑中动脉M1远端无信号；FLAIR (B)示左外侧裂内大脑中动脉分支内有信号（短箭头），提示急性阻塞；DWI (C) 示左侧大脑中动脉分布区域有一小的高信号病灶；SWI (D) 示左侧M1段所在部位低信号，代表血栓。 * Figure 3 The MCA susceptibility sign. (a) Axial SWI image shows acute thrombus in the stem of right MCA with blooming artifact. (b) Diffusion weighted image shows a large acute infarct in the right MCA territory. * 脑卒中后两小时。MRA (A) 示左侧大脑中动脉M1远端无信号；FLAIR (B)未见明显梗塞灶；DWI (C) 示左侧大脑中动脉分布区域有一小的高信号病灶；SWI ( F) 显示左MCA供血区皮层静脉明显的低信号，提示急性缺血区内引流静脉内含相对较高的脱氧血红蛋白, 平均通过时间 (MTT) 图 (H) 示左MCA供血区MTT延长，与SWI显示的异常区域匹配。 rCBF (I)略下降。 * 弥散加权像上显示的高信号区是急性脑梗死受累的范围。SWI显示了由于受梗死的影响而处于风险中的组织（箭头A,B,C)及梗死本身的区域(D)。我们之所以能看到受累的血管分布区，是由于该组织的血氧饱和度下降了，这提示该区域的血流供应可能在梗死后有所下降。还有一种可 能的解释是局部静脉血容量的增加。 * 急性脑梗患者：D为PWI的MTT图，E图箭头指示大量扩张静脉 * 图6显示的是一位70岁的男性患者，接受了冠脉支架置入术后，采用阿司匹林和氯吡格雷抗凝，两个月后患者出现神志异常。CT显示了左颞顶叶后部的出血。X线脑血管造影和MRA均未能显示动静脉畸形或其它的脑血管异常。SWI显示了多发的微出血灶分布于皮层－皮层下白质交界处，高度提示脑血管淀粉样变性(CAA)，抗凝治疗立即停止。 * Figure 4 Post-thrombolysis haemorrhagic transformation (a) Post-thrombolysis diffusion weighted image shows restriction in the left basal ganglia suggestive of acute infarct. (b) Axial SWI shows haemorrhage within the infarct. * Acute phase thrombosis of superior sagittal sinus showed isointense signal on T1FLAIR(A:arrow),hypointense signal on FSE-T2WI(B:arrow),typical MSE(magnetic suscepty effect)was detected on axial T2*GR