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目的探讨妊娠及产褥期出血性脑卒中(hemorrhagic stroke during pregnancy and the puerperium,HSPP)的头部电子计算机体层扫描(CT)、磁共振成像(MRI)、三维计算机断层扫描血管造影(3D-CTA)、数字减影血管造影(DSA)表现的诊断价值。方法 2004年6月至2007年7月中国医科大学附属盛京医院收治7例HSPP,回顾性分析其临床及影像学资料。7例患者发病后均行CT检查,行MRI检查1例,3D-CTA检查2例,DSA检查4例。结果 CT表现基底节或脑叶局部高密度影6例,双侧外侧裂少量高密度充填影1例。1例MRI表现T1WI等高混杂信号、T2WI低混杂信号;1例3D-CTA呈现左顶高密度不规则血管团,另1例3D-CTA正常。4例DSA证实3例脑血管动静脉畸形(arteriovenous malformation,AVM)、1例正常。3D-CTA检查结果与DSA相符。头部影像学检查提示蛛网膜下腔出血(subarachnoid hemorrhage,SAH)1例,基底节区脑出血2例,脑叶出血4例;病因为AVM破裂出血4例,依据DSA诊断3例,依据CT表现及既往病史诊断1例。结论头部CT及MRI是诊断HSPP的首选手段,3D-CTA及DSA有助于病因判断。
Objective To investigate the CT, MRI and 3D-CTA of hemorrhagic stroke during pregnancy and the puerperium (HSPP) , Digital subtraction angiography (DSA) performance of the diagnostic value. Methods From June 2004 to July 2007, Shengjing Hospital Affiliated to China Medical University admitted 7 cases of HSPP, retrospectively analyzed the clinical and imaging data. All the 7 patients underwent CT examination after the onset of disease. MRI was performed in 1 case, 3D-CTA in 2 cases and DSA in 4 cases. Results CT showed basal ganglia or lobar high-density local shadow in 6 cases, bilateral lateral fissure in a small amount of high-density filling shadow in 1 case. One case of MRI showed T1WI contours mixed signals and T2WI low promiscuous signals. One case of 3D-CTA presented left-top high-density irregular vascular groups and the other had 3D-CTA normal. Four cases of DSA confirmed three cases of arteriovenous malformation (AVM) and one case of normal. 3D-CTA results match DSA. Head imaging examination showed subarachnoid hemorrhage (SAH) in 1 case, basal ganglia hemorrhage in 2 cases, lobar lobar hemorrhage in 4 cases. The cause was AVM rupture and bleeding in 4 cases. According to DSA diagnosis in 3 cases, CT 1 case of diagnosis and past medical history. Conclusion CT and MRI of the head are the first choice for diagnosis of HSPP. 3D-CTA and DSA are helpful to the etiological diagnosis.