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Диагностика церебральных микрокровоизлияний

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Цель: повысить эффективность диагностики и дифференциальной диагностики церебральных микрокровоизлияний (ЦМК) с помощью МРТ в режиме градиентного эхо (Т2*) при выявлении заболеваний мелких сосудов головного мозга. Материал и методы. Выполнено пилотное исследование с участием 40 пациентов (средний возраст 73,9 года, 23 (57,5%) пациента мужского пола) с цереброваскулярными и нейродегенеративными заболеваниями с когнитивными нарушениями на базе Городской клинической больницы им. С.П. Боткина Москвы. МРТ проводили на томографе Signa Excite фирмы GE (США, 2006) с напряженностью магнитного поля 1,5 Тл, толщина среза в режиме градиентного эхо 5 мм. Результаты. Общее число ЦМК составило 220, из них 161 корковой локализации. У 11 из 15 пациентов с болезнью Альцгеймера наблюдали ЦМК, локализованные в корковых отделах головного мозга преимущественно в затылочных (65%) и височных (19%) долях. При цереброваскулярных заболеваниях ЦМК встречали только при выраженной сосудистой лейкоэнцефалопатии III стадии (7 случаев, 18%) подкорковой локализации. Выводы. При дифференциальной диагностике следует учитывать локализацию ЦМК, а именно: признаком церебральной амилоидной ангиопатии являются ЦМК корковой локализации, а гипертонической микроангиопатии – ЦМК преимущественно подкорковой локализации.

Ключевые слова:
церебральные микрокровоизлияния, Т2-взвешенный режим градиентного эхо, магнитно-резонансная томография, гипертоническая микроангиопатия, церебральная амилоидная ангиопатия

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Diagnosis of Cerebral Microbleeds

Aim. Improving the efficiency of diagnosis and differential diagnosis of cerebral microbleeds (CM), using T2-weighted gradient echo magnetic resonance imaging for detection of small vessels diseases in the brain. Materials and methods. We carried out a pilot study with 40 patients (mean age 73.9 years, 23 (57,5%) male patients) with cerebrovascular and neurodegenerative diseases with cognitive impairment on the basis of Clinical Hospital of S.P.Bodkin. MRI was performed on a tomograph with a magnetic field of 1.5 Tesla «Signa Excite» company GE (USA, 2006), the thickness of the slice was 5 mm. Results. The total number of CMs were 220, of which 161 cortical localization. 11 patients from 15 with Alzheimer's disease had cortical CMs in the occipital (65%) and temporal (19%) regions. Patients with cerebrovascular disease had subcortical CMs only in cases of severe vascular leukoencephalopathy stage 3 (7 cases, 18%). Conclusions. In the differential diagnosis should consider the localisation CM, namely cortical CMs as a sign of cerebral amyloid angiopathy, and subcortical CMs as hypertensive microangiopathy.

Keywords:
cerebral microbleeds, T2*-weighted gradient-echo, magnetic resonance imaging, hypertensive microangiopathy, cerebral amyloid angiopathy.