CAJ | 학술논문

目的探讨脑内血肿的经颅超声(TCCS)及经颅超声造影(CE-TCCS)特征及其临床价值.方法随机选取临床拟诊断为急性脑内血肿(ICH)患者66例,利用TCCS在急性期、亚急性期与慢性期观察血肿回声、边界改变,计算血肿体积,并在急性期观察颅内结构并发症.随机选取其中32例在亚急性期行CE-TCCS检查,观察血肿大小、形态及灌注情况,并与造影前对比.将TCCS、CE-TCCS结果与CT平扫、CT灌注(CTP)结果进行统计学分析.结果 ①CT:61例(61/66)经CT平扫证实为ICH；②TCCS:共显示50例(50/61)ICH,急性期时探测到其中33例ICH伴有侧脑室受压或扩张、血肿破入脑室及中线移位等并发症.血肿随着时间延长回声逐渐减低,边界逐渐清晰光滑.各期血肿长、宽、厚径及血肿体积与CT平扫测量值之间均具有良好相关性.③CE-TCCS:经病灶同侧颞窗观察的30例ICH均显示清晰,血肿长径、宽径与CT平扫结果的相关性优于TCCS.2例经对侧颞窗观察的ICH均显示不清.7例(21.9％)ICH于血肿周边可见低增强水肿带,其宽度与CTP结果相关性良好.结论 TCCS能够明确血肿部位、出血量、颅内结构并发症及其不同阶段的二维超声特征,可对患者病情进行监测并对疾病病程进行初步判断；CE-TCCS可更加清晰显示血肿形态、边界,提供血肿周围组织的血流灌注信息,能够更方便地动态观察水肿带变化.
목적 탐토뇌내혈종적경로초성(TCCS)급경로초성조영(CE-TCCS)특정급기림상개치.방법 수궤선취림상의진단위급성뇌내혈종(ICH)환자66례,이용TCCS재급성기、아급성기여만성기관찰혈종회성、변계개변,계산혈종체적,병재급성기관찰로내결구병발증.수궤선취기중32례재아급성기행CE-TCCS검사,관찰혈종대소、형태급관주정황,병여조영전대비.장TCCS、CE-TCCS결과여CT평소、CT관주(CTP)결과진행통계학분석.결과 ①CT:61례(61/66)경CT평소증실위ICH；②TCCS:공현시50례(50/61)ICH,급성기시탐측도기중33례ICH반유측뇌실수압혹확장、혈종파입뇌실급중선이위등병발증.혈종수착시간연장회성축점감저,변계축점청석광활.각기혈종장、관、후경급혈종체적여CT평소측량치지간균구유량호상관성.③CE-TCCS:경병조동측섭창관찰적30례ICH균현시청석,혈종장경、관경여CT평소결과적상관성우우TCCS.2례경대측섭창관찰적ICH균현시불청.7례(21.9％)ICH우혈종주변가견저증강수종대,기관도여CTP결과상관성량호.결론 TCCS능구명학혈종부위、출혈량、로내결구병발증급기불동계단적이유초성특정,가대환자병정진행감측병대질병병정진행초보판단；CE-TCCS가경가청석현시혈종형태、변계,제공혈종주위조직적혈류관주신식,능구경방편지동태관찰수종대변화.
Objective To explore the characteristic of transcranial color-coded sonography(TCCS)and contrast-enhanced transcranial color-coded sonography (CE-TCCS) in patients with intracerebral hemorrhage and thiers clinical value.Methods 66 patients were randomly selected,whose preliminary clinical diagnosis were intracerebral hemorrhage (ICH).The patients were followed up by TCCS in acute phase,subacute phase and chronic phase.The changes of the echo,boundary and the hematoma volume were recorded in different stages.In acute phase,patients' complications of intracerebral structure were observed.32 patients were selected randomly to underwent CE-TCCS examination in the subacute phase.The size,shape and the perfusion situation of hematoma were observed.The results of CE-TCCS were compared with the results of TCCS.Correlation analysis was made between the results of ultrasound and CT scan.Results (1) CT results:61 patients (61/66) were confirmed ICH through CT scan.(2) TCCS results:50 patients (50/61) with ICH could show the bleeding site.TCCS showed that 33 patients with ICH accompanied by intraventricular pressure,haematoma defeats ventricle and midline shift in acute phase.The echo became lower and the boundary became more clear with time.The long diameter,wide diameter,thickness diameter and volume of hematoma in different stages on TCCS had a good correlation with that on CT scan.(3)CE-TCCS results:30 cases of intracerebral hematoma could be clearly displayed the situation of hematoma through the ipsilateral temporal window.Compared with TCCS,CE TCCS had a better correlation with CT scan on the measurement of the hematoma length,width.The images of 2 cases observed through contralateral temporal window failded to be clearly shown.In 7 cases of ICH,visible low-enhanced edema area could be seen around the hematoma.The width of the edema area had a good correlation with the CTP result.Conclusions TCCS could clearly show the bleeding sites,hematoma volume and complications and the features of ICH in different stages of disease.TCCS could be used to monitor the condition of patients with ICH and recognized the disease progression initially.CE-TCCS had a much more clear display of intracerebral hematoma location,shape,boundary.At the same time,CE-TCCS could provide blood perfusion information of surrounding tissue in hematoma so that it could observe the change of peripheral edema more convenient.