徐 群

上海交通大学医学院附属仁济医院神经内科，上海 200127



指南解读Comment on Guideline

脑小血管病影像标志共识指南解读

徐 群

上海交通大学医学院附属仁济医院神经内科，上海 200127

摘要

关键词：脑小血管病；神经影像；磁共振成像；标准

徐 群. 脑小血管病影像标志共识指南解读［J］. 神经病学与神经康复学杂志， 2016， 12（1）:17–23.

FUNDlNG/SUPPORT: Supported by Science and Technology Commission of Shanghai Municipality （No. 14411964400）

CONFLlCT OF lNTEREST: The author has indicated she has no conflicts of interest to disclose. Received Jan. 29， 2016； accepted for publication Mar. 1， 2016

Copyright © 2016 by Journal of Neurology and Neurorehabilitation

XU Qun

E-MAIL ADDRESS

xuqun628@163.com

ABSTRACT

Cerebral small vessel disease （CSVD） is a common disease accompanied by aging and is also usually concomitant with neurodegeneration diseases， exacerbating cognitive impairment and physical disability. The lack of consistency of terminology， definition，image acquisition and scientific report of CSVD hampers the further understanding of effects of CSVD on pathophysiological and clinical features of common neurodegenerative diseases. A working group of global research specialists made a comprehensive review of neuroimaging markers of CSVD. The standard of interpretation of terminology and definition of six neuroimaging markers indicating key characteristic manifestations of CSVD， minimum standard for image acquisition and analysis， agreement on scientific reporting of neuroimaging features of CSVD， and new imaging methods for early detection of CSVD， were developed in 2012. These six neuroimaging markers include recent small subcortical infarcts， lacune of presumed vascular origin， white matter hyperintensities ofpresumed vascular origin， perivascular space， cerebral microbleeds and brain atrophy. The new standard should not be applied only to research work but also to the clinical practice，in order to improve the standardization of interpretation， acquisition and reporting of neuroimaging features of CSVD.

To cite: XU Q. New standard of neuroimaging markers of cerebral small vessel disease. J Neurol and Neurorehabil， 2016， 12（1）:17–23.

脑小血管病（cerebral small vessel disease，CSVD）是引发痴呆的最常见病因，亦是引发混合性痴呆的主要因素，且1/5的卒中是由CSVD引起的。临床上常见的神经退行性疾病，如阿尔茨海默病（Alzheimer’s disease，AD），在老年人群中通常与脑血管病并存。CSVD与AD有着共同的危险因素，且均可导致认知障碍和痴呆，临床上难以鉴别血管性认知障碍（vascular cognitive impairment，VCI）与AD。CSVD的传统磁共振成像（magnetic resonance imaging，MRI）表现包括近期皮质下小梗死、MRI白质高信号、腔隙灶、血管周围间隙（perivascular space，PVS）、脑微出血（cerebral microbleed，CMB）及脑萎缩［1］。然而，有关这些损伤的专业术语及其定义在不同的研究中存在显著差异，因此很难对不同的研究进行比较，同时也不利于对这些损伤的危险因素、病理生理及临床结局等进行深入探讨。同一种损伤在各项研究中因定义不同而导致分类不同，例如小空腔（small cavity）在不同研究中被分别定义为PVS或腔隙灶［2］。

急性CSVD及其相关损伤的临床结局各不相同，且不同病因的病损发生融合后，在MRI上可有相似的后期表现，这些均妨碍了对研究数据的解读。在多中心研究中，采用标准化的名词及其定义，并规范影像学检查及分析的方法，有助于在最大程度上消除上述因素对研究的不利影响。此外，将这些标准化措施应用于临床实践，可以进一步提高早期认知障碍患者的诊断及其病因的明确。……