磁敏感加权成像对急性脑梗死缺血半暗带的预测价值

发布时间：2018-01-24 09:07

本文关键词： 急性脑梗死磁敏感加权成像多发低密度血管影缺血半暗带　出处：《中华实用诊断与治疗杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的探讨急性脑梗死患者磁敏感加权成像(susceptibility weighted imaging,SWI)多发低密度血管影(multiple hypointensity vessels,MHV)在预测缺血半暗带中的临床应用价值。方法急性脑梗死患者54例,均于发病3d内行MRI检查,在弥散加权成像(diffusion weighted imaging,DWI)、灌注加权成像(perfusion-weighted imaging,PWI)图像上采用半定量人工手动测量梗死体积并计算PWI-DWI不匹配(PWI-DWI mismatch,PDM);在SWI图像上对低密度血管影进行Albert卒中项目早期CT评分(Alberta Stroke Program Early CT score,ASPECTS),并依据ASPECTS评分将患者分为少血管影组15例(ASPECTS评分1~3分)、较多血管影组27例(ASPECTS评分4~6分)、大量血管影组12例(ASPECTS评分7~10分)。比较3组一般资料,DWI体积、PWI体积以及PDM;分析ASPECTS评分与PWI体积、PDM的相关性。结果大量血管影组年龄[(67.9±8.7)岁]较少血管影组[(57.8±15.6)岁]、多血管影组[(52.0±11.8)岁]大(P0.05);3组性别比例,收缩压,合并心房颤动、糖尿病、高脂血症及吸烟比例差异无统计学意义(P0.05);大量血管影组PWI体积[259.39(216.97,338.35)cm~3]、PDM[208.44(110.58,252.99)cm~3]大于少血管影组[91.21(66.34,202.40)cm~3,24.99(0.91,91.25)cm~3]、多血管影组[98.54(29.88,157.50)cm~3,34.23(3.61,125.49)cm~3](P0.05),3组DWI体积[10.63(5.76,136.21)cm~3,20.88(4.51,116.83)cm~3,14.61(4.54,65.08)cm~3]比较差异无统计学意义(P0.05);Spearman秩相关检验结果显示,ASPECTS评分与PDM和PWI体积呈正相关(r=0.438,P=0.001;r=0.463,P=0.000)。结论 SWI的MHV可替代PWI预测急性脑梗死的缺血半暗带,SWI可作为预测急性脑梗死缺血半暗带的有用放射学工具指导临床治疗。
[Abstract]:Objective to investigate the magnetic sensitivity weighted imaging (Mr) weighted imaging in patients with acute cerebral infarction. Multiple low density hypointensity vessels. Methods 54 patients with acute cerebral infarction were examined with MRI within 3 days. Diffusion-weighted imaging diffusion of weighted imaging DWI). Perfusion-weighted imaging. The infarct volume was manually measured by semi-quantitative manual method on PWI images and the PWI-DWI mismatched PWI-DWI was calculated. Early CT score of Albert Stroke Project on SWI Imaging of low density Vascular Imaging (. Alberta Stroke Program Early CT score. According to the ASPECTS score, the patients were divided into 15 patients with hypovascular shadow group (ASPECTS score 1 ~ 3 points). The ASPECTS score of 27 patients in the multiple vascular shadow group was 4 ~ 6 and that of the large vascular shadow group was 7 ~ 10. The volume of DWI was compared among the 3 groups. PWI volume and PDM; The correlation between ASPECTS score and PWI volume was analyzed. [67.9 卤8.7 years old] less vascular shadow group. [57.8 卤15.6 years old, multi-vessel shadow group. [P0.05 (52.0 卤11.8) years old; There was no significant difference in sex ratio, systolic blood pressure, atrial fibrillation, diabetes mellitus, hyperlipidemia and smoking rate among the three groups (P 0.05). Volume of PWI in large vascular shadow group. [259.39 (216.97) (338.35) / cm ~ (3) > PDM. [208.44 ~ 110.58 ~ 252.99 cm ~ (-1) was larger than that in the small vessel shadow group. [91.21 ~ 66.34 ~ 202.40 cm ~ (-1) C ~ (3) ~ (24. 99) ~ 0. 91.25 cm ~ (3) ~ (-1), multivessel shadow group. [The volume of DWI in the DWI group is 98.54 (29.88) / 157.50 / cm ~ (3) ~ (34.23) ~ 3.61 / 125.49 / cm ~ (3)) / P _ (0.05) / m ~ (3) / m ~ (-1). [10.63 ~ (5.76) ~ (136.21) 路cm ~ (-1) ~ (3) ~ (20.88) ~ (4.51) ~ (116.83) cm ~ (-1) ~ (3) ~ (14) ~ (61) ~ (4) ~ (54). There was no significant difference between the two groups (P 0.05). The results of Spearman rank correlation test showed that there was a positive correlation between ASPECTS score and PDM and PWI volume. Conclusion MHV of SWI can replace PWI in predicting ischemic penumbra of acute cerebral infarction. SWI can be used as a useful radiologic tool to predict ischemic penumbra in acute cerebral infarction.
【作者单位】：郑州大学人民医院河南省人民医院神经内科;
【正文快照】： 急性脑梗死患者缺血半暗带的氧摄取分数(oxygen extraction fraction,OEF)增高。PET脑显像通过向颈血管注射15 O来获得动-静脉间氧差别,进而测量OEF,是目前公认的评估脑缺血半暗带的金标准,但需暴露于电离辐射、检查费用昂贵等因素使其临床应用受限[1]。因此,临床应用灌注加权

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