动态磁敏感对比增强磁共振成像对进展性卒中的脑灌注机制研究

发布时间：2018-07-15 16:24

【摘要】：目的:运用动态磁敏感对比增强磁共振成像(DCS-MRI)技术,获取进展性及非进展性卒中患者部分血流动力学参数,初步探讨进展性卒中脑梗死前期的脑灌注机制,为临床提高疗效、改善预后提供理论基础。方法:发病24 h内急性脑卒中患者60例,入院时首先给予NISS评分,均进行DSC-MRI扫描。发病72 h内病情加重,NISS评分增加2分或以上者归入进展组(24例),未加重者归入非进展组(36例);采用Functool软件进行图像后处理,得到CBV、CBF、MTT及TTP图;利用SPSS 17.0软件,对进展组和非进展组的梗死灶中心及周围CBF、CBV、MTT、TTP进行两独立样本均数比较的t检验;以对侧半球的镜像感兴趣区作为参考,自身对照,计算患侧与对侧灌注参数的相对值。结果:进展组及非进展组梗死中心CBF下降,CBV下降,MTT增加,TTP增加,提示低灌注,两组梗死中心大部分脑组织r CBF0.5,MTT增加1.63,TI4 s,为严重低灌注,可能是缺血脑组织发展为梗死的相关危险因素。病灶周围相对正常区域灌注参数可归纳为4种类型:1低灌注,MTT明显增加,局部CBV下降,局部CBF明显下降;2侧支循环形成,MTT增加,局部CBV增加或尚可;3血流再灌注,MTT下降或正常,局部CBV增加,局部CBF正常或轻度增加;4过度灌注,局部CBV显著增加,局部CBF显著增加。其中,进展组灌注类型主要为低灌注,而非进展组包括以上4种。对病灶周围相对正常区域分析以上微循环的灌注类型,便于有效把握溶栓时间窗及制定个体化的治疗方案。结论:运用DCS-MRI,可提供超急性脑梗死前期缺血半暗带的代谢与超微形态学信息,指导临床治疗,预防和减少最终脑梗死的发生。
[Abstract]:Objective: to obtain some hemodynamic parameters of patients with progressive and non-progressive stroke by using dynamic magnetic sensitivity contrast enhanced magnetic resonance imaging (DCS-MRI), and to explore the preinfarction mechanism of progressive stroke, so as to improve the clinical efficacy. Improving prognosis provides theoretical basis. Methods: 60 patients with acute cerebral apoplexy within 24 hours after onset were given NISS score first and all were scanned by DSC-MRI. Within 72 hours after onset, those with increased NISS score of 2 or more were classified as progress group (24 cases), those without severe disease were classified as non-progressive group (36 cases), CBV CBF MTT and TTP images were obtained by Functool software, and SPSS 17.0 software was used. T test was used to compare the mean of two independent samples of the infarct center and the surrounding CBFV TTP in the progressive group and the non-progressive group, and the relative value of the perfusion parameters between the affected side and the contralateral side was calculated by using the mirror region of interest in the contralateral hemisphere as a reference and self-control. Results: the decrease of CBF and the decrease of CBV in the infarct center of the progressive group and the non-progressive group increased the level of TTP, suggesting that the cerebral tissue in most of the infarct center of the two groups increased by 1.63 TI4 s, which was a severe hypoperfusion. It may be a risk factor for ischemic brain tissue to develop into infarction. The perfusion parameters of the relative normal region around the lesion can be summarized as follows: MTT increased significantly, local CBV decreased, local CBF decreased significantly and the collateral circulation increased, and local CBV increased or decreased or normal. Local CBV increased, local CBF was normal or slightly increased, local CBV increased significantly, local CBF increased significantly. Among them, the type of hypoperfusion in the progressive group was mainly low perfusion, while the non-progressive group included the above four types. The perfusion types of the above microcirculation were analyzed in the relative normal region around the lesion, so as to effectively grasp the thrombolytic time window and formulate individualized treatment plan. Conclusion: DCS-MRI can provide metabolic and ultrastructural information of ischemic penumbra in preacute hyperacute cerebral infarction, guide clinical treatment, and prevent and reduce the occurrence of final cerebral infarction.
【作者单位】：嘉兴市第二医院;
【基金】：嘉兴市科技计划项目(项目编号2012AY1071-5)
【分类号】：R743.3;R445.2

【参考文献】