急性脑梗死FLAIR高信号血管征的影像学评估

发布时间：2018-04-14 21:44

本文选题：急性脑梗死 + 磁共振成像　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的研究大脑中动脉供血区发生急性梗死时,FLAIR高信号血管(FLAIR hyperintense vessel,FHV)征的显影情况,探讨FHV征与入院NIHSS评分、梗死面积、责任血管狭窄程度和位置、脑白质稀疏程度、SWI-m IP图上静脉异常、梗死周围血流灌注状态、出血性转化及近期预后的相关性,评估急性脑梗死患者FHV征的临床意义。材料与方法纳入发病72小时内未经溶栓治疗的急性脑梗死患者67例,采用西门子Skyra 3.0T磁共振仪进行扫描,扫描序列包括T1WI、T2WI、DWI、FLAIR、MRA、SWI及ASL检查,有13例患者在入院后4-8天内复查MRI。根据FLAIR序列上有无FHV征分为FHV阴性组和FHV阳性组,当FHV出现范围超过DWI梗死范围时,存在“FHV-DWI不匹配区”,比较两组基线资料,入院NIHSS评分、梗死面积、责任血管狭窄程度及位置、脑白质稀疏程度、静脉异常、“FHV-DWI不匹配区”血流灌注状态、出血性转化有无差异或相关性;对FHV征阳性患者,FHV分布范围及静脉异常分布范围进行ASPECT评分,分析其FHVASPECT评分与责任血管狭窄程度及位置、脑白质稀疏程度、静脉异常ASPECT评分有无相关性。观察13例FHV征阳性患者复查时FHV征变化,评估其与患者近期病情变化的关系。结果67例急性脑梗死患者,FHV征阳性者38例(56.7%),阴性者29例。FHV征阳性组入院NIHSS评分高于FHV征阴性组(P=0.0250.05)。FHV征阳性组较阴性组梗死面积大(r=0.555,P0.001)。FHV征阳性组较阴性组血管狭窄程度重(r=0.747,p0.001);且FHV-ASPECT评分越高血管狭窄程度越重(r=0.556,P0.001)。FHV征阳性组较阴性组血管病变部位更靠近大动脉近端(r=-0.614,P0.001),且FHV-ASPECT评分越高,血管病变部位越靠近大动脉近端(r=-0.479,P0.001)。FHV征阳性组较阴性组脑白质稀疏程度重(r=0.281,P=0.0210.05);且FHV-ASPECT评分越高,脑白质稀疏程度越重(r=0.363,P=0.0250.05)。FHV征阳性患者多存在静脉异常(X2=59.101,P0.001);且二者ASPECT评分具有良好的一致性(r=0.888,P0.001)。“FHV-DWI不匹配区”存在灌注异常(X2=19.813,P0.001),且多为低灌注,占76.5%(26/34)。FHV征与梗死后急性期颅内出血性转化无关(P=0.3930.05)。13例FHV征阳性患者复查结果示:无患者FHV-ASPECT评分升高;8例FHV征消失或FHV-ASPECT评分降低患者,无再发梗死,NIHSS评分降低;5例FHV-ASPECT评分无变化患者,有再发梗死,NIHSS评分不变或升高。结论急性脑梗死患者,FHV征的出现提示颅内大动脉近端严重狭窄或闭塞,且患者脑白质稀疏程度相对较重。FHV与SWI-m IP静脉异常分布范围具有良好的一致性,二者均反映脑组织缺血期间血流动力学的改变;FHV征可反映梗死周围脑组织的血流灌注状态,对无法或没有条件进行灌注扫描患者,FHV征有助于临床评估患者病情,指导进一步治疗方案。FHV征的出现提示梗死面积大、神经功能障碍重;对FHV征阳性患者,FHV-ASPECT评分降低提示近期预后相对较好。
[Abstract]:Objective to study the flair hyperintense vessel hyperintense (FHVV) sign in patients with acute infarction in the middle cerebral artery (MCA) supply area, and to investigate the FHV sign and admission NIHSS score, infarct size, degree and location of responsible vessel stenosis.To evaluate the clinical significance of FHV sign in patients with acute cerebral infarction (ACI), the degree of white matter sparsity and the correlation among the superior venous abnormalities on SWI-m IP, the blood perfusion state around the infarction, the hemorrhagic transformation and the short-term prognosis.Materials and methods 67 patients with acute cerebral infarction who were not treated with thrombolysis within 72 hours were examined by Siemens Skyra 3.0T magnetic resonance imaging. The scanning sequence included T1WII T2WIT FLAIRMRAMRASWI and ASL, and 13 patients were re-examined within 4-8 days after admission.According to the FHV sign on FLAIR sequence, the patients were divided into FHV negative group and FHV positive group. When the range of FHV appeared beyond the infarct area of DWI, there was "FHV-DWI mismatch area". The baseline data, NIHSS score of admission, infarct area were compared between the two groups.The degree and location of blood vessel stenosis, the degree of white matter sparsity, the venous abnormality, the blood perfusion state of "FHV-DWI mismatch area", whether there is any difference or correlation in hemorrhagic transformation;The distribution and abnormal distribution of FHV in patients with FHV sign were evaluated by ASPECT. The relationship between FHVASPECT score and the degree and location of responsible vascular stenosis, the degree of white matter sparsity, and the ASPECT score of venous abnormality was analyzed.The changes of FHV sign in 13 patients with positive FHV sign were observed.Results in 67 patients with acute cerebral infarction, 38 patients were positive for FHV sign and 29 patients were negative for FHV sign. The NIHSS score was higher in the positive group than that in the negative group of FHV sign. The degree of vascular stenosis in the positive group was higher than that in the negative group.The higher the FHV-ASPECT score was, the more severe the stenosis degree was, and the higher the FHV-ASPECT score was, the closer the lesion site was to the proximal end of the great artery in the positive group than to the negative group. The higher the FHV-ASPECT score was, the higher the FHV-ASPECT score was.The closer the lesion was to the proximal end of the great artery, the more sparse the white matter in the positive group was than that in the negative group, and the higher the FHV-ASPECT score was, the higher the FHV-ASPECT score was.The more serious the degree of white matter sparsity is, the more severe the patients with positive FHV sign are, the more serious the white matter is, the more the patients with positive FHV sign have venous abnormalities, and the ASPECT scores of them are in good agreement with that of 0.888U P0.001.There are abnormal perfusion in the "FHV-DWI mismatch area", and most of them are low perfusion, and most of them are low perfusion.There was no correlation between 76.5%(26/34).FHV sign and acute intracranial hemorrhagic transformation after infarction. The results showed that no increase in FHV-ASPECT score was found in 8 patients with disappearance of FHV sign or decrease in FHV-ASPECT score, and no change in FHV-ASPECT score was found in 5 patients with no recurrent infarction.The NIHSS score of recurrent infarction remained unchanged or increased.Conclusion the appearance of FHV sign in patients with acute cerebral infarction suggests severe stenosis or occlusion of the proximal part of the large intracranial artery, and the degree of cerebral white matter sparsity is relatively heavy. FHV has a good consistency with the abnormal distribution of SWI-m IP veins.Both of them reflect the changes of hemodynamics during cerebral ischemia. FHV sign can reflect the perfusion state of cerebral tissue around infarction.The appearance of FHV sign suggested that the infarct size was large and the neurological dysfunction was serious, and the lower FHV-ASPECT score in the patients with positive FHV sign suggested a relatively good prognosis in the near future.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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