亚急性期脑梗死病灶微结构和微循环改变的IVIM研究

发布时间：2018-04-20 13:16

  本文选题：脑梗死 + 亚急性期　； 参考：《浙江大学》2017年硕士论文

【摘要】：研究目的探讨基于体素内不相干运动(introvoxel incoherent motion,IVIM)的亚急性期脑梗死病灶内微结构和微循环的改变,并初步探究IVIM参数值和临床转归的关系。研究方法纳入25例起病第3-7天、未进行溶栓治疗的大脑中动脉供血区域脑梗死患者,进行弥散加权成像(diffusion-weighted imaging,DWI)及IVIM扫描,记录入院基线 NHISS(NationalInstitute of Health stroke scale)评分,并且以 3 个月后 mRS(modified Rankin Scale)评分2分定义为预后较差。依据表观弥散系数(apparent diffusion coefficient,ADC)值将病灶分为不同感兴趣区(region ofinterest,ROI),包括核心梗死区(ADC≤0.55×10-3 mm2/s)和核心周围区(ADC0.55×10-3 mm2/s),再分别得到这些ROI的体积、ADC值和IVIM各参数值。IVIM经过图像处理后得到的参数:慢弥散系数(slow diffusion coefficient,D)、快弥散系数(fast diffusion coefficient,D*)和灌注分数(perfusion fraction,f)。校正 ADC(rADC)值定义为核心梗死区ADC值与对侧ADC值的比值,同理可得病灶内核心梗死区和核心周围区的各rADC值、rD值、rD*值和rf值。采用配对T检验和Pearson相关分析比较各ROI影像学参数存在的差异及关系。进一步分析IVIM各参数分别和入院NIHSS评分、3月后随访mRS评分的相关性。研究结果(1)病灶内ADC、D和f值均较对侧下降(P0.05)。(2)核心周围区rADC,rD和rf值较核心梗死区明显降低(P0.001)。(3)在核心梗死区rADC和rD呈负相关(P=0.004),在核心周围区 rADC 和 rD(P=0.01)、rADC 和 rf(P=0.029)均呈负相关。(4)核心梗死区的rD值分别和NIHSS评分、3月后mRS评分呈负相关。研究结论核心周围区较核心梗死区D和f值增高,提示脑梗死亚急性期核心周围区病理生理的代偿,微结构和微循环代偿可能。D值能为脑梗死的临床预后评价提供信息。
[Abstract]:Objective to investigate the changes of microstructures and microcirculation in subacute cerebral infarction lesions based on intra voxel incoherent motionIVIMA, and to explore the relationship between IVIM parameters and clinical outcome. Methods Twenty-five patients with cerebral infarction in the middle cerebral artery supplying region without thrombolytic therapy were enrolled in the study. Diffusion weighted imaging imaging (DWI) and IVIM scan were performed to record the baseline NHISS(NationalInstitute of Health stroke scale score. And the mRS(modified Rankin scale score of 2 was defined as poor prognosis 3 months later. According to the apparent diffusion coefficient diffusion diffusion coefficient, the lesions are divided into different regions of interest, including ADCs 鈮，

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