磁共振液体衰减反转恢复序列高信号表现对前循环脑梗死静脉溶栓的意义

发布时间：2018-03-06 05:25

本文选题：脑梗死　切入点：前循环　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的：本研究分为两块,分别探讨磁共振液体衰减反转恢复序列(fluid-attenuated inversion recovery imaging, FLAIR)病灶实质高信号(FLAIR Lesional Parenchymal Hyperintensity, FPH)以及血管高信号(FLAIR vascular hyperintensity, FVH)与静脉溶栓的关系。研究方法：回顾性分析本科2009年5月至2013年12月连续收集的具有溶栓前和溶栓后24小时多模式磁共振的缺血性脑卒中静脉溶栓患者的临床和影像资料。选取前循环梗死的病例,评估梗死病灶是否存在高信号表现(FPH)以及大脑中动脉远端供血区域FVH的程度,并分析FPH、FVH与静脉溶栓后再灌注、出血转化以及功能预后的关系,溶栓后3月随访改良Rankin评分,2分定义为预后不良。研究结果：共纳入95例患者分析,39例(41.0%)FPH阳性,与FPH阴性者相比,FPH阳性者年龄小(64.0±11.8vs.72.2±11.5；P=0.001)、起病-影像检查时间长(onset to imaging time, OIT)(217.6＋78.6vs.180.0±63.5; P=0.012)高血压病史少见(50.9%vs.80.4%；P=0.023),其独立影响因素是OIT(OR=1.011,95%CI：1.004—1.018；P=0.003)、年龄(OR=0.926,95%CI：0.887—0.968；P=0.001)和既往卒中史(OR=4.412,95%CI:1.188—16.379；P=0.027)。FPH阳性不增加溶栓后出血转化的风险(43.5%vs.34.6%； P=0.434),意味着较低的溶栓后再通率(OR=0.203,95%CI：0.043—0.961；P=0.044),是3月预后不良的独立危险因素(OR=5.461,95%CI:1.346-22.151；P=0.017)。57例(60.0%)存在FVH,较FVH阴性者基线NIHSS高(7.2±4.5vs.12.1+6.1；P0.001)、弥散成像(diffusion weighted imaging,DWI)病灶更大(2vs.5.5；P=0.002)、灌注成像(perfusion weighted imaging,PWI)低灌注区更大(3vs.73.5；P0.001)、近端大血管闭塞者多见(10.5%vs.82.5%；P0.001),其中后者为FVH阳性的独立影响因素(OR=48.712,95%CI：7.772-305.326; P0.001); FVH日性者出血转化率更高(80.8%vs.52.2%；P=0.011),但不构成出血转化的独立影响因素(OR=1.079,95%CI：0.278—4.181；P=0.913)；FVH阳性基线目标不匹配更大(OR=8.557,95%CI：2.592—28.245；P0.001),但不增加早期再灌率(OR=0.441,95%CI:0.089—2.179；P=0.315),是3月预后不良的独立危险因素(OR=3.826,95%CI:1.125-13.257；P=0.032)；早期再灌是所有溶栓患者3月预后良好的独立预测因素(OR=5.196,95%CI：1.266-21.322；P=0.022),对FVH阳性者预后改善尤其显著(OR=14.908,95%CI：2.100-105.852；P=0.007)。研究结论： FPH的存在与缺血事件持续的时间有关,其存在降低溶栓后再通率；FVH的存在则与大血管严重狭窄有关,基线梗死更严重,目标不匹配区更大；二者均不增加溶栓出血转化风险,均影响静脉溶栓远期预后,但早期再灌注可显著改善FVH阳性者的溶栓预后。相对于物理时钟,FPH可能是更准确的组织时钟；而FVH作为侧枝血供,可能为再灌注策略选择提供一定的信息。
[Abstract]:Objectives of the study:. The purpose of this study was to investigate the relationship between fluid-attenuated inversion recovery imaging (flair) and vascular hyperintense vascular (FVH) in patients with fluid-attenuated inversion recovery imaging (flair). Research methods:. The clinical and imaging data of ischemic stroke patients with multimode magnetic resonance imaging before and after thrombolysis were analyzed retrospectively from May 2009 to December 2013. The patients with anterior circulation infarction were selected. To evaluate the presence of hyperintense FVH in the infarct focus and the extent of FVH in the distal middle cerebral artery (MCAA), and to analyze the relationship between FVH and reperfusion, hemorrhage transformation and functional prognosis after thrombolytic therapy. The modified Rankin score was followed up on March after thrombolysis and 2 points were defined as poor prognosis. Results of the study:. A total of 95 patients were included in this study. 39 patients with FPH were found to be 41.0 positive. The age of patients with positive FPH was 64.0 卤11.8vs.72.2 卤11.5p 0.001g, the onset time was longer than that of imaging time, OIT)(217.6+78.6vs.180.0 卤63.5; P0.012) the patient had a rare history of hypertension. The independent influential factors were: OITOR1.01195CIW 1.004-1.018P0.003, age OR260.995 CIW 0.887-0.368 P0.001) and stroke history OR4.412951.188-16.379P0.027P0.27. the independent influential factors were: OITOR1.01195CIw 1.004-1.01818P0.003, age OR260.995CI0 0.887-0.368 P0.001) and stroke history OR4.41295951.188-16.379P0.027Ph + no increase in CI. The risk is 43.5vs.34.6. P0. 3434, which means that the lower rate of recanalization after thrombolysis is OR0.203 / 95CIV: 0.043-0.961P0.0444.It is an independent risk factor for poor prognosis on March, OR5.461C95CI: 1.346-22.151P0.017.57) FVHs, 7.2 卤4.5vs.12.1 6.1P0.001N, 2vs.55.5P0. 00PPWT, 2vs.55.5P0. 00PPW2, perfusion imaging weighted imaging / weighted imaging / weighted imaging / imaging / imaging / imaging / DWI / P / P / P ~ (0.001) / P ~ (0.001) / P ~ (0.001) / P ~ (0.001) / P ~ (0.0011), P = = =. The larger note area is 3vs.73.5% P0.001T, and 10.5vs.82.5% P0.001g is more common in the patients with proximal macrovascular occlusion. The latter is the independent influencing factor of FVH positivity, OR48.712C95CIV7.772-305.326; P0.001; FVH daily haemorrhage conversion rate is higher than 80.8vs.52.2g / P0.01; but the independent influencing factor does not constitute the independent factor of OR1.079-95CI0.278-4.181Pt0. 0278-4. 181Pt0. 0278-4. 181Pt0. 9131Pt0 mismatch the FVH positive baseline target. The larger OR8.55795 CIV 2.592-28.245P0.001, but without increasing the early reperfusion rate, OR0.441-95CI0.089-2.179P0.315, is an independent risk factor for poor prognosis on March, OR3.82695CII 1.125-13.257P0.032; early reperfusion is an independent predictor of a good prognosis for all thrombolytic patients on March; an independent predictor of the prognosis of all patients with thrombolytic thrombolysis is 5.19695CI1.266-322P0.022222.The prognosis of FVH positive patients is especially improved by 14.90895CI2.100-105.852P0.072. Conclusion:. The presence of FPH was related to the duration of ischemic events. The presence of FPH was associated with severe stenosis of large vessels, more severe baseline infarction and larger target mismatch area, and neither of them increased the risk of thrombolytic hemorrhage. Early reperfusion could significantly improve the prognosis of thrombolytic therapy in patients with FVH positive. FVH may be a more accurate tissue clock than physical clock. It may provide some information for the choice of reperfusion strategy.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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