SWI与ASL联合应用对轻中度急性脑梗死诊断及预后评估的价值

发布时间：2018-03-14 10:28

本文选题：缺血性脑卒中　切入点：动脉自旋标记　出处：《磁共振成像》2016年09期 　论文类型：期刊论文

【摘要】：目的探讨3.0 T MR磁敏感加权成像(SWI)与动脉自旋标记成像(ASL)对于急性缺血性脑卒中缺血半暗带(IP)、侧支代偿储备、出血转化(HT)、责任血管及近期预后评估的临床应用价值。材料与方法 35例急性缺血性脑卒中患者行常规MR序列、SWI和3D-PCASL检查,通过软件进行后处理,得出SWI最小密度投影图和3D-ASL伪彩图。观察35例患者梗死核心区周围引流静脉形态学改变,分为引流静脉明显显示组和正常显示组,分别对两组入院当日及15 d NIHSS评分进行分析。将未经溶栓治疗的33例患者,依据3D-ASL伪彩图提示梗死核心区周围是否出现匍匐走行条状高灌注信号,分为侧支代偿组和对照组,并对其入院当日与15 d后NIHSS评分进行分析。依据3D-ASL提示的梗死核心区灌注状态不同,分为高灌注组和低灌注组,结合SWI提示HT的发生率,统计分析梗死核心区不同灌注状态与HT发生之间的关联。结果梗死区周围引流静脉明显显示组预后好转、稳定及进展比例分别为13/27、6/27和8/27;正常显示组预后好转、稳定及进展比例分别为6/8、2/8和0/8,两组近期预后进展差异有统计学意义(P=0.0432)。侧支代偿组与对照组入院当日NIHSS评分差异无统计学意义(t=0.886,P=0.392),侧支代偿组近期预后好转、稳定及进展比例为13/17、3/17和1/17;而对照组近期预后好转、稳定及进展比例为5/16、4/16和7/16,两组15 d后NIHSS评分差异有统计学意义(t=2.296,P=0.039)。梗死核心高灌注组HT发生比例为6/6,低灌注组HT发生比例为5/29,两组差异有显著统计学意义(P=0.000)。结论 SWI与ASL联合MR常规序列检查,能够更好评估IP范围、侧支循环代偿建立状态、责任血管及HT等相关信息,对于了解急性脑卒中患者缺血梗死现状及近期预后评估提供客观依据。
[Abstract]:Objective to investigate the effects of 3.0 T Mr magnetic sensitivity weighted imaging (SWI) and spin-labeled arterial imaging (ASL) on the collateral compensatory reserve in the ischemic penumbra of acute ischemic stroke. Materials and methods 35 patients with acute ischemic stroke were examined with conventional Mr sequence SWI and 3D-PCASL. SWI minimum density projection and 3D-ASL pseudochromatic images were obtained. The morphological changes of peripheral drainage veins in 35 patients were observed and divided into two groups: obvious display group and normal display group. 33 patients without thrombolytic therapy were divided into two groups according to 3D-ASL pseudochromogram indicating whether there were creeping stripe hyperperfusion signals around the core area of infarction, and were divided into two groups: collateral compensation group and control group. The NIHSS scores on the day of admission and 15 days after admission were analyzed. According to the different perfusion states of the infarcted core area indicated by 3D-ASL, the patients were divided into high perfusion group and low perfusion group, and the incidence of HT was indicated by SWI. Results the peripheral drainage veins in the infarct area showed a significant improvement in the prognosis, the proportion of stability and progression were 13 / 27, 6 / 27 and 8 / 27, respectively, and the prognosis of the normal group was improved. The stable and progressive ratios were 6 / 8 / 8 and 0 / 8, respectively. There was a significant difference in the short-term prognosis between the two groups. There was no significant difference in NIHSS scores between the collateral compensation group and the control group on the admission day. The short-term prognosis of the collateral compensation group was better than that of the control group. The ratio of stability to progression was 13 / 17 / 17 and 1 / 17, while the control group had a better prognosis in the near term. The ratio of stable and progressive was 5 / 16 / 4 / 16 and 7 / 16. The difference of NIHSS score between the two groups was statistically significant after 15 days. The incidence rate of HT was 6 / 6 in the high perfusion group of infarct core and 5 / 29 in the low perfusion group. Conclusion the difference between the two groups is statistically significant (P0.000). SWI and ASL combined with conventional Mr sequence examination, It can better evaluate the range of IP, the state of collateral compensatory establishment, responsible blood vessels and HT, and provide an objective basis for understanding the status quo of ischemic infarction and short-term prognosis evaluation in patients with acute stroke.
【作者单位】：南京中医药大学附属连云港市中医院影像科;苏州大学附属第一医院影像科;
【分类号】：R445.2;R743.3

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