[1]徐胜男,马贺骥.磁共振多模态成像在超急性期大面积脑梗死诊断中的价值研究[J].陕西医学杂志,2021,50(8):995-998.[doi:DOI:10.3969/j.issn.1000-7377.2021.08.023]
　XU Shengnan,MA Heji.Value of multi-modal magnetic resonance imaging in diagnosis of hyperacute massive cerebral infarction[J].,2021,50(8):995-998.[doi:DOI:10.3969/j.issn.1000-7377.2021.08.023]
点击复制

磁共振多模态成像在超急性期大面积脑梗死诊断中的价值研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年8期
页码:
995-998
栏目:
临床研究
出版日期:
2021-08-05

文章信息/Info

Title:
Value of multi-modal magnetic resonance imaging in diagnosis of hyperacute massive cerebral infarction
作者:
徐胜男; 马贺骥
(锦州医科大学附属第一医院磁共振室,辽宁 锦州 121001)
Author(s):
XU Shengnan; MA Heji
(Magnetic Resonance Imaging Room,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121001,China)
关键词:
超急性期大面积脑梗死;  诊断;  磁共振多模态成像;  扩散加权成像;  灌注成像;  弥散张量成像
Keywords:
Hyperacute massive cerebral infarction;  Diagnosis;  Multi-modal magnetic resonance imaging;  Diffusion weighted imaging;  Perfusion imaging;  Diffusion tensor imaging
分类号:
R 743.33
DOI:
DOI:10.3969/j.issn.1000-7377.2021.08.023
文献标志码:
A
摘要:
目的:探究磁共振(MR)多模态成像对超急性期大面积脑梗死的诊断价值。方法:选取大面积脑梗死患者119例,其中85例患者发病时间为小于6 h,为超急性期大面积脑梗死,计为观察组; 34例患者发病时间为7～72 h,为急性期大面积脑梗死,计为对照组。收集两组患者发病时的磁共振多模态成像资料,对比两组患者相关参数。结果:观察组患者脑缺血半暗带(IP)区域的扩散加权成像(DWI)指数表观扩散系数(ADC)值大于病灶中心区(P<0.05),小于IP对侧健区(P<0.05),对照组患者IP、病灶中心区的ADC值差异无统计学意义(P>0.05); 观察组患者IP的ADC值大于对照组(P<0.05),两组病灶中心区ADC值比较无统计学差异(P>0.05); 观察组患者IP区的表观扩散系数比率(ADCR)值大于病灶中心区(P<0.05),大于对照组IP的ADCR(P<0.05); 患侧脑血流量平均通过时间(MTT)长于对侧健区(P<0.05)、局部对脑血容量(rCBV)小于对侧健区(P<0.05),观察组患者的MTT小于对照组(P<0.05),rCBV大于对照组(P<0.05); 观察组患者患侧、对侧健区弥散张量成像(DTI)参数各向异性指数(FA)、容积比各向异性(VRA)比较无统计学差异(P>0.05),而对照组患侧上述参数要小于对侧健区(P<0.05),两组患者患侧、对侧健区平均弥散系数(DCavg)比较均无统计学差异(P>0.05)。结论:IP在DWI中呈现高信号、低ADC值,且ADC值处于病灶中心区、对侧健区之间,而ADCR值大于病灶中心区; 在灌注成像(PWI)中表现为低rCBV、长MTT; 超急性期大面积脑梗死患者患侧FA、VRA并未发生显著变化,而急性期患者显著降低,MR多模态成像对超急性期大面积脑梗死具有一定的临床诊断价值。
Abstract:
Objective:To explore the clinical value of multi-modal magnetic resonance(MR)imaging in the diagnosis of hyperacute massive cerebral infarction.Methods:Totally 119 patients with massive cerebral infarction were enrolled in this study.Among them,85 patients whose onset time was shorter than 6 hours were diagnosed with hyperacute massive cerebral infarction and included in the observation group,while 34 patients whose onset time was 7 to 72 hours were diagnosed with acute massive cerebral infarction and included in the control group.The multi-modal MR imaging data of the two groups at onset were collected,and relevant parameters were compared between the two groups.Results:In the observation group,the apparent diffiusion coefficient(ADC)value in diffusion weighted imaging(DWI)of ischemic penumbra(IP)was higher than that of the lesion centre,and smaller than that of IP on the contralateral side(all P<0.05).In the control group,the ADC values of IP and the lesion centre showed no statistically significant difference(P>0.05).The ADC value of IP in the observation group was higher than that in the control group(P<0.05),but there was no difference in the ADC value of the lesion centre between the two groups(P>0.05).The apparent diffiusion coefficient ratio(ADCR)of IP in the observation group was higher than that of the lesion centre,and higher than that of IP in the control group(both P<0.05).The mean transmitting time(MTT)on the affected side was longer than that on the contralateral healthy side(P<0.05),and region cerebral blood volume(rCBV)was smaller than that on the contralateral healthy side(P<0.05).The observation group had shorter MTT and higher rCBV than the control group(both P<0.05).In the observation group,there were no significant differences in diffusion tensor imaging parameters fractional anisotropy(FA)and volume ratio anisotropy(VRA)between the affected side and contralateral healthy side(all P>0.05).The above parameters on the affected side of the control group were smaller than those of the observation group(all P<0.05).The average diffusion coefficient(DCavg)values on the affected side and the contralateral healthy side showed no significant difference between the two groups(P>0.05).Conclusion:IP shows high signal and low ADC value in DWI,and its ADC value is between the value of lesion centre and the value of contralateral healthy side,while the ADCR value is higher than that of lesion centre.Low rCBV and long MTT are observed in perfusion weighted imaging(PWI).No obvious changes in FA and VRA on the affected side are observed in patients with hyperacute massive cerebral infarction,but the two parameters decrease significantly in acute phase,which indicates that multi-modal MR imaging has certain clinical value in the diagnosis of hyperacute massive cerebral infarction.

参考文献/References:

[1] 杨 琳,常 翔,张 伟.通窍活血法治疗急性大脑中动脉大面积脑梗塞临床观察[J].陕西中医,2017,38(11):1515-1516.
[2] 徐 蕊,燕桂新,陈文静.磁敏感加权成像、磁共振常规序列及扩散加权成像在大面积脑梗死出血性转化中的诊断价值[J].中国临床实用医学,2018,9(2):13-16.
[3] 汤奉琼,李洪义.老年超急性与急性缺血性脑梗死患者磁共振弥散张量成像特征比较[J].中国老年学杂志,2020,40(8):34-37.
[4] 蔡传萍,金冬梅,录欣欣,等.功能性电刺激治疗对脑梗死大鼠神经功能和缺血半暗带GSK-3β蛋白的影响[J].中国康复医学杂志,2018,33(6):647-652.
[5] 方 琪,王希明,李子惠.急性缺血性脑卒中缺血半暗带影像评估研究进展[J].第二军医大学学报,2018,39(9):954-958.
[6] 林惠花,王瑞芳,宁清灵,等.超急性期脑梗死大脑中动脉高密度征的综合分析[J].中国临床医学影像杂志,2018,29(9):8-10,18.
[7] 俞 茜,冯天保,王晓慧,等.磁共振成像平扫、磁敏感加权成像诊断急性脑梗死临床价值对比研究[J].陕西医学杂志,2021,50(4):425-427.
[8] 杜 伟,庞长河,薛亚轲,等.美国神经重症监护学会《大面积脑梗死治疗指南(2015)》解读[J].中华神经医学杂志,2016,15(1):2-5.
[9] 华神经外科学会.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381 -383.
[10] 张小芬,闻彩云,李建策,等.急性脑梗死大脑皮、髓静脉的磁敏感加权成像解剖研究[J].中国临床解剖学杂志,2018,36(2):153-157.
[11] 张 冰,刘 筠,廉凯茜,等.磁敏感加权成像诊断急性脑梗死动脉血栓的临床应用价值[J].中国临床医学影像杂志,2017,28(5):315-317.
[12] 吕铁钢,刘挨师,杨晓光,等.MRI与颅脑CT在早期脑梗死诊断中的价值对比分析[J].中国地方病防治杂志,2017,32(9):1042,1045.
[13] 赵大聪,鲁广华,郭 江,等.SWI在超急性大面积脑梗死中的应用价值[J].实用放射学杂志,2016,32(4):517.
[14] 滕志朋,罗 超,彭 形,等.DWI显影延迟的急性脑梗死1例报告[J].中国神经精神疾病杂志,2017,9(43):16,34
[15] 朱云波,李佳佳,高燕军,等.大鼠急性脑梗死后超时间窗溶栓治疗对脑损伤的影响[J].中国老年学杂志,2018,2(38):30-33.
[16] 马得廷,王君霞,张有军,等.表观扩散系数在中脑脚间区扩散高信号与急性脑梗死中的鉴别诊断价值[J].临床放射学杂志,2016,35(2):174-178.
[17] 张 佳,朱海峰,马运萍.核磁共振脑灌注成像及DWI联合应用在诊断早期脑梗死缺血半暗带中的临床价值[J].卒中与神经疾病,2018,25(3):14-17.
[18] 任国利,袁 涛,全冠民.脑缺血半暗带酰胺质子转移成像研究进展[J].中国医学影像学杂志,2017,25(1):54-57.
[19] 付志勇,王正则,孙晓红.磁共振血管成像-扩散加权成像不匹配预测基底动脉闭塞型急性后循环脑梗死缺血半暗带的价值[J].中国脑血管病杂志,2019,16(11):587-592.
[20] 张 茹,朱政锜,朱 丽,等.基于ADC图的影像组学模型在判断急性缺血性脑卒中缺血半暗带的价值[J].中华放射学杂志,2021,55(4):383-389.
[21] 张雯丽,卜 宁,李晓会,等.高分辨磁共振对急性脑梗死患者的颅内动脉评估[J].中风与神经疾病杂志,2019,36(4):30-34.

相似文献/References:

[1]王双龙,于 美,吕 镔,等.声脉冲辐射力成像定量评估兔肝缺血再灌注损伤实验研究*[J].陕西医学杂志,2020,49(2):140.
　WANG Shuanglong,YU Mei,LV Bin,et al.Quantitative assessment of hepatic ischemia reperfusion injury with acoustic radiation force impulse in rabbit[J].,2020,49(8):140.
[2]陈 爽.不同彩色多普勒超声检查方式在异位妊娠早期诊断中的应用研究[J].陕西医学杂志,2020,49(2):154.
　CHEN Shuang..Application of different color Doppler ultrasonography in early diagnosis of ectopic pregnancy[J].,2020,49(8):154.
[3]刘永收,张 媛,秦 梅,等.手环血氧仪在阻塞性睡眠呼吸暂停低通气综合征诊断中的应用[J].陕西医学杂志,2020,49(2):176.
　LIU Yongshou,ZHANG Yuan,QIN Mei,et al.Application of wearable reflex oximeter in the diagnosis of obstructive sleep apnea-hypopnea syndrome[J].,2020,49(8):176.
[4]宋亚邛,胡海燕△.VEGF、TGF-β1、CA19-9、CA242和DKK1联合检测对早期胰腺癌临床诊断价值研究*[J].陕西医学杂志,2020,49(2):237.
　SONG Yaqiong,HU Haiyan..Clinical value analysis of combined examination of VEGF,TGF-β1,CA19-9,CA242 and DKK1 in patients with early pancreatic cancer[J].,2020,49(8):237.
[5]郭晓波,蔺 京,来春艳,等.新型冠状病毒与实时荧光RT-PCR核酸检测*[J].陕西医学杂志,2020,49(3):264.
[6]王 琪,卢朝祥△,陈晓峰,等.预测6月龄以下骶尾部畸胎瘤良恶性的列线图建立研究[J].陕西医学杂志,2020,49(3):313.
　WANG Qi,LU Chaoxiang,CHEN Xiaofeng,et al.Establishment of anomogram for predicting benign and malignant sacrococcygeal teratomas below 6 months[J].,2020,49(8):313.
[7]王迎春,孔延亮,蔚文祥,等.家庭聚集性新型冠状病毒肺炎患者初次就诊临床检验与CT特征分析[J].陕西医学杂志,2020,49(4):392.
　WANG Yingchun,KONG Yanliang,WEI Wenxiang,et al.Laboratory examination and CT features of family aggregative corona virus disease 2019 patients at first visit[J].,2020,49(8):392.
[8]杨自华,郭平学,王西辉,等.miRNA-244与miRNA-328在胆管癌患者血清中的表达及意义*[J].陕西医学杂志,2020,49(5):549.
　YANG Zihua,GUO Pingxue,WANG Xihui,et al.Expression and significance of miRNA-244 and miRNA-328 in serum of patients with cholangiocarcinoma[J].,2020,49(8):549.
[9]王双龙,吕 镔△,李 龙,等.超声造影参数成像在甲状腺微小乳头状癌鉴别诊断中的应用价值*[J].陕西医学杂志,2020,49(5):599.
　WANG Shuanglong,LV Bin,LI Long,et al.The value of parametric imaging of contrast-enhanced ultrasound in differential diagnosis of papillary thyroidmicrocarcinoma[J].,2020,49(8):599.
[10]权浩浩,于小勇,程小红,等.血清抗M型磷脂酶A2受体抗体检测在膜性肾病诊断中的价值研究*[J].陕西医学杂志,2020,49(6):755.[doi:DOI:10.3969/j.issn.10007377.2020.06.029]

更新日期/Last Update: 2021-08-05