本文選題：急性腦梗死 + 磁共振成像��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的研究大腦中動(dòng)脈供血區(qū)發(fā)生急性梗死時(shí),FLAIR高信號(hào)血管(FLAIR hyperintense vessel,FHV)征的顯影情況,探討FHV征與入院NIHSS評(píng)分、梗死面積、責(zé)任血管狹窄程度和位置、腦白質(zhì)稀疏程度、SWI-m IP圖上靜脈異常、梗死周圍血流灌注狀態(tài)、出血性轉(zhuǎn)化及近期預(yù)后的相關(guān)性,評(píng)估急性腦梗死患者FHV征的臨床意義。材料與方法納入發(fā)病72小時(shí)內(nèi)未經(jīng)溶栓治療的急性腦梗死患者67例,采用西門子Skyra 3.0T磁共振儀進(jìn)行掃描,掃描序列包括T1WI、T2WI、DWI、FLAIR、MRA、SWI及ASL檢查,有13例患者在入院后4-8天內(nèi)復(fù)查MRI。根據(jù)FLAIR序列上有無(wú)FHV征分為FHV陰性組和FHV陽(yáng)性組,當(dāng)FHV出現(xiàn)范圍超過(guò)DWI梗死范圍時(shí),存在“FHV-DWI不匹配區(qū)”,比較兩組基線資料,入院NIHSS評(píng)分、梗死面積、責(zé)任血管狹窄程度及位置、腦白質(zhì)稀疏程度、靜脈異常、“FHV-DWI不匹配區(qū)”血流灌注狀態(tài)、出血性轉(zhuǎn)化有無(wú)差異或相關(guān)性;對(duì)FHV征陽(yáng)性患者,FHV分布范圍及靜脈異常分布范圍進(jìn)行ASPECT評(píng)分,分析其FHVASPECT評(píng)分與責(zé)任血管狹窄程度及位置、腦白質(zhì)稀疏程度、靜脈異常ASPECT評(píng)分有無(wú)相關(guān)性。觀察13例FHV征陽(yáng)性患者復(fù)查時(shí)FHV征變化,評(píng)估其與患者近期病情變化的關(guān)系。結(jié)果67例急性腦梗死患者,FHV征陽(yáng)性者38例(56.7%),陰性者29例。FHV征陽(yáng)性組入院NIHSS評(píng)分高于FHV征陰性組(P=0.0250.05)。FHV征陽(yáng)性組較陰性組梗死面積大(r=0.555,P0.001)。FHV征陽(yáng)性組較陰性組血管狹窄程度重(r=0.747,p0.001);且FHV-ASPECT評(píng)分越高血管狹窄程度越重(r=0.556,P0.001)。FHV征陽(yáng)性組較陰性組血管病變部位更靠近大動(dòng)脈近端(r=-0.614,P0.001),且FHV-ASPECT評(píng)分越高,血管病變部位越靠近大動(dòng)脈近端(r=-0.479,P0.001)。FHV征陽(yáng)性組較陰性組腦白質(zhì)稀疏程度重(r=0.281,P=0.0210.05);且FHV-ASPECT評(píng)分越高,腦白質(zhì)稀疏程度越重(r=0.363,P=0.0250.05)。FHV征陽(yáng)性患者多存在靜脈異常(X2=59.101,P0.001);且二者ASPECT評(píng)分具有良好的一致性(r=0.888,P0.001)。“FHV-DWI不匹配區(qū)”存在灌注異常(X2=19.813,P0.001),且多為低灌注,占76.5%(26/34)。FHV征與梗死后急性期顱內(nèi)出血性轉(zhuǎn)化無(wú)關(guān)(P=0.3930.05)。13例FHV征陽(yáng)性患者復(fù)查結(jié)果示:無(wú)患者FHV-ASPECT評(píng)分升高;8例FHV征消失或FHV-ASPECT評(píng)分降低患者,無(wú)再發(fā)梗死,NIHSS評(píng)分降低;5例FHV-ASPECT評(píng)分無(wú)變化患者,有再發(fā)梗死,NIHSS評(píng)分不變或升高。結(jié)論急性腦梗死患者,FHV征的出現(xiàn)提示顱內(nèi)大動(dòng)脈近端嚴(yán)重狹窄或閉塞,且患者腦白質(zhì)稀疏程度相對(duì)較重。FHV與SWI-m IP靜脈異常分布范圍具有良好的一致性,二者均反映腦組織缺血期間血流動(dòng)力學(xué)的改變;FHV征可反映梗死周圍腦組織的血流灌注狀態(tài),對(duì)無(wú)法或沒有條件進(jìn)行灌注掃描患者,FHV征有助于臨床評(píng)估患者病情,指導(dǎo)進(jìn)一步治療方案。FHV征的出現(xiàn)提示梗死面積大、神經(jīng)功能障礙重;對(duì)FHV征陽(yáng)性患者,FHV-ASPECT評(píng)分降低提示近期預(yù)后相對(duì)較好。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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