【摘要】：研究目的 評估磁敏感血管征及其幅度值、相位值對預(yù)測靜脈內(nèi)rt-PA溶栓治療的急性腦梗塞患者的溶栓再通的意義。 方法 回顧性研究了28例MRA上存在頸內(nèi)或大腦中動脈閉塞、并行靜脈內(nèi)rt-PA溶栓治療的急性腦梗塞患者。根據(jù)溶栓前ESWAN上是否存在磁敏感血管征(susceptibility vessel sign, SVS)將患者分為SVS(+)與SVS(-)組,比較兩組間臨床及影像學(xué)特征。對SVS(+)的患者,在8個回波疊加后的幅度圖上沿SVS邊界作出感興趣區(qū)(ROI),將此ROI對應(yīng)到8回波疊加后的相位圖及不同回波時間(TE)幅度圖上,分別記錄總的SVS及大腦中動脈M1段SVS(M1SVS)在TE=5ms與40ms幅度圖上所對應(yīng)的平均幅度值、及在疊加后相位圖上的平均相位值。溶栓后24h內(nèi)MRA上的血管再通情況根據(jù)心肌梗塞溶栓再通分級(Thrombolysis In Myocardial Infarction, TIMI)評定。比較再通組(TIMI≥2)組與無再通組間總的SVS及M1SVS的平均幅度值、相位值的差異,并分析這些測量值與溶栓后TIMI等級間的相關(guān)性。P0.05被認(rèn)為具有統(tǒng)計學(xué)意義。 結(jié)果 SVS(+)組與SVS(-)組間,除溶栓前NIHSS評分及溶栓后1d時神經(jīng)功能改善良好的患者所占比例外,其它臨床、影像學(xué)特征,以及溶栓后血管再通情況無顯著差異。SVS(+)的16例患者中,SVS在TE=5ms時圖像上的平均幅度值與溶栓后再通等級存在負(fù)相關(guān)(rs=-0.652,P=0.006),溶栓再通的患者其平均幅度值低于無再通的患者(P=0.042)；其中M1SVS(+))的14例患者中,M1SVS在TE=5ms圖像上的平均幅度值與溶栓后TIMI等級存在負(fù)相關(guān)(rs=-0.636,P=0.015)；M1SVS的平均相位值與溶栓后TIMI等級呈正相關(guān)(rs=0.622,P=0.017),再通組平均相位值高于無再通組(P=0.024)。SVS/Ml SVS在TE=40ms圖像上的幅度值與溶栓再通等級無顯著關(guān)系。溶栓前后均存在SVS的患者(n=8),其前后SVS的幅度值、相位值并無顯著變化(P均＞0.05)。 結(jié)論 溶栓前是否存在SVS并不能幫助預(yù)測靜脈溶栓的溶栓效果,但SVS/Ml SVS的平均幅度值、相位值與溶栓后血管再通等級相關(guān),存在較低相位值與短回波時較高幅度信號的SVS的患者傾向于溶栓后血管無再通,對SVS的定量一定程度上可幫助預(yù)測靜脈溶栓效果。
[Abstract]:Objective to evaluate the significance of magnetic sensitive vascular sign and its amplitude and phase value in predicting thrombolytic recanalization in patients with acute cerebral infarction treated with intravenous rt-PA thrombolytic therapy. Methods 28 cases of acute cerebral infarction with internal carotid or middle cerebral artery occlusion and intravenous rt-PA thrombolysis on MRA were retrospectively studied. The patients were divided into SVS () and SVS (-) groups according to the presence of magnetic sensitive vascular sign (susceptibility vessel sign, SVS) on ESWAN before thrombolysis. The clinical and imaging features of the two groups were compared. For the patients with SVS (), the region of interest (ROI),) was made along the boundary of SVS on the amplitude map of 8 echo stack. The ROI was corresponding to the phase map after 8 echo stacking and the (TE) amplitude map of different echo time. The mean amplitudes of total SVS and M1 segment SVS (M1SVS) of middle cerebral artery on TE=5ms and 40ms amplitudes were recorded respectively, and the average phase values on superimposed phase maps were also recorded. The vascular recanalization on MRA within 24 hours after thrombolysis was evaluated by (Thrombolysis In Myocardial Infarction, TIMI) classification of thrombolytic reperfusion in myocardial infarction. The average amplitude and phase of total SVS and M1SVS were compared between the recanalization group (TIMI 鈮，

本文編號：2308519