發(fā)布時(shí)間：2018-03-14 10:28

  本文選題：缺血性腦卒中　切入點(diǎn)：動(dòng)脈自旋標(biāo)記　出處：《磁共振成像》2016年09期 　論文類型：期刊論文

【摘要】：目的探討3.0 T MR磁敏感加權(quán)成像(SWI)與動(dòng)脈自旋標(biāo)記成像(ASL)對(duì)于急性缺血性腦卒中缺血半暗帶(IP)、側(cè)支代償儲(chǔ)備、出血轉(zhuǎn)化(HT)、責(zé)任血管及近期預(yù)后評(píng)估的臨床應(yīng)用價(jià)值。材料與方法 35例急性缺血性腦卒中患者行常規(guī)MR序列、SWI和3D-PCASL檢查,通過軟件進(jìn)行后處理,得出SWI最小密度投影圖和3D-ASL偽彩圖。觀察35例患者梗死核心區(qū)周圍引流靜脈形態(tài)學(xué)改變,分為引流靜脈明顯顯示組和正常顯示組,分別對(duì)兩組入院當(dāng)日及15 d NIHSS評(píng)分進(jìn)行分析。將未經(jīng)溶栓治療的33例患者,依據(jù)3D-ASL偽彩圖提示梗死核心區(qū)周圍是否出現(xiàn)匍匐走行條狀高灌注信號(hào),分為側(cè)支代償組和對(duì)照組,并對(duì)其入院當(dāng)日與15 d后NIHSS評(píng)分進(jìn)行分析。依據(jù)3D-ASL提示的梗死核心區(qū)灌注狀態(tài)不同,分為高灌注組和低灌注組,結(jié)合SWI提示HT的發(fā)生率,統(tǒng)計(jì)分析梗死核心區(qū)不同灌注狀態(tài)與HT發(fā)生之間的關(guān)聯(lián)。結(jié)果梗死區(qū)周圍引流靜脈明顯顯示組預(yù)后好轉(zhuǎn)、穩(wěn)定及進(jìn)展比例分別為13/27、6/27和8/27;正常顯示組預(yù)后好轉(zhuǎn)、穩(wěn)定及進(jìn)展比例分別為6/8、2/8和0/8,兩組近期預(yù)后進(jìn)展差異有統(tǒng)計(jì)學(xué)意義(P=0.0432)。側(cè)支代償組與對(duì)照組入院當(dāng)日NIHSS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(t=0.886,P=0.392),側(cè)支代償組近期預(yù)后好轉(zhuǎn)、穩(wěn)定及進(jìn)展比例為13/17、3/17和1/17;而對(duì)照組近期預(yù)后好轉(zhuǎn)、穩(wěn)定及進(jìn)展比例為5/16、4/16和7/16,兩組15 d后NIHSS評(píng)分差異有統(tǒng)計(jì)學(xué)意義(t=2.296,P=0.039)。梗死核心高灌注組HT發(fā)生比例為6/6,低灌注組HT發(fā)生比例為5/29,兩組差異有顯著統(tǒng)計(jì)學(xué)意義(P=0.000)。結(jié)論 SWI與ASL聯(lián)合MR常規(guī)序列檢查,能夠更好評(píng)估IP范圍、側(cè)支循環(huán)代償建立狀態(tài)、責(zé)任血管及HT等相關(guān)信息,對(duì)于了解急性腦卒中患者缺血梗死現(xiàn)狀及近期預(yù)后評(píng)估提供客觀依據(jù)。
[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.
【作者單位】： 南京中醫(yī)藥大學(xué)附屬連云港市中醫(yī)院影像科;蘇州大學(xué)附屬第一醫(yī)院影像科;
【分類號(hào)】：R445.2;R743.3

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本文編號(hào)：1610806