~1H-MRS采用短回波扫描在超急性脑梗死治疗中的应用价值

目的探讨MR波谱采用激励回波采集方法、短回波时间扫描时,MR波谱在超急性脑梗死治疗中的临床应用价值。材料与方法采取溶栓治疗与非溶栓治疗的超急性期脑梗死患者经住院治疗1 w后均行常规磁共振及MR波谱扫描,对病灶中心区、病灶边缘区、病灶周围正常区及对侧镜像区N-乙酰天门冬氨酸(N-acetylpartate,NAA)/总肌酸(肌酸+磷酸肌酸)(Creatine,Cr)、胆碱化合物(Choline,Cho)/Cr、NAA/Cho等比值进行分析。结果 (1)非溶栓组病灶中心区NAA/Cr、NAA/Cho值明显降低,Cho/Cr、肌醇(Myo-inositol,m I)/Cr值高于病灶边缘区,谷氨酸复合物(Glutamine/Glutamate,Glx)/Cr值高于对侧镜像区(P0.05);病灶边缘区NAA/Cr值低于病灶周围正常区,NAA/Cho值低于对侧镜像区(P0.05);病灶中心区NAA/Cho、Cho/Cr及Glx/Cr值与临床美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)呈明显相关性(r=-0.626、0.629、-0.689,P0.05),病灶边缘区域乳酸(Lactate,Lac)/Cr值与临床NIHSS评分具有明显相关性(r=0.812,P0.05)。(2)溶栓组病灶中心区Cho/Cr值高于病灶边缘区,病灶边缘区NAA/Cr、m I/Cr值低于对侧镜像区,病灶边缘区NAA/Cho值低于病灶周围正常区(P0.05);病灶中心区NAA/Cho、Cho/Cr、m I/Cr及Glx/Cr值与临床NIHSS评分具有明显相关性(r=-0.686、0.791、-0.757、-0.791,P0.05),病灶边缘区Lac/Cr值与临床NIHSS评分具有明显相关性(r=0.735,P0.05)。(3)溶栓组病灶边缘区NAA/Cr、NAA/Cho及m I/Cr值明显高于非溶栓组,病灶中心区、病灶周围正常区Lac/Cr值明显低于非溶栓组,病灶中心区Glx/Cr值明显高于非溶栓组(P0.05)。结论 ~1H-MRS采用短回波时间扫描检测到更多代谢物的变化,能更全面地检测脑梗死临床治疗后受损脑组织的恢复情况,能客观评估诊疗效果及其预后,为临床应用提供客观的影像学依据。

The application value of 1H-MRS in the treatment of hyperacute cerebral infarction by using short-TE scanning

Objective: To investigate the application value of magnetic resonance spectroscopy (MRS) in the treatment of hyperacute cerebral infarction by using stimulated echo acquisition mode and short echo time scan. Materials and Methods:The patients of hyperacute infarction treated with thrombolytic therapy or non-thrombolytic therapy underwent regular magnetic resonance and MR spectrum scan after 1 week of hospitalization. Then we respectively analyzed the ratios of NAA/Cr, Cho/Cr and NAA/Cho in the infraction center, the border region, the normal region around the lesion and the contralateral area. Results: (1) In the non-thrombolysis group, in the infraction center,the ratios of NAA/Cr, NAA/Cho decreased significantly, the ratios of Cho/Cr and mI/Cr were higher than in the border region, the ratio of Glx/Cr was higher than that in the contralateral area (P<0.05). In the border region, the ratio of AA/Cr was lower than in the normal region around the lesion, and the ratio of NAA/Cho was lower than in the contralateral area (P<0.05). The ratios of NAA/Cho, Cho/Cr and Glx/Cr in the infraction center and Lac/Cr in the border region were significantly correlated with the clinical NIHSS score (r=-0.626, 0.629, -0.689, 0.812, P<0.05). (2)In the thrombolysis group, in the infraction center, the ratio of Cho/Cr was higher than in the border region. In the border region, the ratios of NAA/Cr, mI/Cr were lower than in the contralateral area, and the ratio of NAA/Cho was lower than in the normal region around the lesion. The ratios of NAA/Cho, Cho/Cr, mI/Cr and Glx/Cr in the infraction center and Lac/Cr in the border region were significantly correlated with the clinical NIHSS score (r=-0.686, 0.791, -0.757, -0.791, 0.735, P<0.05). (3) In the thrombolysis group, the ratios of NAA/Cr, NAA/Cho and mI/Cr in the infraction center, the border region was significantly higher than in non-thrombolysis group, the ratio of Lac/Cr in the infraction center, the border region and the normal region around the lesion was lower than that in non-thrombolysis group, the ratio of Glx/Cr in the infraction center was significantly higher than in non-thrombolysis group. Conclusions: 1H-MRS can detect more metabolite changes by using short echo time scanning and more comprehensively detect the recovery of damaged brain tissue after the clinical treatment. It can objectively evaluate the effect of clinical treatment and prognosis of cerebral infarction, providing objective imaging evidence for clinical application.