大面积脑梗死再灌注损伤的磁敏感加权成像与临床对照研究

目的探讨磁敏感加权成像（SWI）技术评价大面积脑梗死再灌注损伤的价值及其与临床的相关性。方法选择21例临床和影像确诊的大面积脑梗死患者为研究对象。脑梗死后出血程度分为重度、中度和轻度；病灶周围小血管数目显示分为0～Ⅱ度。将患者临床状态进行NIHSS评分，并与SWI评价结果对照。结果本组病例有16例（76．2％）发生自发性梗死后出血，其中11例（68．8％）发生于亚急性期，重度出血4例（25．0％），中度出血5例（31.3％），轻度出血7例（43．8％）；重度出血与临床NIHSS评分具有正相关性（rs=0．765，P=0．001）。有14例（66．7％）显示梗死灶周围小血管影。21例中Ⅱ度显示者10例（47．6％），Ⅰ度4例（19．0％），0度7例（33．3％），其显示程度与临床NIHSS评分无显著相关性（rs=0．408，P=0．066）。结论SWI技术可以敏感、客观地评价脑梗死后再灌注损伤的出血及侧支循环情况，有望成为脑梗死患者病情预测与治疗评估的有效方法。

Susceptibility weighted imaging of reperfusion injury after mass cerebral infarction and correlation to clinical measures

Objective： To evaluate susceptibility-weighted imaging （SWI） in the assessment of reperfusion injury after mass cerebral infarction and the correlation between imaging manifestations and clinical measures. Materials and Methods： Twenty-one patients with mass cerebral infarction were determined by the clinical and imaging manifestations. Patients with post-infarction hemorrhage were divided into mild, moderate and severe groups according to the volume of bleeding. The extent of micro-vessels around the infarction focus revealed in SWI was classified as 0-Ⅱ degrees. The NIHSS scores of all the subjects were obtained and were correlated to SWI results. Results： Spontaneous post-infarction hemorrhage was observed in 16 subjects （76.2%）, with 4 cases （25.0%） of severe bleeding, 5 cases （31.3%） of moderate bleeding, and 7 cases （43.8%） of mild bleeding, among which bleeding was found in 11 cases （68.8%） of sub-acute period. Severe hemorrhage positively correlated with NIHSS scores （rs=0.765, P=0.001）. Micro-vessels around the lesions were found in 14 cases （66.7%）. In 21 cases, 10 cases （47.6%） were II degree, 4 cases （19.0%） were Ⅰ degree, 7 cases （33.3%） were 0 degree. The display degree of micro-vessels had no significant correlation with the NIHSS score （rs=0.408, P=-0.066）. Conclusion： SWI can make a sensitive, objective assessment of the reperfusion injury and collateral circulation after cerebral infarction, which is promisingly to be an effective evaluation method for the prognosis and treatment of the patients with infarction.