甲亢与脑梗死的相关性研究

目的:探讨甲亢与脑梗死之间的相关性。方法:65例住院患者随机分为甲亢组33例、对照组32例,两组均在入院后次日清晨空腹化验甲状腺功能、血脂、血糖、血液流变学。结果:甲亢组空腹血糖显著高于对照组(P<0.05)、高密度脂蛋白显著低于对照组(P<0.05),而胆固醇、甘油三酯与低密度脂蛋白无明显差异(P≤0.05),血液流变学指标均显著高于对照组(P<0.05)结论:甲亢患者血糖增高、血酯代谢异常、血液流变学发生改变,造成血液粘稠,而甲亢直接导致的心脏和血液动力学的改变,更加速了脑梗死的发生,甲亢是脑梗死的重要原因。     

表观弥散系数在急性缺血性卒中分期及判断脑组织灌注状态中的作用

目的探索表观弥散系数(apparent diffusion coefficient,ADC)在急性缺血性卒中患者分期及判断缺血半暗带中的价值。方法收集经临床和影像确诊为急性缺血性卒中的患者,根据行磁共振成像(magnetic resonance imaging,MRI)检查距起病时间的长短分为6 h组,6~24 h组,24~48 h组,48~72 h组,所有患者在治疗前行MRI弥散加权像(diffusionweighted imaging,DWI)检查,评估DWI图像及常规MRI图像显示病变的情况,测定各时间段病灶的ADC、健康对侧相应位置的ADC值、病灶中心及边缘的ADC值。结果共纳入62例患者,发病时间6 h的病例10例,常规MRI图像阳性检出率为0(0/10),DWI阳性检出率为100%(10/10);发病6~24 h的病例27例、24~48 h的病例13例、48~72 h的病例12例,总共52例,其中常规MRI阳性检出率为88.4%(46/52),DWI阳性检出率为100%(52/52)。不同时间段病灶侧ADC值与健侧ADC值分别为:6 h组(0.601±0.079,1.261±0.085)×10~(-3)mm~2/s,6~24 h组(0.623±0.097,1.152±0.083)×10~(-3)mm~2/s,24~48 h组(0.635±0.103,1.036±0.112)×10~(-3)mm~2/s,48~72 h组(0.631±0.082,1.225±0.097)×10~(-3)mm~2/s;不同时间段病灶侧ADC值与健侧ADC值之间均有显著性差异(P分别为0.006,0.007,0.008和0.017)。不同时间段组病灶侧ADC值之间无显著差异。不同时间段组病灶中心及边缘的ADC值分别为:6 h组(0.547±0.089,0.624±0.096)×10~(-3)mm~2/s,两者之间有显著性差异(P=0.027);6~24 h组(0.572±0.074,0.647±0.107)×10~(-3)mm~2/s,两者之间有显著性差异(P=0.032);24~48 h组(0.615±0.104,0.636±0.082)×10~(-3)mm~2/s,两者之间无显著差异;48~72 h组(0.631±0.081,0.625±0.102)×10~(-3)mm~2/s,两者之间无显著差异。结论 DWI的ADC值可以早期准确发现急性缺血性卒中的责任病灶,而且可以区分24 h梗死灶的中心和边缘,边缘区可能为缺血半暗带,但对于急性缺血性卒中(0~3 d)的细化分期意义不大。     

脑梗死与睡眠时间的相关性研究

目的 分析脑梗死与睡眠时间的相关性.方法 脑梗死患者126例,依据入院时美国国立卫生院卒中量表(NIHSS)评分,将NIHSS评分≤12分的27例患者作对照组,NIHSS评分在13～24分的58例患者作观察A组,NIHSS评分≥25分的41例作观察B组,分析其与睡眠结构与睡眠之间的相关性.结果 观察A、B2组经多导睡眠图与主诉所得睡眠时间组间比较,差异无统计学意义(P＞0.05);观察A组与对照组2组的SL与REM水平组间比较,观察B组与对照组2组的TST、SL、SE与REM水平组间比较,差异有统计学意义(P＜0.05);观察B组的SE与REM水平均比观察A组低,差异有统计学意义(P＜0.05).结论 睡眠时间＞8h是神经功能损伤程度重度脑梗死患者的独立危险因素.     

首发症状性脑梗死与无症状性脑梗死的相关性

目的 探讨首发症状性脑梗死(FEIS)与无症状性脑梗死(SBI)相关性及其影响因素.方法 采用回顾性、单中心队列研究,纳入115例FEIS患者,依照是否伴有SBI分为SBI组和无SBI组,比较两组患者临床特征、SBI部位与FEIS部位是否有一致性、SBI数量是否影响FEIS的严重性.结果 合并SBI的FEIS患者伴高血压病及心脑血管病者比例更高;SBI部位与FEIS部位是否具有一致性对FEIS严重性无影响;SBI数量多的患者FEIS病灶大.结论 SBI与FEIS存在一定相关性,伴有SBI数量多的患者FEIS梗死灶大,临床症状严重.     

高同型半胱氨酸与脑梗死的相关性研究

目的探究脑梗死和高同型半胱氨酸间的相关性。方法选取我院2014-06-2016-03收治的脑梗死患者53例为观察组进行回顾性分析,并选取同期健康体检者53例作对照研究。取患者晨起空腹静脉血,测定2组同型半胱氨酸水平,对比分析测定结果。结果观察组存在高同型半胱氨酸血症17例(32.08%),对照组为8例(15.09%),2组比较差异有统计学意义(P0.05);观察组同型半胱氨酸水平为(24.2±2.8)μmol/L,对照组为(14.8±1.4)μmol/L,2组比较差异有统计学意义(P0.05)。以脑梗死患者性别、年龄及高同型半胱氨酸因素为自变量,以脑梗死发生为因变量,采取多因素Logistic回归分析,高同型半胱氨酸是脑梗死发生的主要危险因素。结论高同型半胱氨酸与脑梗死存在直接相关性,是脑梗死发生的主要危险因素。可通过加强同型半胱氨酸水平检测,降低高同型半胱氨酸血症的发生,对于预防脑梗死发生起到明显作用     

血浆同型半胱氨酸与脑梗死的相关性

目的研究血浆同型半胱氨酸（Hey）与脑梗死的关系,以及Hey对其严重程度的影响。方法测定50例脑梗死患者和50例健康者血浆Hey水平,同时记录人院时两组患者年龄、性别、神经功能缺损评分（NIHSS评分）、血压及血糖。并对其进行多元线性回归分析,分析它们之间的关系。结果病例组的Hey水平明显高于对照组（P=0．025）;其中病例组患者高Hcy的比例（41％）明显高于对照组（10％）,差异有统计学意义（P=0．017）。病例组高血压、糖尿病患者的Hey与正常血压、正常血糖的患者的Hey相比差异无统计学意义（P值分别是0．758及0．615）;高Hcy患者的NIHSS评分明显高于正常Hcy患者的NIHSS评分（P=0．037）,多元逐步Logistic回归结果显示Hey水平升高是脑梗死的一个独立危险因子（OR：4．02,95％CI：2．33-10．24,P=0．007）。结论高同型半胱氨酸血症与脑梗死的危险性增加有关,并且增加其严重程度。     

H型高血压与复发性脑梗死的相关性研究

目的探讨H型高血压与脑梗死复发的相关性。方法 96例合并H型高血压的脑梗死患者,随机分为依那普利治疗组（10mg）或依那普利叶酸复合制剂（10mg∶0.8mg）治疗组,随访1a后,比较2组患者治疗前后血压、Hcy水平变化及脑梗死复发次数。结果 2组治疗前后血压差异有统计学意义（P〈0.05）,Hcy水平在依那普利叶酸片治疗组差异有统计学意义,依那普利叶酸片治疗组脑梗死患者复发次数明显降低。结论对H型高血压进行干预能有效降低同型半胱氨酸水平及脑梗死的复发。     

无症状性脑梗死与脑血管性痴呆的相关性研究

目的：探讨无症状性脑梗死（ＡＣＩ）与脑血管性痴呆（ＶＤ０的关系。方法：采用病例对照的方法对６２例脑血管性痴呆患者和６２名正常老年人进行ＣＴ或ＭＲＩ检查,比较两组ＡＣＩ发生情况。结果：６２例正常老年人中发现ＡＣＩ１１例（１７．７％）,６２例ＶＤ中发现ＡＣＩ３２例（５１．６％）,显著高于正常组（Ｐ〈０．００５）,结论：ＡＣＩ与ＶＤ密度相关。     

血浆同型半胱氨酸与急性脑梗死的相关性研究

目的探讨血浆同型半胱氨酸与急性脑梗死的相关性。方法将80例急性脑梗死患者设为观察组,同时收集80例健康体检者设为对照组,比较2组患者的血浆同型半胱氨酸、叶酸以及维生素B12指标。结果观察组患者血浆同型半胱氨酸水平显著高于对照组,观察组叶酸及维生素B12水平显著低于对照组,2组比较差异均具有统计学意义(P<0.05)。结论对脑梗死高危人群进行血浆同型半胱氨酸、叶酸和维生素B12水平检测,有利于早期采取干预措施,降低急性脑梗死的发生率,有利于对患者预后的评估。     

颈动脉粥样硬化与脑梗死相关性分析

我们对168例缺血性脑梗死患者的颈动脉超声检查结果作了回顾性分析,现报告如下.     

磁共振弥散成像在超急性缺血性脑梗死诊断中的研究

目的评价磁共振扩散加权成像（DWI）和表观扩散系数（ADC）图对超急性期脑梗死的诊断价值。方法对17例以卒中样发病6h以内、临床怀疑脑梗死的患者进行单次激发平面回波DWI和常规T2WI扫描,测定梗死灶和对侧相应部位正常脑组织的ADC值。结果DWI上表现为高信号,ADC图上表现为低信号,病灶ADC值较对侧相应区域明显下降者,诊断为脑梗死阳性,共15例,其最终临床诊断均为超急性脑梗死;阴性2例,其最终临床诊断均为短暂性脑缺血发作。DWI和ADC图诊断超急性期脑梗死的敏感性和特异性均为100％,比常规T。wI有更高的敏感性与特异性。结论DWI和ADC图对超急性期脑梗死的诊断中发挥重要作用。     

磁共振弥散加权成像对急性脑梗死的诊断价值

目的:探讨磁共振弥散加权成像(DWI)对急性脑梗死的诊断价值.方法:对26例急性脑梗死患者(发病＜6h4例、6-24h14例、1-7d8例)进行常规MRI(T,flair,T2WI,T2flair)检查以及DWI检查,并由计算机算出表观扩散系数(ADC)图.结果:发病＜6h的4例患者常规MRI未见异常;DWI均出现高信号;ADC均为低信号.发病6h-7d的22例患者MRI T2 WI均为高/稍高信号,T1 flair均为低/稍低信号;DWI均为高信号;ADC均为低信号.结论:DWI能在超早期显示急性脑梗死的病灶,对急性脑梗死有着非常重要的诊断价值.     

急性脑梗死病人溶栓前后缺血半暗带相对弥散系数的变化及意义

目的探索急性脑梗死(ACI)病人溶栓前后缺血半暗带(IP)相对表观弥散系数(rADC)的变化及意义。方法按照PWI/DWI错配原理入选具有IP的ACI病人60例,随机分为实验组及对照组各30例,分别给予动脉介入溶栓及静脉溶栓。根据DWI异常信号的高低选取梗死核心区、核心区边缘、梗死核心区与边缘之间、梗死区外周4个点,并测量手术前后4点的rADC。用美国国立卫生研究院卒中量表(NIHSS)进行神经功能评分,并将术后NIHSS评分及住院时间与rADC进行相关性分析。结果术前两组病人以上4点的rADC均无统计学差异(P>0.05);rADC从梗死核心区到梗死区外周呈单调递增。除梗死核心区外,术后实验组其余3点的rADC均高于对照组(均P<0.05)。两组的并发症发生率无统计学差异(均P>0.05);实验组的NIHSS评分及住院时间均少或短于对照组(P=0.016,P=0.000)。术后rADC与NIHSS评分及住院时间均呈显著负相关性(均P=0.000)。结论 IP区的rADC越高代表脑细胞生命力越强,rADC可量化评价溶栓的疗效且表明动脉介入溶栓效果优于静脉溶栓。     

Significance of diffusion-weighted imaging and apparent diffusion coefficient maps for the evaluation of pyogenic ventriculitis

OBJECTIVE: The aim of this study is to assess the significance of an apparent diffusion coefficient (ADC) modality for the diagnosis and follow-up evaluation of ventriculitis. PATIENTS AND METHODS: Twelve patients with ventriculitis were enrolled in this study. Diffusion-weighted (DW) magnetic resonance images (MRI) and ADC maps of the periventricular white matter, intraventricular collections detected in the third or lateral ventricles and normal cerebrospinal fluid (CSF) were obtained. The images and ADC data from each lesion were correlated and then compared amongst the different lesions. CSF studies were performed via external ventricular drain (EVD) catheters or lumbar punctures performed on the same day as ADC mapping. Linear regression was used to analyze relationships among pleocytosis, glucose, chloride, protein content of pus, and ADC counting. RESULTS: A total of 24 ADC values for intraventricular pus and CSF findings were obtained from 12 patients and analyzed. The DW MRI showed marked hyperintensity in purulent lesions, and the corresponding ADC maps revealed prominent hypointensity and decreased ADC values in dependent CSF compared with non-dependent CSF and normal white matter. Dependent CSF is defined as the CSF which is mixed with purulent discharge which is located at the lower portion of the ventricle by gravity. The correlations between ADC counting and pleocytosis, and also protein content were strong: r(2)=-0.84, r(2)=-0.62, respectively (p<0.001). CONCLUSION: A decreased ADC value and increased signal intensity of dependent intraventricular fluid by DW MRI suggests the presence of material with restricted water diffusion in the ventricular space. This is seen in pyogenic ventriculitis when water diffusion is restricted in suppurative fluid. ADC counting is negatively correlated with pleocytosis and the protein content of CSF. Therefore, the ADC value might be a useful non-invasive method for the follow-up evaluation of ventriculitis as well as the diagnosis of it.     

弥散磁共振成像观察实验性脑梗死ADC值的变化

目的　用弥散磁共振成像观察实验性脑梗死灶水表面弥散系数 (apparentdiffusioncoefficient,ADC)值的变化。方法　用 60只SD大鼠行易卒中型肾血管性高血压 (RHRSP)模型 ,在术后 1 0周按Longa’s方法改良行左侧大脑中动脉闭塞 (MCAO)术。分别在闭塞 1 2h内的不同时间点及再灌注 48h后行T2加权成像 (T2WI)、磁共振弥散加权成像 (DWI) ,完成检查后将大鼠处死行TTC染色 ,比较在闭塞不同的时间点上在两次T2WI和DWI上病灶的演变和ADC值的改变。结果　缺血中心区的ADC值为 ( 0 45± 0 0 1 )× 1 0 - 5cm2 /s,半暗带为 ( 0 5 6± 0 0 2 )× 1 0 - 5cm2 /s,对侧平均值为 ( 0 66± 0 0 2 )× 1 0 - 5cm2 /s,相邻正常信号组织平均值为 ( 0 65± 0 0 3)× 1 0 - 5cm2 /s,经方差分析表明 ,前三者相互之间比较均有显著性差异 (P <0 0 0 1 ) ,而后两者之间比较无显著性差异 (P >0 0 5 ) ;再灌注 48h后 ,在 3h内复流各组梗死灶的平均ADC值为 ( 0 65± 0 0 2 )× 1 0 - 5cm2 /s ,与相邻正常信号组织相比无显著性差异 (P>0 0 5 )。而在 6h后复流各组的平均ADC值为 ( 0 70± 0 0 3)× 1 0 - 5cm2 /s,与相邻正常信号组织相比有显著性差异(P <0 0 5 )。结论　实验性MCAO 1 2h内缺血或梗死灶的ADC值降低 ,而再     

Distinguishing ischemic stroke from the stroke-like lesions of MELAS using apparent diffusion coefficient mapping

We report two patients with migraine, acute visual field defects and other neurological symptoms who were found to have high T(2) signal and FLAIR abnormalities on brain MRI in temporal and parieto-occipital regions. In these patients, the apparent diffusion coefficient (ADC) of their lesions was increased, distinguishing these lesions from those of ischemic stroke. Both were ultimately diagnosed with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). We conclude that conventional MRI when used with diffusion-weighted MR imaging may be invaluable in detecting mitochondrial-related CNS dysfunction.     

扩散加权成像的表观扩散系数对兔早期后循环缺血模型的评价

目的探讨磁共振扩散加权成像（diffusion weighted imaging,DWI）的表观扩散系数（apparent diffusion coefficient,ADC）对兔早期后循环缺血模型的评价。方法16只新西兰大白兔随机平均分为假手术组和三血管结扎组。两组分别于术前及术后15min、30min、1h、1.5h、2h行磁共振DWI检查,并测量ADC值。于最后一次检查完后,每组各取6只动物分别取相同兴趣区（region of interest,ROI）：2只行病理检查,2只行电子显微镜检查,2只行2,3,5-三苯基氯化四氮唑（2,3,5-triphenyl tetrazolium chloride,TTC）染色。结果两组动物DWI均无异常高信号,但三血管结扎组ADC值与对照假手术组相比在2h时降低（P〈0.01）。病理检查无异常,电镜检查：细胞器发生异常改变,细胞轻度水肿,但无神经元坏死的结构改变,TTC染色正常。结论利用DWI之ADC值可以评价三血管结扎法是否造成兔早期后循环缺血,是进行活体评价后循环缺血的可靠指标。     

ADC直方图在高级别胶质瘤与脑单发转移瘤鉴别中的应用价值

目的 探讨表观扩散系数（ADC）直方图鉴别高级别胶质瘤（HGG）与单发脑转移瘤（SBM）的价值。方法 回顾性分析病理或临床随访证实的7例HGG与19例SBM（腺癌脑转移瘤11例,鳞癌脑转移瘤8例）的MRI资料,测量瘤体和瘤周水肿区ADC直方图参数,利用受试者工作特征曲线评价ADC直方图参数鉴别HGG与SBM的诊断效能。结果 HGG瘤体ADC第5、25百分位数（ADC_5th、ADC_25th）及瘤周水肿ADC最小值（ADCmin）均明显低于SBM（P<0.05）,而瘤体体素计数明显高于SBM（P<0.05）。鳞癌脑转移瘤瘤体ADC_5th、ADC_25th均明显低于腺癌脑转移瘤（P<0.05）。瘤体ADC_5th=926×10-6 mm2/s鉴别诊断HGG与SBM的效能最高。结论 ADC直方图有助于HGG与SBM的鉴别诊断,瘤体ADC_5th鉴别诊断HGG与SBM的效能最高。     

早期腔隙性脑梗死的临床与磁共振弥散加权成像

目的:从临床角度探讨磁共振弥散加权成像(diffusion weighted i maging,DWI)对早期腔隙性脑梗死(lacu-na cerebral infarction,LI)的诊断价值。方法:分析60例早期腔隙性脑梗死患者的临床资料,同时进行MRI常规序列及DWI序列检查,并由4位经验丰富的医师在不了解患者临床体征的情况下进行阅片,记录出病变所在的详细的神经解剖部位,对同一层面所有的磁共振像进行比较,重点分析信号强度和病灶大小。数据经统计学分析。结果:60例患者中高血压病45例(75%)、高脂血症21例(35%)、糖尿病18例(30%);常见临床类型为纯运动性轻偏瘫(PMH)及变异型20例,腔隙状态(LS)12例,无症状腔隙性梗死(ALI)10例,感觉运动性卒中(SMS)8例。病灶部位主要为尾状核(29.1%)、豆状核(23.3%)、放射冠(15.1%)、丘脑(10.5%)、内囊(7.0%)。60例患者中超急性期(≤6小时)20例,DWI扫描均检出病灶,常规MRI扫描均未检出病灶;急性期(7~24小时)患者22例,DWI扫描均检出病灶,DWI检出率为100%,而常规MRI共检出12例,检出率为55%(P<0.05)。DWI在超早期及急性期可显示T2加权像不能显示的病灶,并随时间延长显影范围逐渐增大。在T2加权像上可显示的病灶中,DWI可更清楚、更全面地显示病灶,大于T2病灶。结论:高血压病是LI的直接原因;腔隙病灶主要位于基底节,LS及ALI的检出率有上升趋势,DWI对早期LI的诊断显著优于常规MRI。DWI应作为早期LI的首选检查方法。     

Consistency between magnetic resonance diffusion-weighted images and pathological findings in a hyperacute cerebral infarction rabbit model

BACKGROUND： Because magnetic resonance diffusion-weighted imaging is sensitive to water molecule movement, it has particular advantages for early diagnosis of cerebral infarction. However, the relationship between apparent diffusion coefficient changes with ischemia time, particularly relative apparent diffusion coefficient and tissue pathological changes remains controversial. OBJECTIVE： To explore the correlation between apparent diffusion coefficient changes and pathologic changes in hyperacute cerebral infarction. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment of neuroimaging. The study was performed at the Laboratory of Radiology Department, Longgang Central Hospital of Shenzhen from October 2007 to October 2008. MATERIALS： Magnetic resonance scanner was purchased from Philips Medical Systems, Best, the Netherlands. METHODS： A total of 42 healthy, adult, New Zealand rabbits were randomly assigned into sham-operation, ischemia 0.5-, 1-, 2-, 3-, 4-, and 6-hour groups, with six animals in each group. Local cerebral ischemia model was established by right middle cerebral artery occlusion, and cranial MRI scanning and pathologic observation were performed, respectively, at 0.5, 1,2, 3, 4, and 6 hours following ischemia. The middle cerebral artery of sham-operation group was only exposed, but not occluded. Images at the above-mentioned time points were also collected. MAIN OUTCOME MEASURES： Apparent diffusion coefficient and relative apparent diffusion coefficient values of abnormal signal on diffusion-weighted imaging were calculated and compared with pathological changes in the ischemic region. RESULTS： No abnormal diffusion-weighted imaging signals or pathological changes were observed in the sham-operation group. Abnormal signal intensity on diffusion-weighted imaging was first observed in the 0.5-hour group. Apparent diffusion coefficient and relative apparent diffusion coefficient values decreased in all middle cerebral artery occlusion rabbits and reached lowest levels at 3 hours, followed by a gradual increase. The right ischemic basal ganglia region with high signal intensity on diffusion-weighted imaging extended with increasing time of occlusion, and the pathologic outcome corresponded with MRI changes. CONCLUSION： Relative apparent diffusion coefficient values changed regularly with ischemia time and displayed good correspondence to pathological manifestations.