DWI联合头颈部TOF-MRA在超急性期脑梗死诊断中的应用价值

[摘要] 目的 探讨弥散成像(DWI）与头颈部时间飞跃法血管成像（TOF-MRA）的联合应用在诊断超急性期脑梗死中的应用价值。方法 搜集临床诊断脑梗死的、发病时间在6 h内的患者20例，其中发病在4 h内的7例，4～6 h 内13例；所有患者均进行头部横断面T2WI、T1WI、DWI及横断面或冠状面FLAIR成像、头部3D-TOF-MRA血管成像，部分患者进行颈部2D-TOF-MRA成像，分析常规序列成像、DWI及头颈部TOF-MRA血管成像的影像学表现。结果 发病在4 h内的7例中，DWI只有3例示脑沟稍变浅，信号均无明显异常，但血管明显狭窄或闭塞；发病在4～6 h内的13例中，DWI正常1例，血管明显狭窄；DWI呈散在斑点状及小片状稍高信号影2例，颈内动脉起始部闭塞及大脑中动脉全程均未见显示；DWI呈散在小片状较高信号影 10例，大脑中动脉主干未见显示5例，颈内动脉起始部闭塞及大脑中动脉全程未见显示2例，大脑中动脉回转段未见显示3例。结论 DWI联合头颈部TOF-MRA可提高超急性期脑梗死的诊断准确率，同时能明确狭窄血管的位置及狭窄程度，有助于及时指导临床选择合理的治疗方案。

The Diagnostic Value of DWI and TOF-MRA in Super-acute Cerebral Infarction

Objective To explore the diagnostic value of diffusion(DWI) and magnetic resonance angiography(MRA) in super-acute cerebral infarction。Methods 20 cases of super-acute cerebral infarction within 6 hours from the onset of symptoms were scanned using MRI T2WI,T1WI, FLAIR,DWI and TOF-MRA 。Results The brain sulcus be lightly narrowed on DWI in 3 cases and no signal changes in 7 cases wihich 4 hours from the onset of symptoms,but artery be hing grade stenosis or occlusion. During the time range 0f 4 hours ~6 hours, no signal changes on DWI in one case and artery be hing grade stenosis;DWI in 2 cases were slightly flecky hyper-intensity and the internal carotid artery and middle cerebral artery can’t be displayed; DWI in 10 cases were superior hyper-intensity , the middle cerebral artery can’t be displayed in 5 cases, the internal carotid artery and middle cerebral artery can’t be displayed in 2 cases, the M2 of middle cerebral artery can’t be displayed in 3 cases。Conclusion DWI combined with TOF-MRA can improve the diagnostic accuracy in super-acute cerebral infarction, the position and extent of stenosis artery can be definituded simultaneously;DWI combined with TOF-MRA can be used for planning treatment in time。