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。

Clinical of diffusion weighted imagining in acute lacuna cerebral infarction patient

Objective:To probe into the clinical value of diffusion weighted imaging(DWI)in diagnosing the early lacuna cerebral infarction.Methods:The clinical data of 60 patients with early lacuna infarction(LI)were analyzed and the patients underwent routine magnetic resonance imaging(MRI)sequence and DWI sequence.Readings were performed jointly by four well-experienced neuroradiologists who were unknowing with the cases.The neuroanatomically relevant lesions were identified.All images within one layer were compared,special emphasis placed on the signal intensity and lesion size.All the statistics were analyzed statistically.Results:Among the 60 patients,there were 45patients with hypertension(75%),21 with hyper lipidemia(35%)and 18 with diabetes(30%);The common clinical types are 20 cases of pure motor hemiparesis(PMH)and aberrant types of PMH,12 cases of lacuna state(LS),10 cases of asymptomatic lacuna infarction(ALI)and 8 cases of sensorimotor stroke(SMS).The lesion areas could be divided into caudate nucleus(29.1%),lenticular nucleus(23.3%),corona radiata(15.1%),thalamus(10.5%)and internal capsule(7.0%).As for the 20 cases of hyperacute stage(≤6h),DWI found the lesion areas while regular MRI did not.As for the 22 cases of acute stage(7~24h),DWI found all the lesion areas and the rate of detection was 100% while MRI found only 12 cases with the rate of 55%(P<0.05).During the hyperacute and acute period,DWI could show the lesion areas while T_2-weighted imaging(T_2-WI)couldn't do and the scope of images increased as time prolonged.DWI could show the lesions more clearly and wholly than T_2-WI.Conclusion:Hypertension was the direct cause of LI.The lesion areas of LI lay mainly in basal nuclei.Rates of detection were tending upwards in LS and ALI cases and DWI was superior to MRI in diagnosing the early LI cases.DWI should be the prior method of checking early LI.