脑梗死正常、病变区ADC差值对出血性转化风险的评估价值

目的研究脑梗死正常、病变区表观弥散系数差值对出血性转化风险的评估价值。方法选取我院2014年7月-2016年6月神经内科收治的50例早期脑梗死患者,入院后给予螺旋CT和MRI常规颅脑平扫,所有患者均行DWI、ADC扫描,在患者MR ADC图上分别测量并计算脑梗死正常区、病变区的ADC差值;发病2周后随访行MR复查,观察HT发生情况,并进一步分析HT和ADC差值的相关性。结果通过随访复查,50例CI患者中共有5例出现HT,未发生HT(NHT)为45例,HT发病率为10.0%,低于未发生HT(NHT)比重90.0%;早期ADC差值测量显示5例明显205.5×10-6mm2/s,且与随访复查出现HT的5例患者完全吻合,ADC差值预测体现较好的准确度和特异性;HT患者ADC差值(221.4±10.2)×10-6mm2/s高于NHT(145.3±11.4)×10-6mm2/s,差异显著(P0.05)。结论早期脑梗死正常、病变区ADC差值测量能较好的反映梗死灶出血状况,本次研究认为当ADC差值205.5×10-6mm2/s即提示HT发生的高风险可能,对临床预测评估HT和指导治疗具有较高的参考价值。

Value of ADC Difference Value between Cerebral Infarction Normal and Affected Area in Evaluating the Risk of Hemorrhagic Transformation

Objective To study the value of apparent diffusion coefficient (ADC) difference value between cerebral infarction (CI) in normal and affected area in evaluating the risk of hemorrhagic transformation (HT).Methods 50 cases of patients with early CI who were treated in the department of neurology of our hospital between July 2013and June 2015 were included in the study. All patients were given spiral CT and MRI routine brain scan after admission and all of them underwent DWI and ADC scan. On MR ADC images, ADC difference value between CI normal and affected area was measured and calculated; 2 weeks after attack, the patients were followed up and underwent MR reexamination. The occurrence of HT was observed. The correlation between HT and ADC difference value was further analyzed.Results Through follow-up and reexamination, among 50 cases of patients with CI, 5 cases were with HT and the incidence of HT (10%) was lower than that of non-HT (NHT) (90%). Early ADC difference measurements showed that there were 5 patients with >205.5×10-6mm2/s and 5 patients with HT were in complete agreement with follow-up and reexamination. ADC difference prediction showed better accuracy and specificity. ADC difference of patients with HT [(221.4±10.2)×10-6 mm2/s] was higher than NHT [(145.3±11.4)×10-6mm2/s] (P<0.05).Conclusion ADC difference measurement between early CI normal and affected area can better reflect hemorrhage in infarcted lesions. This study shows that ADC difference >205.5×10-6mm2/s prompting high risk of HT, which is of high reference value in clinical evaluation and prediction of HT and guiding treatment.