探讨急性脑梗死不同治疗方法的TOAST分型及其影像学表现

目的应用多模磁共振扩散加权成像-灌注加权成像分析急性脑梗死不同治疗方法的影像学表现特征。材料与方法回顾性分析在我院神经内科住院治疗的急性脑梗死患者110例,所有患者均行多模磁共振检查,记录其影像学表现、临床资料和实验室常规检查,并根据结果行扩散加权成像(diffusion weighted imaging,DWI)分型及急性卒中治疗Org 10172试验(trial of org 10172 in acute stroke treatment,TOAST)分型,根据不同治疗方法分为静脉溶栓组(43例)、动脉取栓组(34例)及保守治疗组(33例),并对3组的影像学及临床资料进行统计学分析。结果 (1)动脉取栓组患者存在半暗带及血管高信号征的比率均高于静脉溶栓组及保守治疗组,差异均有统计学意义(F=13.713,P=0.001;F=8.108,P=0.017)。(2)在DWI分型构成比方面,静脉溶栓组以小穿支梗死及单侧前循环梗死所占比率较大(25.58%、23.26%),动脉取栓组和保守治疗组以单侧前循环及前-后循环所占比率较大(52.94%、21.43%;30.30%、30.30%)。(3)在TOAST分型构成比方面,静脉溶栓组以大动脉粥样硬化型(largeartery atherosclerosis,LAA)所占比率最高(39.53%),动脉取栓组以不明原因型(undetermined etiology,UND)所占比率最高(73.53%),保守治疗组以小动脉闭塞型(small artery occlusion,SAO)所占比率最高(48.48%)。(4)在磁共振血管造影(magnetic resonance angiography,MRA)影像学表现上,静脉溶栓组及保守治疗组MRA表现正常所占比率最高(72.09%、51.52%),而动脉取栓组MRA表现为大脑中动脉狭窄或闭塞所占比率最高(41.18%)。(5)3组间比较,动脉取栓组的出血转化率最高(26.47%),差异有统计学意义(F=6.462,P=0.040)。(6)入院美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及高血脂症在3组间比较差异具有统计学意义(t=6.209,P=0.003;F=6.176,P=0.046)。(7)保守治疗组发病时间(6.55±4.70)长于静脉溶栓组(2.93±1.05)及动脉取栓组(3.07±2.51),3组间差异有统计学意义(t=16.246,P=0.000)。结论了解不同治疗方法患者的影像学表现特征,可帮助临床医生根据具体情况选择合理的治疗方案,实现个性化治疗。

The TOAST classification and imaging characteristics in acute cerebral infarction with different treatment methods

Objective: To analyze the imaging features of acute cerebral infarction with different therapies using multi-mode magnetic resonance diffusion weighted imaging-perfusion weighted imaging. Materials and Methods: One hundred and ten patients admitted to our hospital neurology department with acute cerebral infarction were retrospectively analyzed. All patients were performed multi-mode magnetic resonance examination, the imaging findings, clinical data and laboratory findings were recorded. The diffusion weighted imaging (DWI) and trial of org 10172 in acute stroke treatment (TOAST) of patients were classified according to them. The patients were divided into vein thrombolysis group (43 cases), artery bolt group (34 cases) and conservative treatment group (33 cases), and the imaging and clinical data of three groups were statistically analyzed. Results: (1) The ratio of ischemic penumbra and hyperintense vessel in artery bolt group were higher than the ratio of vein thrombolysis and conservative treatment group, and the difference had statistical significance (F=13.713, P=0.001;F=8.108, P=0.017). (2) In terms of DWI classification, the small penetrating branch infarction and unilateral anterior circulation infarction for lager ratio in vein thrombolysis group (25.58%, 23.26%), unilateral anterior circulation infarction and anterior-posterior circulation infarction for larger ratio in artery bolt group (52.94%, 21.43%) and conservative treatment group (30.30%, 30.30%). (3) In terms of TOAST classification, LAA for larger ratio in vein thrombolysis group (39.53%), UND for lager ratio in artery bolt group, SAO for conservative treatment group. (4) In terms of MRA imaging findings, both middle cerebral artery and internal carotid artery showed the highest proportion of normal in intravenous thrombolysis and conservative treatment group (72.09%, 51.52%), and middle cerebral artery stenosis or occlusion showed the highest proportion in artery bolt group (41.18%). (5) Artery bolt group had the highest bleeding conversion rate in the three groups (26.47%), the difference was statistically significant (F=6.462, P=0.040). (6) Hospital NIHSS score and hyperlipidemia in the three groups had statistical difference (t=6.209, P=0.003; F=6.176, P=0.046). (7) the onset time in conservative treatment group (6.55±4.70) was longer than that in intravenous thrombolysis group (2.93±1.05) and artery bolt group (3.07±2.51). There were significant differences in three groups (t=16.246, P=0.000). Conclusion: Knowledge of the imaging findings of patients with different treatment characteristics, can help clinical doctors choose reasonable treatment scheme according to the concrete situation, realize the personalized treatment.