磁共振弥散加权成像在栓塞性脑梗死诊断中的应用

目的评价磁共振弥散加权成像(DWI)在鉴别栓塞性脑梗死中的诊断价值.方法对202例急性颈内动脉及椎基底动脉系统脑梗死患者分别进行MRI(T1、T2、FLAIR、DWI)、磁共振血管造影(MRA)、颈动脉超声、经颅多普勒超声(TCD)及超声心动图(UCG)等检查,比较栓塞源性卒中的特点.结果有心源性栓塞病因的脑梗死患者30例(14.9%),DWI证实单发梗死12例(5.9%),多发梗死18例(8.9%);无明确栓塞病因的脑梗死患者,经DWI证实有71(35.1%)例患者存在多发的、时间上关系密切的急性栓塞性梗死灶;全部栓塞性脑梗死患者中,小血管腔隙性梗死的患者有46例(22.8%).结论DWI能区分急、慢性脑缺血,协助鉴别责任病灶,有助于进一步筛查卒中的病因及二级预防的开展;MRA、颈动脉超声、TCD及超声心动图等检查在卒中病因学调查中起重要作用.

The diagnostic application of MR diffusion weighted imagine in the patients with embolic cerebral infaction

Objective To evaluate the diagnostic value of MR diffusion weighted imagine(DWI) in the patients with embolic cerebral infarction. Methods 202 patients with cervical carotid arteries and vertebral-basil arteries system infarction were perforned with MRI (T1, T2, FLAIR, DWI), MRA, carotid Duplex, TCD and UCG respectively. The characteristics of the infarction were compared based on the source of emboli. Results 30(14.9%) of patients had cardiogenic embolic infarction. DWI showed single infarction in 12(5.9%) and maltiple infarction in 18(8.9%), 71(35.1%) whose causes could be identified showed that the infarctions occured simultaneously or closely related in time on DWI, 46(22.8%) lacunar infarction of small vessels were found in all patients with cerebral embolism. Conclusions DWI can distinguish acute or chronic ischemic lesions and identify the index lesions DWI may help to differentiate the etiologic mechanisms and secondary prevention therapy. MRA carotid Duplex, TCD and UCG are important in etiologic identification of stroke.