应用磁共振弥散加权成像量化指标评估急性脑缺血溶栓预后

目的:探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)量化指标对急性脑缺血溶栓治疗预后评估的价值。方法:112例急性脑缺血患者在溶栓前进行磁共振(MR)检查,包括常规序列及DWI序列。对其中46例符合溶栓条件的患者进行溶栓治疗,作为治疗组；48例不符合溶栓条件的患者进行常规治疗,作为对照组；其余3例带有金属假牙及填充物患者MR图像质量不满意；15例诊断为TIA发作,进行保守治疗。测量所得DWI图像显示的梗死体积、梗死部位、梗死边缘及进展区弥散系数(ADC)值,将梗死体积与ADC值指标量化后与溶栓预后指标进行相关性分析,探讨其可能的评估价值。结果:对照组与溶栓组中的DWI各区域的ADC值无统计学差异(P=0.07、0.46、0.71、0.34)。溶栓组DWI所测量的梗死体积与临床NIHSS评分、住院天数、预后以及颅内出血(ICH)密切相关(P=0.009、0.034、0.048、0.015)。梗死体积越大,NIHSS评分越高、并发出血的可能性也越大。结论:DWI测量脑梗死范围大小可能有助于评价急性脑缺血溶栓治疗预后,ADC值可能评估价值不大

Quantitative parameters of diffusion weighted imaging in evaluating prognoses of patients with hyperacute cerebral infarction after thrombolysis

Objective:To investigate the role of diffusion weighted imaging (DWI) in evaluating prognoses of patients with hyperacute cerebral infarction after thrombolysis.Methods: A total of 112 patients with hyperacute cerebral infarction underwent MR examination (including routine MR and DWI) before thrombolysis.Forty-six patients met the standard of thrombolysis and were treated with rt-PA.Control group included 48 patients who did not meet the thrombolysis standard and were treated routinely.The other 3 patients had a poor MRI quality due to metal denture or other fillers.Fifteen patients had the onset of TIA and received conservative treatment.The measurements included the infarction volume,location,margin and ADC value of the progression area.Correlation analysis was conducted between the above parameters and the related parameters after thrombolysis to assess their roles in evaluating of patients prognoses.Results: There was no significant difference in the ADC values of different areas of DWI between the control group and thrombolysis group (P=0.07,0.46,0.71,and 0.34).Significant correlation was found between the infarction volume with the NIHSS score,length of hospital stay,mRS,and intracerebral hemorrhage(ICH)(P=0.009,0.034,0.048,and 0.015,respectivley).The larger the volume of infarction was,the higher the NIHSS score and the more the possibility of ICH.Conclusion: The determination of cerebral infarction area by DWI may help to evaluate the prognoses of patients with hyperacute cerebral infarction after thrombolysis; the ADC value only play a little role for the evaluation.