多模式MRI在急性脑梗死rt-PA静脉溶栓治疗中的评估作用

目的:评价多模式磁共振成像(MRI)在急性脑梗死重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓中的作用。方法:选择我院神经内科卒中单元筛选的35例符合溶栓标准CT阴性的脑梗死患者进行多模式MRI检查,进一步评估其溶栓风险和获益。结果:9例患者不符合多模式MRI筛选标准,不适合进行溶栓治疗。另4例患者拒绝溶栓,7例患者在溶栓前肌力好转未予溶栓,15例患者接受了rt-PA静脉溶栓。3个月随访改良Rankin评分(mRS)0～2分者11例,3分者4例,无4～5分患者,无颅内出血病例,无死亡病例。结论:对于发病3h之内的超早期脑梗死患者,溶栓前多模式MRI评估有助于选择可能从rt-PA溶栓中获益的患者;对于发病3.0～4.5h的患者,能扩大rt-PA溶栓时间窗。

Application Value of Multi-modality Magnetic Resonance Imaging on Intravenous Thrombolysis with rt-PA in Acute Stroke

Objective: To evaluate the value of multi-modality magnetic resonance imaging (MRI) on intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in acute cerebral infarction. Methods: Total 35 patients with acute cerebral infarction were enrolled. All patients were found normal on CT imaging and met the thrombolysis criterion,and were scanned by multi-modality MRI to assess the risk and potential benefits. Results: Nine patients did not suit the multi-modality MRI thrombolysis criterion.Seven patients had improving neurological signs,4 patients rejected and 15 patients accepted rt-PA therapy. There were 11 cases with mRS 0-2 and 4 cases with mRS 3. There was no death and hemorrhagic case. Conclusion: Multi-modality MRI is helpful to choose patients that may be benefit from thrombolysis therapy and exclude the risk of bleeding after thrombolysis and expensed rt-PA use time window.