大脑中动脉供血区急性脑梗死磁共振成像与神经功能缺损的关系  

The relashionship between MRI and neurological deficits during acute cerebral infartion in middle cerebral artery region

作　　者：孟强[1] 赵英[2] 董曼丽[1] 陈文利[1] 刘江[1] 翟明[1] 戴敏方[2] 张金章[1] 

机构地区：[1]昆明医院附属昆华医院云南省第一人民医院神经内科,650032 [2]昆明医院附属昆华医院云南省第一人民医院磁共振室,650032

出　　处：《中国脑血管病杂志》2007年第11期481-485,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：云南省自然科学基金资助项目(2002C0003R)

摘　　要：目的研究MCA供血区脑梗死急性期的磁共振弥散（DWI）及灌注（PWI）加权成像的特点,并探讨其与发病时神经功能缺损评分之间的关系。方法对发病时间在6h内的35例MCA供血区的急性脑梗死患者,进行DWI及PWI（达峰时间图,TTP图）检查,计算图像信号异常区域的体积,将其依次与患者发病时的欧洲卒中量表（ESS）值进行相关分析。结果35例患者的DWI信号异常区域体积为0.2-252.8cm^3（中位数为40.7cm^3）,TTP图上低灌注区体积为0.4-309.5cm^3（中位数为141.2cm^3）,二者均与患者临床ESS评分呈明显负相关（依次为r=-0.673,P=0.000;r=-0.572,P=0.000）;但TTP-DWI不匹配区的体积（0.2-179.9cm^3,中位数56.7cm^3）与ESS评分无明显相关性（r=-0.304,P=0.076）。其中有69%（24/35）患者的PWI异常区域的体积超过DWI体积的20%以上。结论DWI与PWI异常区域的体积与MCA供血区急性脑梗死患者临床症状密切相关,决定MCA供血区急性脑梗死患者临床症状的主要因素是DWI体积,TTP-DWI不匹配区与临床症状相关性的差异无统计学意义,提示其对急性期神经功能缺损的影响较小。　Objectives To study the characteristics of diffusion-weighted imaging （DWI） and perfusion-weighted imaging （PWI） of hyperacute cerebral infarction in middle cerebral artery （MCA） region and to explore the relationship between these characteristics and the neural function deficit scales at the onset of disease.Methods Thirty-five patients with hyperacute cerebral infarction in MCA region underwent DWI （b=1000 s/mm^2） and PWI （TTP map） within 6 hours after onset of symptoms. The volume of image signal in abnormal region was calculated. Correlation analysis were performed with the Europe stroke scale （ESS） scores in the order of symptom onset.Results In 35 patients, the volumes of abnormal signal intensity areas on DWI ranged from 0.2 to 252.8 cm^3 （median 40.7 cm^3）; the volumes of low perfusion areas on TTP map ranged from 0.4 to 309.5 cm^3 （median 141.2 cm^3）, and both presented obviously negative correlation with the clinical ESS scores of patients （they were r=-0.673,P=0.000 and r =-0.572,P=0.000, respectively）; however, the volumes of TTP-DWI mismatch areas （ranged from 0.2 to 179.9 cm^3, median 56.7 cm^3） did not have obvious correlation with the ESS scores （r=-0.304,P=0.076）. Of 68.6% （24/35） patients, the volumes of abnormal signal intensity areas on PWI were more than 20% of those on DWI.Conclusions The volumes of abnormal areas on DWI and TTP were closely correlated with the clinical symptoms in patients with hyperactute cerebral infarction in MCA regions; the main factor of determining clinical symptoms in patients with hyperactute cerebral infarction in MCA regions is the volume on DWI; there is no statistical difference in correlation between TTP-DWI mismatch areas and clinical symptoms, which may suggest that they has less effect on acute neurological deficit, and therefore, they may respond to neuroprotective or thrombolytic agents.

关 键 词：梗塞 大脑中动脉 磁共振成像 自主神经系统疾病 

分 类 号：R743.3[医药卫生—神经病学与精神病学]