多序列磁共振在急性脑卒中诊断流程中的应用  

The diagnostic procedure in acute stroke by multi-sequence MRI

作　　者：王宝军[1] 刘国荣[1] 李月春[1] 李静[1] 庞江霞[1] 张京芬[1] 崇奕[1] 李锐铭[1] 张晖[1] 

机构地区：[1]包头市中心医院神经内科,包头014040

出　　处：《中华行为医学与脑科学杂志》2011年第2期149-151,共3页Chinese Journal of Behavioral Medicine and Brain Science

摘　　要：目的探讨急性脑卒中发生后最佳的影像诊断流程。方法发病在1—72h的53例急性脑卒中患者在CT检查后行T1加权成像（T1WI）、T2加权成像（T2WI）、梯度回波他’加权成像（GRE—T2＊WI）、弥散加权成像（DWI）检查，缺血性卒中患者中15例行灌注加权成像（PWI）检查。结果15例急性脑出血及1例瘤卒中患者的出血灶在GRE-1、29WI上全部清楚显影，3例TIA患者各项均正常。发病在6h内的18例脑梗死患者各项均呈等信号，其中7例患者行PWI检查：3例PWI≥DWI，4例PWI=DWI；发病大于6h的14例患者行GRE-12＊WI均为高信号，DWI均显示有与体征相对应的高信号病灶，其中8例行PWI检查，6例PWI=DWI，2例PWI正常，本组患者中有7例患者GRE—T2＊WI呈现有l～18个直径为2～5mm的极低信号；另有1例头痛伴一侧肢体偏瘫的患者在CT上未见异常，T2＊WI显示环池有低信号影后证实为蛛网膜下腔出血。结论对急性脑卒中患者可直接通过MRI多序列检查流程在较短的时间内一站式地鉴别脑出血、脑梗死和TIA，明确微出血情况，确定缺血半暗带，指导溶栓治疗的选择。Objective To study the best diagnostic imaging procedure afler acute stroke. Methods 53 patients with acute stroke were recruited within 72 hours after symptom onset. CT was performed in all patients firstly, then T1 weighted-imaging（T1WI） ,T2 weighted-imaging（ T2WI）, gradient recalled echo T2 ＊ weighted-im- aging（ GRE-T2 ＊WI） and difl＇usion-weighted imaging（DWI） were examined at 1. ST. Furthermore 15 patients with isehemic stroke received peffusion-weighted imaging（PWI） examination. Results 15 patients with acute cerebral hemorrhage and one patient of hemorrhagic brain tumor appeared clear on GRE-T2 ＊ WI. 3 patients with transient ischemic attack（TIA） were normal on T1WI,T2WI, GRE-T2 ＊ WI and DWI. 18 cases with cerebral infarction appeared normal on GRE-T2 ＊ WI within 6 hours after symptom onset, and 7 cases of them underwent PWI examination,the signal intensity of 3 cases were PWI≥ DWI and of 4 cases were PWI = DWI. 14 patients appeared hyperin- tense on GRE-T2 ＊ WI within 6 - 72 hours after symptom onset. 8 patients of them underwent PWI examination, the signal intensity of 6 cases were PWI ≥ DWI and of 2 cases were PWI = DWI. Of 14 patients,7 patients appeared as 1 - 18 dot or patchy hypointense whose diameter was about 2 - 5ram on GRE-T2 ＊ WI. Another case of headache with hemiplegia and the side of the limb didnt show abnormalities on the CT, but showed a low signal in ambient cistern on T2 ＊ WI and was proved to be subarachnoid hemorrhage. Conclusion Mter acute stroke,multi-sequence MRI enables the ＂one-stop shopping＂ imaging of cerebral hemorrhage,cerebral infarction and TIA in a shorter time,makes the state of micro-bleeding clear,determines ischemic penumbra,and even guides for thrombolytic treatment.

关 键 词：多序列磁共振 急性脑卒中 诊断流程 

分 类 号：R445.2[医药卫生—影像医学与核医学]