~1H-MRS对单发急性脑梗死治疗前与后病灶整体取样的监测价值  

The Value of ~1H-MRS in Monitoring Single Acute Cerebral Infarction with Whole Infarction Lesion Sample Before and After Treatment

作　　者：李石坚[1] 翟健[2] 张金平[3] 刘维洲[4] 汤永祥[3] 钱振[3] 孔小权[3] 高萍[3] 吴小燕[3] 

机构地区：[1]安徽省皖南医学院,241002 [2]安徽省皖南医学院附属弋矶山医院影像科,241001 [3]安徽省皖南医学院附属铜陵市人民医院MRI室,244000 [4]安徽省皖南医学院附属铜陵市人民医院神经内科,244000

出　　处：《临床放射学杂志》2012年第3期332-337,共6页Journal of Clinical Radiology

摘　　要：目的研究单发急性脑梗死整体病灶区治疗前与后氢质子磁共振波谱(1H-MRS)特征,并探讨其临床应用价值。资料与方法 26例患者分别在急性期和治疗平稳期行常规MRI及1H-MRS检查。1H-MRS检测采用单体素或多体素对病灶区行整体取样。对比分析治疗前与后整体梗死病灶区氮-乙酰天门冬氨酸(NAA)、胆碱类复合物(Cho)和肌酸(Cr)积分值,记录乳酸(Lac)峰次数;同时检测对侧正常脑组织区相应代谢物。运用Barthel指数量表记录患者的神经功能评分。扩散加权成像(DWI)上测量病灶容积并分析治疗前与后容积变化。比较治疗前与后病灶区NAA积分值与梗死病灶容积(V)的比值并分析其与神经功能评分的相关性。结果 26例患者在12～72 h和治疗(20±7.17)天接受了两次MR检查,获得52次1H-MRS结果。治疗前、后病灶区NAA分别与对侧半球相应正常区相比均有下降(P<0.05),梗死病灶区治疗前与后NAA未见明显改变(P>0.05);治疗后梗死病灶容积较治疗前变小(P<0.05);治疗后NAA/V比值及神经功能评分较治疗前值均有升高(P<0.05);NAA/V比值与患者神经功能评分呈正相关(r=0.315,P<0.05)。病灶区治疗前与后Cho及Cr值相比及其分别与对侧相应区相比,无显著性差异(P>0.05),但部分Cho(9/26)及Cr(7/26)治疗前后的值起伏较大。Lac峰出现率为23%(12/52)。结论1H-MRS对单发急性脑梗死治疗前与后病灶整体取样动态监测其单一的NAA水平改变,对于评价临床神经功能康复有局限性;动态监测梗死病灶区NAA水平与梗死病灶容积比值,可能是一项反映临床神经功能恢复的客观指标;Cho与Cr值总体相对平稳;Lac峰的出现有一定的诊断价值。Objective To study the characteristics of metabolite in the whole single acute cerebral infarction before and after treatment by 1H-MRS and explore its clinical value.Materials and Methods Routine MRI and 1H MRS were performed for 26 patients in the acute stage and the stationary phase of the disease respectively.1H-MRS with single voxel（SV） or multivoxel was used to detect cerebral infarction.The metabolite score of NAA,Cho and Cr and the appearance times of Lac wave in the whole lesion area and the normal cerebral area were analyzed before and after treatment respectively,meanwhile,the degree of neurologic impairment were assessed with Barthel index in the all cases.The volume of cerebral infarction was measured on DWI and the ratio between NAA score of the cerebral infarction and its volume was calculated in every patient before and after treatment respectively.The correlation between the ratio（NAA/V） and the Barthel index was analyzed.Results MRI was performed in acute stage（12～72 h） and after treatment（20±7.17 d） respectively and 52 results of 1H-MRS were obtained in 26 cases.The cerebral infarction NAA score before and after treatment were all lower than that in the anti cerebral normal area（P0.05）,but the difference of cerebral infarction NAA score between before treatment and that after treatment was not significant（P0.05）.The lesion volume of cerebral infarction after treatment was smaller than that before treatment（P0.05）;The identical patient ratio of NAA/V after treatment was obviously higher than that before treatment（P0.05）.The rang of Barthel index of 26 cases（93.5±10.8） after treatment was higher than that（79.23±17.42） before treatment（P0.05）.The relationship between NAA/V and Barthel index of 26 cases was positive correlation（r=0.315,P0.05）.The difference between Cr or Cho scores before and after treatment and in anti cerebral area were all not significant（P0.05）,but the huge change of the scores of Cr（7/26）and Cho（9/26） were appear

关 键 词：质子磁共振波谱 急性脑梗死 氮-乙酰天门冬氨酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]