MRI界定的超急性缺血性脑卒中溶栓与发病时间窗的研究  

Study of MRI Defined Hyperacute Ischemic Stroke Thrombolysis and Onset Time Window

作　　者：陆练军[1] 白青科[1] 赵振国[2] 陈娟[1] 隋海晶[2] 谢秀海[2] 赵晓晖[1] 沈健[1] 周媛[1] 杨娟[2] 

机构地区：[1]上海市浦东新区人民医院神经内科 [2]上海市浦东新区人民医院放射影像科

出　　处：《中国医学计算机成像杂志》2013年第5期398-402,共5页Chinese Computed Medical Imaging

基　　金：浦东新区卫生系统重点学科建设基金(PWZXK2010-03);浦东新区卫生系统领先人才培养基金(PWR1201002);上海市浦东新区卫局项目及科技发展基金创新项目(PKJ2010-Y28;PW2011B-7);上海市卫生计划生育委员会科研项目基金(2013-179)~~

摘　　要：目的：探讨MRI快速评价界定的超急性脑梗死与发病时间窗的关系。方法：分析发病12h内526例缺血性脑卒中，197例（37．5％）因cT平扫显示明显低密度改变而除外超急性期脑梗死。初筛后的329例缺血性脑卒中患者行MR快速成像序列检查，筛选符合超急性期脑梗死者，即DWI呈高信号，而T2WI、FLAIR无高信号改变及T1WI无低信号改变者186例（186／329，56．53％）行rt—PA静脉溶栓治疗。结果：MRI界定的发病12h内的超急性期脑梗死占35．4％（186／526），其中≤4．5h组为66．7％，4．5～12h组19．5％，差异有统计学意义（P〈0．01）。结论：随着发病时间的延长，MRI界定的超急性脑梗死逐渐减少，但4．5～12h时间窗仍可筛选出适合溶栓的病例。Purpose： To study the relationship of MRI defined hyperacute ischemic stroke and onset time window. Methods： Five hundreds and twenty-six ischemic stroke patients within 12h time window who had been prescreened by CT plain scan were enrolled in our study. And 197 cases （37.5%） were exclusive because of obvious low density found at plain CT. MR fast imaging sequences were performed on 329 cases, and 186 cases （186/329, 56.53%） were confirmed with superacute ischemic stroke which was shown hyper-intense on DWI, no hyper-intense changes on T2WI and FLAIR and no hypo-intense change on T1WI. These 186 cases were treated by rt-PA intravenous thrombolysis. Results： These 186 cases （35.4%, 186/526） were confirmed with superacute ischemic stroke, 66.7% and 19.5% of these patients were belonged to ≤4.5h and 4.5h-12h time window group, and the difference between them was with statistical significant （P〈0.01）. Conclusion： With the extension of the onset time window, the number of the MRI defined superacute ischemic stroke decreased gradually, but suitable thrombolysis cases still can be selected from the 4.5h-12h time window.

关 键 词：脑梗死 磁共振成像 体层摄影术 X线计算机 血栓溶解疗法 

分 类 号：R445.2[医药卫生—影像医学与核医学]