磁共振氢质子波谱序列点分解频谱分析法和弥散加权成像在超急性期脑梗死缺血半暗带的临床应用  

Clinical research on ischemic penumbra of cerebral infarction by scan pulse sequence point resolved spectroscopy sequence of magnetic resonance spectroscopy and diffusion-weighted imaging

作　　者：蒋宇宏[1] 宋少辉[1] 刘海滨[1] 

机构地区：[1]武汉市第一医院放射科,湖北武汉430022

出　　处：《新乡医学院学报》2014年第5期353-355,共3页Journal of Xinxiang Medical University

基　　金：武汉市卫生局资助项目(编号:WX09A03)

摘　　要：目的探讨磁共振波谱分析（MRS）的氢质子波谱序列点分解频谱分析法（PRESS）序列脉冲扫描技术与弥散加权成像（DWI）在超急性期脑梗死缺血半暗带（IP）的临床应用价值。方法选择11例发病时间在2~6 h、存在磁共振（MRI）灌注加权成像（PWI）和弥散加权成像（DWI）不匹配的超急性脑梗死患者,对其行磁共振波谱分析（MRS）的PRESS序列脉冲扫描技术与弥散加权成像（DWI）检查。测量分析IP的区域。结果 8例在常规序列T2WI均未显示新近梗死灶,3例显示出明确的新近梗死灶;4例表现为脑回肿胀、脑沟变浅及动脉高密度征。11例均在DWI显示异常高信号,4例病灶直径〈1.5 cm（3例梗死中心未见Lac峰出现）,7例病灶直径〉1.5 cm（均见Lac峰出现）,平均直径（4.6±2.3）cm。N-乙酰天门冬氨酸/肌酸（NAA/Cr）比值在IP平均为1.71±0.58,梗死中心区平均为1.38±0.86,NAA/Cr比值在梗死中心区降低更明显。相对NAA浓度（rNAA）梗死中心区为0.84±0.51,IP区为0.93±0.35,Lac/Cr比值梗死中心区为0.22~1.69,平均0.79±0.29,IP为0.10~0.89,平均0.58±0.15。结论 MRS的PRESS序列脉冲扫描技术与DWI联合应用在显示早期脑IP上更具优势。Objective To explore the clinical application of point resolved spectroscopy sequence（PRESS） of the mag- netic resonance spectroscopy（MRS） and diffusion-weighted imaging （DWI） in the ischemic penumbra of hyperacute cerebral infarction. Methods The pulse scanning technology PRESS sequence of MRS and DWI were performed in 11 patients in 2 - 6 h after hyper acute cerebral infarction who had a mismatch of perfusion weighted magnetic resonance imaging（PWI） and dif- fusion weighted magnetic resonance imaging（DWI）. The area of ischemic penumbra（IP） was measured and analyzed. Results Eight cases in regular sequence T2WI showed no recent infarction,3 cases showed clear recent infarction;4 cases showed brain swelling and high density sign of artery; DWI showed abnormal high signal in 11 cases,4 cases with lesion diameter 〈 1.5 cm（3 cases of infarction center had no Lac peaks） ,7 cases whose Lac peaks were seen with lesions 〉 1.5 cm and the av- erage diameter was （4.6±2.3 ） cm. The average of N-acetylaspartate/creatine（ NAA/Cr） ratio in IP was 1.71± 0.58, and in infarction center district was 1.38 ± 0.86 which reduced more obviously. The relative concentration of NAA（rNAA） in the in- farction central area was 0. 84 ±0.51 ,and in the IP district was 0.93±0.35 ,Lac / Cr ratio was 0.22 to 1.69 in the infarction central area whose average was 0.79 ±0.29 ,and was 0.10 to 0.89 in the IP whose averagewas 0.58 ±0.15. Conclusion The PRESS sequence of MRS and DWI bring more advantages when it is applied to show ischemic penumbra of hyperacute cer- ebral infarction.

关 键 词：脑梗死 缺血半暗带 磁共振氢质子波谱序列点分解频谱分析法 弥散加权成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学]