磁敏感加权成像对大面积脑梗死后出血转化早期诊断临床价值的预探索研究  

Clinical Value of Susceptibility Weighted Imaging on Hemorrhagic Transformation after Massive Cerebral Infarction

作　　者：刘远洪[1] 牛智领[1] 梁金花[1] 马娜[1] 张盼盼[1] 刘乐喜[1] 聂志余[2] 

机构地区：[1]濮阳市人民医院神经内科,濮阳457000 [2]同济大学附属同济医院神经内科

出　　处：《中国卒中杂志》2014年第5期404-408,共5页Chinese Journal of Stroke

摘　　要：目的探讨磁共振成像(magnetic resonance imaging,MRI)磁敏感加权成像(susceptibility-weightedimaging,SWI)技术在早期诊断大面积脑梗死后出血转化(hemorrhagic transformation,HT)中的价值。方法纳入39例经磁共振确诊的大面积脑梗死患者为研究对象,在发病72 h内行头颅计算机断层扫描(computed tomography,CT)和SWI检查,比较两种检查方法对脑梗死后HT的检出率及敏感性。参考欧洲协作性急性卒中研究(European Cooperative Acute Stroke Study,ECASS)分型标准对脑梗死后HT患者的HT进行分级,比较HT分级在两种检查方法中的差异,分析脑梗死后HT分级与美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分的相关性。结果 SWI、CT两种方法诊断脑梗死HT的阳性率分别为61.54%和12.82%(P<0.001);SWI检出发生脑梗死后HT者24例,其中1级占12.82%;2级占25.64%;3级占15.48%;4级占7.69%;经Spearman相关性分析,SWI序列的HT分级与临床NIHSS评分的增长呈正相关(R=0.94,P<0.01)。结论 SWI技术可以早期、敏感评价大面积脑梗死后HT。Objective To investigate the early diagnostic value of susceptibility weighted imaging（SWI） on hemorrhagic transformation（HT） after massive cerebral infarction.Methods Thirty nine cases with massive cerebral infarction diagnosed by magnetic resonance were enrolled and head computed tomography（CT） and magnetic resonance imaging（MRI） including SWI were performed within 72 hours after onset. The detection rate and the sensitivity of two methods for diagnosing HT were compared. The HT after cerebral infarction was graded based on European Cooperative Acute Stroke Study（ECASS）, the difference in HT grade by two examination methods was compared, HT grading and the National Institutes of Health Stroke Scale（NIHSS） score correlation were analyzed.Results The positive rates of SWI or CT in the diagnosis of HT were 61.54% and 12.82%（P0.001） respectively. Twenty four cases（61.54%） with HT after massive cerebral infarction were detected by SWI, grade 1 accounted for 12.82%, and grade 2, 3, 4 for 25.64%, 15.48% and 7.69%, respectively. SWI was significantly superior to conventional CT in early detection of hemorrhagic transformation after massive cerebral infarction. HT grading by SWI was positively correlated with NIHSS scores（R=0.94, P0.01）.Conclusion The HT after massive cerebral infarction can be early, sensitively, objectively evaluated by SWI, which provides the basis for the adjusting treatment programs.

关 键 词：磁敏感加权成像 大面积脑梗死 出血转化 体层摄影术 X线计算机 

分 类 号：R743.33[医药卫生—神经病学与精神病学]