磁共振弥散加权成像及血管造影对短暂性脑缺血发作后脑卒中复发风险的评估  

Value of DWI and MRA in assessing the recurrent risk of ischemic stroke following transient ischemic attack

作　　者：王光胜[1] 周倩茹[2] 童道明[1] 杨同慧[1] 常春红[1] 顾汉沛[1] 许改红[1] 

机构地区：[1]江苏省沭阳县人民医院神经内科,223600 [2]江苏省沭阳县中医院影像科

出　　处：《中华老年心脑血管病杂志》2015年第9期919-921,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的评估核磁共振弥散加权成像(DWI)及磁共振血管造影(MRA)在短暂性脑缺血发作(TIA)患者中的应用价值。方法收集TIA患者305例,其中颈内动脉系统228例和椎基底动脉系统77例,ABCD2评分分为低危73例(23.9%)、中危159例(52.1%)及高危73例(23.9%)。入院后24h内进行DWI检查确定是否存在缺血灶,MRA进行颅内外血管病变评估。结果 305例TIA患者中,7d内发生缺血性脑卒中27例,发生率8.9%,其中低危、中危、高危患者7d发生缺血性脑卒中分别为0例、10例、17例,差异有统计学意义(P=0.000)。DWI阳性89例(29.2%),7d发生缺血性脑卒中24例(27.0%),DWI阴性216例(70.8%),7d发生缺血性脑卒中3例(1.4%),差异有统计学意义(P=0.000)。MRA示颅内动脉狭窄108例(35.4%),颅外动脉狭窄77例(25.2%),正常血管120例(39.3%),7d发生缺血性脑卒中分别为18例、7例、2例,差异有统计学意义(P=0.000)。颅内动脉病变、DWI、反复TIA、ABCD2评分是TIA患者7d发生缺血性脑卒中的独立危险因素。结论 TIA患者DWI阳性、颅内动脉狭窄与7d缺血性脑卒中发生相关,MRA及DWI对TIA后脑卒中复发风险有预测价值。Objective To study the value of DWI and MRA in assessing the recurrent risk of ische- mic stroke within 7 days following transient ischemic attack （TIA）. Methods Three hundred and five patients were divided into low recurrent risk group （n=73）,moderate recurrent risk group （n=159）, and high recurrent risk group （n=73） according to their ABCD2 score. Their ischemic lesions were detected by DWI within 24 hours after admission,and their intracranial and extracra- nial vascular lesions were assessed by MRA. Results Ischemic stroke occurred in 27 （8.9%） out of the 305 patients within 7d following TIA, including in 0,10 and 17 patients of low, moderate and high recurrent risk groups （P=0. 000）. The DWI was positive in 89 （29.2%） patients and is- chemic stroke occurred in 24 （27.0%） patients within 7d following TIA,the DWI was negative in 216（70.8%） patients and ischemic stroke occurred in 3 （1.4%） patients within 7 d following TIA （P=0. 000）. MRA showed intracranial artery stenosis, extracranial artery stenosis and no artery stenosis in 108 （35.4%）,77 （25.2%） and 120 （39.3%） patients respectively and ischemic stroke in 18,7 and 2 patients respectively following TIA（P=0. 000）. Logistic regression analysis re- vealed that intracranial artery stenosis, DWI, repeated TIA and ABCD2 score were the independent risk factors for ischemic stroke within 7d following TIA. Conclusion Positive DWI and intracra- nial artery stenosis are closely related with ischemic stroke within 7d following TIA. MRA and DWI can predict the recurrent risk of ischemic stroke following TIA.

关 键 词：脑缺血发作 短暂性 卒中 复发 磁共振血管造影术 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]