磁共振扩散张量成像在急性缺血性脑梗死预后判断中的临床应用  

Clinical application of magnetic resonance diffusion tensor imaging in judging prognosis of acute ischemic cerebral infarction

作　　者：胡建斌[1] 陈飞[1] 甘敏[1] 王雪扬[1] 许岗[1] 叶杨[1] 

机构地区：[1]东南大学医学院附属盐城医院影像科,江苏盐城224001

出　　处：《医学影像学杂志》2016年第6期958-961,975,共5页Journal of Medical Imaging

摘　　要：目的评价磁共振扩散张量成像(DTI)各参数在急性缺血性脑梗死预后判断中的临床应用价值。方法回顾分析我院48例经临床及磁共振诊断为单侧急性缺血性脑梗死并成功随访3个月以上患者的DTI序列各参数图。根据随访改良Rankin量表(mRS)评分结果,将患者分为预后良好、预后一般和预后差三组。在DTI序列各项异性指数(FA)、容积比各项异性(VRA)、平均弥散系数(DCavg)及衰减指数(Exat)参数图上选取病灶及对侧为感兴趣区(ROI),记录各ROI参数值并计算病灶-对侧各参数的相对值。同时以病灶及对侧ROI为种子点重建弥散张量纤维束成像(DTT)图。比较病灶与相应对侧间各参数值的差异,分析病灶-对侧各参数相对值在三组间的差异。结果急性缺血性脑梗死DTT图可观察到纤维束损伤表现。脑梗死病灶区FA、VRA和DCavg值各组均低于对侧,Exat值各组均高于对侧(P<0.05)。从预后良好组到预后差组脑梗死病灶-对侧FA和VRA相对值逐渐减低(P<0.05),其中FA相对值在预后良好和预后一般组间无统计学差异,VRA相对值在预后一般与预后差组间无统计学差异。三组病灶-对侧DCavg和Exat相对值均无统计学差异。结论 FA、VRA、DCavg及Exat值在急性缺血性脑梗死中存在特定的改变规律;其中病灶-对侧FA和VRA相对值可作为临床预后判断的有力依据。Objective To evaluate the clinical application value of each parameter from magnetic resonance diffusion tensor imaging（ DTI） in judging prognosis of acute ischemic cerebral infarction. Methods We analysed each parameter images from DTI of 48 patients with unilateral acute ischemic cerebral infarction and more than 3 months follow up diagnosed by clinic and magnetic resonance imaging,divided the patients to three groups of favourable prognosis,general prognosis and bad prognosis according to the follow up results of modified Rankin scale（ mRS）,set the regions of interest（ ROI） of infarction lesions and the contra on DTI parameters mapping of fractional anisotropy（ FA）,volume ratio anisotropy（ VRA）,average diffusion coefficient（ DCavg） and exponential attenuation（ Exat）,and recorded the parameters values of ROI and calculate the relative parameters value of infarction lesion to the contra. Meanwhile,we reconstructed the DTT images based on the seed points（ infarction lesion and the contra）. We compared the differences of each parameter value between infarction lesions and the contra,also analysed the differences of relative parameters values of infarction lesion to contra among three groups. Results The DTT images of acute ischemic cerebral infarction could show the manifestation of fasciculi damag. The FA,VRA and DCavg value of cerebral infarction lesions were lower and the Exat value was higher than the contra in each group（ P〈0. 05）. The relative FA and VRA value of infarction lesion to the contra were gradually decreased from favourable prognosis to bad prognosis group（ P〈0. 05）,but there were no differences of the relative FA value between favourable prognosis and general prognosis and the relative VRA value between general prognosis and bad prognosis. The relative DCavg and Exat value were no difference among three groups. Conclusion The FA,VRA,DCavg and Exat value have specific change mode in acute ischemic cerebral infarction. Among them,the relative FA and VRA v

关 键 词：磁共振成像 弥散张量成像 脑梗死 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]