全脑3D-ASL和SWI联合检查在急性大面积脑梗死治疗中的价值  

The value of combined use of 3D arterial spin-labeled perfusion imaging and susceptibility weighted imaging in the therapy of acute large cerebral infarction

作　　者：张国伟[1] 陈锋[1] 李忠维[1] 王爱杰[1] 梁辉[2] 王英[2] 任金岩[2] 张光辉[1] 

机构地区：[1]山东省烟台市烟台山医院CT/MR室,山东烟台264001 [2]山东省烟台市烟台山医院神经内科,山东烟台264001

出　　处：《医学影像学杂志》2016年第7期1170-1174,共5页Journal of Medical Imaging

摘　　要：目的 探讨3D-ASL和SWI技术对急性大面积脑梗死治疗方案的指导价值。方法 回顾性分析46例急性大面积脑梗死患者在治疗前后的ASL和SWI表现,其中4例于治疗前、4例于动脉溶栓治疗后、5例静脉溶栓治疗后、33例抗凝治疗后、12例于治疗后30~60天复查,根据治疗方案的不同,分别统计急性大面积脑梗死患者ASL像高/低灌注、SWI像出血或侧枝循环形成的影像学表现,按NIHSS评分评价临床愈后效果。结果 本组46例中,14例患者ASL像上呈局部或大部分高灌注,占30%,其余32例为低灌注,占70%;4例行动脉溶栓,ASL像上呈局部或大部分高灌注,SWI像上均可见面积大小不等的低信号出血灶;5例行静脉溶栓,ASL像上呈高灌注3例、呈低灌注2例,SWI像可见脑出血1例;33例行抗凝治疗,7例于治疗后ASL像上呈高灌注,其中5例SWI像可见低信号出血灶,2例SWI像上未见出血灶;26例ASL像呈低灌注,10例SWI像上可见出血灶,16例SWI像未见出血灶。4例有房颤病史且平常口服抗凝药物的患者在抗凝治疗后均于ASL像上表现为高灌注。本组16例中,24例于SWI像上显示梗死区或周围血管增多、增粗,占52%。SWI像上9例可见沿大脑中动脉走行的条状低信号影,占20%。NIHSS评分：1例死亡,5例无变化,其余40例经治疗后均有不同程度好转。结论 联合运用3D-ASL和SWI技术指导急性大面积脑梗死患者的治疗,具有重要的临床价值。Objective To investigate the value of 3D arterial spin labeling （3D-ASL） and susceptibility weighted imaging （SWI） in guiding treatment plan of the acute large cerebral infarction. Methods We retrospectively studied findings of ASL and SWI in 63 patients with acute large cerebral infarction. The patients included 4 patients before therapy, 4 patients after intra-arterial thromholysis, 5 patients after intra-venous thromholysis, 33 patients after anticoagulant therapy. 12 patients were rechecked after 30 -60 days. According to different treatment plan, two experienced neuroradiologists statistical analyzed independently and separately imaging findings of ASL and SWI of the acute large cerebral infarction. Neurologists evaluated clinical prognosis by using NIHSS （ National Institutes of Health Stroke Scale） score. Results 1 ） Hyperperfusion was observed on ASL in 14/46 patients, and hypoperfused regions in 32/46 patients; 2） In 4 patients with intra-arterial thrombolysis, partial or most hyperperfu- sion was observed on ASL, and signs of hemorrhage within or around hypoperfusion areas were detected by SWI ; 3 ） In 5 patients with intra-venous thromholysis, 3 patients showed hyperperfusion on ASL, the other two cases showed hypoperfusion. Sign of hemorrhage was detected by using SWI in 1/5 patient; 4） Hyperperfusion was shown on ASL in 7/33 patients with anticoagulant therapy, 5 of them showed sign of hemorrhage on SWI. Hypoperfusion was observed on ASL in 26/33 patients with anticoagulant therapy, 10 of them were observed sign of hemorrhage on SWI. 4 patients with atrial fibrillation, which often took orally anticoagulant medicine, showed hyperperfusion on ASL after anticoagulant therapy; 5 ） Increased microvessels inside or around hypoperfusion areas were detected by SWI in 24/46 patients, and thrombosis within middle cerebral artery was showed by SWI in 9/46 patients ; 6） A case of patients was death, NIHSS score did not change in 5 patients, the rest patients were improved on NIHSS score

关 键 词：3D-ASL SWI 急性大面积脑梗死 溶栓治疗 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]