SWI与3D-PCASL联合应用对急性脑梗死出血转化的预测研究  

Combined with SWI and 3D-PCASL in prediction of bleeding after acute cerebral infarction

作　　者：许开喜[1] 丰广魁[1] 马先军[1] 陈新建[1] 左涛生[1] 卞光荣[1] 王金[1] 胡方云[1] 吴常征 

机构地区：[1]江苏省连云港市中医院南京中医药大学附属连云港医院,江苏连云港222000

出　　处：《中国临床医学影像杂志》2017年第5期309-314,共6页Journal of China Clinic Medical Imaging

基　　金：连云港市科技局科研项目(编号SH617)

摘　　要：目的:探讨3.0T磁共振的磁敏感加权成像(SWI)与三维的准连续式动脉自旋标记技术(3D-PCASL)评价急性脑梗死后出血转化(HT),预测评估的临床应用价值。方法:54例急性脑梗死(<72 h)均行常规MRI、3D-PCASL及SWI检查,利用SWI评估HT的类型,结合3D-PCASL获得梗死和HT区及病灶周围脑血流量(CBF)变化进行相关性分析。结果:本组54例急性脑梗死中有19例HT,其中出血性梗死(HI)型13例(HI-1型9例、HI-2型4例),脑血肿形成(PH)型6例(PH-1、2型各3例),HI和PH型的病灶区及病灶周围的局部脑血流量(rCBF)均值区分别为(32.787±10.876)mL/(100g·min)、(26.655±19.325)mL/(100g·min),(26.033±10.930)mL/(100g·min)、(28.984±11.019)mL/(100g·min),HI和PH型的病灶区的rCBF差异有统计学意义(t=0.766,P=0.000,<0.01,t=0.834,P=0.041,<0.05)。在54例急性脑梗死中,病灶内及周围高灌注出血分别占42.8%、50%,正常灌注区及周围出血分别占50%、37.5%,低灌注区及周围分别占31.7%、28.1%,急性脑梗死与HT病灶区及周围低、正常、高灌注的进行t检验分析具有统计学意义(t=0.658,P=0.002,<0.01)。结论:SWI与3D-PCASL联合应用对急性脑梗死和HT病灶内及周围量化分析rCBF变化情况,对急性脑梗死HT预测,为临床制定正确的治疗方案和预后判断具有重要临床意义。Objective： To evaluate the clinical value of combined using 3.0T magnetic resonance magnetic susceptibility weighted imaging（SWI） and three dimensional pseudo continuous arterial spin labeling（3D-PCASL） in prediction of hemorrhagic transformation（HT） after acute cerebral infarction. Methods： Fifty-four cases of acute cerebral infarction（〈72 h） were performed conventional MRI, 3D-PCASL and SWI. The SWI were used to assess the type of HT. Combined with SWI and 3D-PCASL, the infarction area, HT area and cerebral blood flow （CBF） of each patient were calculated and the correlation relationship among them were analyzed. Results： In 54 cases of acute cerebral infarction, 19 cases were HT, 13/19 cases were HI type, 6/ 19 cases were PH type. The average rCBF zone in HI or PH lesions and area around two types of the lesions were （32.787± 10.876）, （26.655±19.325）, （26.033±10.930）, （28.984±11.019）mL/（100g.min）, the differences of rCBF in HI and PH lesions area difference was statistically significant （t=0.766, P=0.000, 〈0.01, t=0.834, P=0.041, 〈0.05）. Within and around the 54 cases of acute cerebral infarction lesions, the high perfusion hemorrhage presented in 42.8% and 50% lesions, respectively. Normal perfusion and surrounding hemorrhage presented in 50% and 37.5% of lesions, respectively. Hypo-perfusion and the surrounding hemorrhage presented in 31.7% and 28.1% lesions, respectively. Acute cerebral infarction and HT lesion area and the surrounding low, normal, high perfusion of the t test analysis statistically significant （t=0.658, P=0.002, 〈0.01）. Conclusion： Combined the SWI and 3D-PCASL is useful in prediction of HT after acute cerebral infarction.

关 键 词：脑梗塞 磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]