磁共振扩散峰度成像诊断亚急性脑梗死进展性的价值  

Diffusional kurtosis imaging in evaluating progression of subacute stroke

作　　者：郭岳霖[1] 张忠平 张桂珊 孔令梅[1] 饶海冰[1] 陈薇[4] 陈璇[4] 沈智威[1] 郑文斌[1] 吴仁华[1] 

机构地区：[1]汕头大学医学院第二附属医院医学影像科,汕头515041 [2]GE公司 [3]中山大学电子与信息工程学院 [4]汕头大学医学院第二附属医院神经内科

出　　处：《国际医学放射学杂志》2017年第6期634-640,共7页International Journal of Medical Radiology

基　　金：国家自然基金面上项目(81471730)

摘　　要：目的利用MR扩散峰度成像(DKI)研究亚急性期进展性脑梗死责任病灶,并结合NIHSS评分探讨其影像征象与临床相关性。方法前瞻性研究发病时间>72 h且在本影像中心行MRI扫描的亚急性期脑梗死病人79例,其中男45例,女34例,年龄43~88岁,平均(64.75±11.05)岁。根据NIHSS评分和病灶数目将其分为4组:单发脑梗死进展阴性组、多发脑梗死进展阴性组、单发脑梗死进展阳性组、多发脑梗死进展阳性组。对所有病人进行颅脑DKI及常规MRI扫描,获取MD和MK参数图,并于相应的参数图测量相应的参数值及病灶面积。多发性脑梗死病例在MD和MK图同一层面选取同一供血区内的2个独立病灶,分别将兴趣区设置于该缺血区的核心区(ROI 1)和周边区(ROI 2)。采用配对样本Wilcoxon符号秩检验比较MD图和MK图中病灶面积和信号的差异,采用散点图和信号变化百分比描述缺血灶的时间-信号变化。结果 (1)病灶面积。进展阴性组病人MD图与MK图中不同梗死灶的面积大小均相仿,其差异均无统计学意义(均P>0.05);进展阳性组MD图中不同梗死灶的面积均大于MK图(均P<0.05)。进展阴性组和阳性组的MD/MK不匹配区面积(显著的MD/MK不匹配区)百分比分别为0.2%和9.7%。(2)时间-信号散点图。a单发脑梗死组:与正常脑区相比,不同进展程度的单发脑梗死病人的病灶区均表现为MD值显著下降、MK值显著上升。进展阳性组病灶的信号恢复延迟,且MD、MK值偏离正常值的幅度大于进展阴性组。两组的MK值偏离正常值的幅度均大于MD值的变化幅度。b多发脑梗死组:多发性脑梗死进展阴性组病灶的MD和MK的时间-信号散点图与单发脑梗死进展阴性组相仿,ROI 1和ROI 2的时间-信号变化趋向一致性良好。多发性脑梗死进展阳性组ROI 1的MD和MK的时间-信号散点图与单发脑梗死进展阳性组相仿,而ROI 2的MD和MK的时间-信号散点图则呈无规律的杂乱曲线,�Objective This study aimed to identify the responsible lesions that may lead to progression in subacute ischemic stroke patients using diffusional kurtosis imaging （DKI） and the National Institutes of Health Stroke Scale （NIHSS） score, as well as to analyze the association between imaging findings and clinical features. Methods Seventy-nine patients with subacute cerebral infarction were divided into 4 groups according to neurological deterioration and lesion number： single infarction neurological deterioration negative group, single infarction neurological deterioration positive group, multiple in-farction neurological deterioration negative group, and multiple infarction neurological deterioration positive group. For multi -ple infarction subjects, two independent ischemic lesions were selected in the same blood supplying areas on the same brain slice of the MD and MK maps, and the ROIs were outlined within the core region （ROI 1） and the surrounding region （ROI 2） respectively. All patients underwent cranial DKI and conventional MRI scan, then maps of diffusion （MD） and mean kurtosis （MK） were calculated. The MD, MK, and areas of lesions on parameter maps were measured and compared with Wilcoxon Signed Ranks Test. Scatter plots were used to describe the time-signal evolution. Result 1. lesion areas： The MD lesions were significantly larger than the MK deficits in the neurological deterioration positive group （P〈0.05）, But no significant dif-ference in the neurological deterioration negative group （P〉0.05）. The proportion of MD/MK mismatch in the subacute is-chemic stroke patients with neurological deterioration was 9.7%; however, this rate was only 0.2% in the patients without neurological deterioration. 2. Time-signal scatter plots： a. The single infarction group： The MD in the ischemic lesions was significantly decreased compared to the contralateral normal region, whereas the MK was significantly increased. The recov-ery trends in the neurologica

关 键 词：脑梗死 缺血性卒中 扩散峰度成像 磁共振成像 

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