弥散加权成像阴性临床证实急性缺血性卒中的临床和影像学特征  

Clinically confirmed acute ischemic stroke with negative diffusion-weighted imaging： Clinical and imaging features

作　　者：曹树刚[1] 吴倩[1] 葛婷婷[1] 贺军[1] 夏明武[1] 徐文安[1] 

机构地区：[1]安徽医科大学附属合肥医院、合肥市第二人民医院神经内科,合肥230011

出　　处：《国际脑血管病杂志》2017年第9期792-799,共8页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨弥散加权成像（diffusion—weighted imaging，DWI）阴性临床证实急性缺血性卒中患者的临床和影像学特征。方法回顾性收集首次DWI阴性临床证实为急性缺血性卒中患者的临床和影像学资料，根据DwI复查结果分为DWI持续阴性组和DWI假阴性组，对2组患者的人口统计学、临床和影像学资料进行比较，并分析首次DWI阴性的原因。结果共纳入DwI阴性临床证实为急性缺血性卒中患者15例，其中DWI持续阴性组9例（9／15，60．0％），DWI假阴性组6例（6／15，40．0％）；8例（8／15，53．3％）为小卒中（美国国立卫生研究院卒中量表评分≤3分）。15例患者发病至入院时间为1～48h，发病至首次DWI检查时间为5～65h，发病至复查DWI时间为38～190h。2组患者人口统计学、基线临床和影像学资料均无显著统计学差异。在6例DWI假阴性患者中，5例（5／6，83．3％）为后循环卒中，1例（1／6，16．7％）为前循环卒中；5例（5／6，83．3％）为小卒中；1例考虑可能发生二次梗死，1例可能与检查时间较短（发病后5h）有关，1例可能与症状加重前未达到弥散受限阈值和MRI伪影影响有关，其余3例可能与病灶较小且位于后循环有关。9例DWI持续阴性患者的原因不明。结论DWI持续阴性与DWI假阴性患者基线临床和影像学特征无显著差异。DWI假阴性的急性缺血性卒中主要见于后循环卒中和小卒中患者。ObjectiveTo investigate the clinical and imaging features in patients with clinically confirmed acute ischemic stroke and negative diffusion-weighted imaging （DWI）.MethodsThe clinical and imaging data in patients with clinically confirmed acute ischemic stroke and initial negative DWI were collected retrospectively. According to the repeat DWI findings, they were divided into either a persistent-negative DWI group or a false-negative DWI group. The demographics, and data of clinical and imaging at baseline between the 2 groups were compared, and the causes of the initial negative DWI were analyzed.ResultsA total of 15 patients with clinically confirmed acute ischemic stroke and initial negative DWI were enrolled, including 9 in the persistent-negative DWI group （9/15, 60.0%） and 6 in the false-negative DWI group （6/15, 40.0%）, and 8 with minor stroke （National Institute of Health Stroke Scale score ≤3; 8/15, 53.3%）. The time from onset to admission ranged from 1 to 48 h. The time from onset to initial DWI examination ranged from 5 to 65 h. The time from onset to repeat DWI ranged from 38 to 190 h. There were no significant differences in demographics, and data of clinical and imaging at baseline between the 2 groups. In 6 patients with false-negative DWI findings, 5 were posterior circulation stroke （5/6, 83.3%） and 1 was anterior circulation stroke （1/6, 16.7%）; 1 might have a second infarct, 1 might be associated with shorter examination time （5 h after onset）, 1 was associated with not reaching the diffusion limited threshold and the influence of MRI artifact before symptom aggravation, and the remaining 3 might be associated with smaller lesions and locating in the posterior circulation. The causes of 9 patients with persistent-negative DWI findings were unknown.ConclusionsThere were no significant differences in features of clinical and imaging at baseline between persistent-negative and false-negative DWI findings. False-negative DWI findings in acute ischemic stroke can be mai

关 键 词：卒中 脑缺血 磁共振成像 弥散磁共振成像 时间因素 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]