ADC值变化对溶栓治疗前后脑缺血性半暗带的评估  

The Value of Apparent Diffusion Coefficient(ADC) in Ischemic Penumbra(IP) Before and After Thrombolytic Therapy

作　　者：赵学媛 么恩亮 孙志华[2] 

机构地区：[1]天津市东丽医院放射科,300300 [2]天津医科大学总医院放射科

出　　处：《临床放射学杂志》2016年第2期171-174,共4页Journal of Clinical Radiology

摘　　要：目的通过分析溶栓治疗前后脑缺血区ADC值的变化探讨其在脑缺血半暗带(IP)中的价值。方法对38例超急性期及急性期脑梗死患者分别于就诊当日及经溶栓治疗20天后进行DWI、T_2WI、T_2-FLAIR扫描,将就诊时DWI高信号大小定义为初始病灶(L0),治疗后病灶在T_2WI或T_2-FLAIR大小定义为最终梗死面积(P),前者大于后者的面积为组织存活区(ST),后者大于前者的面积为扩大区(LG)。根据患者就诊时间不同分为4组,分别测量P、ST、LG及对侧正常区的ADC值,计算相对ADC值(rADC)进行统计学分析。结果病变侧DWI高信号区ADC值均较对侧减低,病变从中心到周边ADC值由低到高不同程度增加。相同时间点P、ST及LG的ADC值由低到高不同程度增加。随着脑梗死时间延长组织存活区所占比例逐渐减小。结论(1)缺血半暗带可能在脑梗死24 h内都存在。(2)计算rADC值可以辅助判断脑损伤程度及评估溶栓预后。Objective To analysis the changes of apparent diffusion coefficient( ADC) value in cerebral ischemic tissue before and after thrombolytic therapy and to assess its value in the ischemic penumbra( IP). Methods Thirty-eight cases of patients with hyperacute and acute cerebral infarction underwent DWI、T2WI、T2-FLAIR on the first day and 20 days after treatment. High signal region on DWI on the first day was defined as initial lesion( L0). High signal region on the followup T2 WI or T2-FLAIR was defined as the final infarct size( P). The area which the former was greater than the latter was defined as survival tissue( ST),while the area which the latter was greater than the former was defined as lesion growth( LG). All patients were divided into four groups according to the time of attack. Measured ADC value on P、ST、LG and contralateral normal brain tissue in each groupand calculated. n the relative ADC value( r ADC). Results The ADC value of ischemic tissue was lower than the contralateral brain tissue. ADC value was different extent increased from center to periphery. At the same time point,ADC value was different with extent increase from P、ST to LG. The survival area was gradually decreased when the time of cerebral infarction prolonged. Conclusion ADC can easily evaluate the cerebral infarction and ischemic penumbra. The time window may be until 24 h. The calculation of r ADC value can be an early judge of the degree of brain injury and evaluate the prognosis of thrombolysis.

关 键 词：磁共振成像 脑梗死 脑缺血半暗带 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]