脑梗死后磁共振灌注加权成像-弥散加权成像CBF-DWI不匹配的临床意义和动态变化  

Clinical significance and dynamic changes of CBF-DWI mismatch between Mr Perfusion weighted Imaging and Diffusion weighted Imaging after stroke

作　　者：刘东清 赵建华[1] 张龙[1] 梁可可[1] 潘蕊 LIU Dongqing;ZHAO Jianhua;ZHANG Long(Department of Neurology Henan Province People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院神经内科,河南郑州450000

出　　处：《中风与神经疾病杂志》2018年第9期791-795,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨脑梗死后磁共振灌注加权成像-弥散加权成像(PWI-DWI)不匹配区血流灌注水平的变化,观察其对临床治疗及预后的影响。方法选取2015年1月~2017年12月在河南省人民医院诊断为脑梗死且发病在72 h内的急性前循环梗死住院患者50例,采用3.0T磁共振对急性脑梗死患者进行PWI和DWI检查。根据PWI-DWI的匹配情况将患者分为不匹配组(n=16)和匹配组(n=34),两组均接受相同的标准内科治疗。入院时、病程14 d和病程1 m时分别行NIHSS评分和梗死体积测量;入院时和病程3 m时行改良Rankin量表(mRS)评分;比较两组患者梗死体积和神经功能的恢复情况。不匹配组患者在治疗14 d时复查磁共振灌注扫描,比较治疗前后灌注参数的变化情况。结果 16例患者72 h内PWI-DWI不匹配≥20%,7 d时甚至14 d时继续存在梗死区并不断扩大,34例患者7 d时PWI-DWI匹配组,治疗后病情稳定恢复较好。两组患者NIHSS、mRS评分、梗死体积在入院时差异无统计学意义(P> 0.05),而在病程14 d、1 m时差异有统计学意义(P <0.05);结论梗死灶周围具有PWI-DWI不匹配区域的患者远期神经功能和梗死体积未见改善,甚至进一步加重,可能与不匹配区的脑组织灌注进一步降低有关。Objective To investigate the changes of blood perfusion in the mismatched area of Mr perfusion weighted imaging diffusion weighted imaging(PWI-DWI)after cerebral infarction and to observe its effect on clinical treatment and prognosis.Methods From January 2015 to December 2017,50 patients with acute anterior circulatory infarction who were diagnosed as cerebral infarction in Henan Provincial people’s Hospital within 72 hours were selected.DWI and PWI in patients with Acute Cerebral Infarction by 3.0T Magnetic Resonance Imaging.According to the matching condition of PWI-DWI,the patients were divided into mismatched group(n=16)and matched group(n=34).Both groups received the same standard medical treatment.NIHSS scores and infarct volume measurements were performed at admission,14 days and 1 month,respectively.At the time of admission and 3 months duration by modified Rankin scale(mRS)score;The infarct volume and the recovery of nerve function were compared between the two groups.The patients in the mismatched group were examined with Mr perfusion scan after 14 days of treatment to compare the changes of perfusion parameters before and after treatment.Results PWI-DWI mismatch≥20 in 16 patients within 72 hours.The infarct area continued to exist at 7 days and even 14 days.34 patients in 7 days PWI-DWI matched group,after treatment,stable recovery was better.There was no significant difference in infarct volume between the two groups(P<0.05).At 14 days,the difference was statistically significant at 1 month(P<0.05).Conclusion Long term neurological function and infarct volume did not improve or even aggravated further in patients with PWI-DWI mismatch area around infarction,which may be related to further reduction of cerebral perfusion in mismatched areas.

关 键 词：脑梗死 缺血半暗带 磁共振 

分 类 号：R743[医药卫生—神经病学与精神病学]