磁共振3DASL灌注成像在超急性脑梗塞中的诊断价值  

The Effect of Palliative Nursing Care and Its Influence on the Quality of Life of Elderly Patients with Advanced Malignant Tumors

作　　者：黄德干 胡青松 田野[1] Huang Degan;Hu Qingsong;Tian Ye(Guangdong No. 2 Hospital of Traditional Chinese Medicine 510095)

机构地区：[1]广东省第二中医院/放射科,广东广州510095

出　　处：《现代医用影像学》2019年第6期1216-1218,1226,共4页Modern Medical Imageology

摘　　要：目的:在超级脑梗塞患者中应用磁共振(MRI)、三维动脉自旋标记成像(3DASL)技术,探讨其在超急性脑梗塞中的诊断价值。方法:选取本院2016年2月到2018年1月收治的47例超急性脑梗塞患者作为研究对象。47例患者均采用MRI扫描,对于MRI扫描发现异常后加大扫描而没有强化的患者,进一步采用3D-ASL扫描,统计分析47例临床诊断明确的超级性脑梗塞患者的血流灌注情况、信号特点等情况。结果:血流灌注分为高关注和低灌注,实验组以MRI和3DASL扫描方法检测出40例患者为梗死区血流低灌注,7例表现出血流高灌注,其中5例为低灌注区的高灌注,2例为边缘局灶性高灌注。血流低灌注患者中,有32例的低灌注区明显大于DWI弥散高信号范围,存在缺血半暗带(图1);12例低灌注区范围与DWI高信号范围差不多大,无明显缺血半暗带(图2);血流高灌注患者中,10例高灌注区均明显大于DWI范围(图3)。MRI+3DASL扫描中,14例急性脑梗死患者在梗死区内或边缘检测出斑片状低信号(图2,3),提示梗死区出现微出血灶,这些微出血灶在MRI扫描序列中没有发现;其中10例是血流低灌注患者(图2),4例是血流高灌注患者(图3)。有1例ASL低灌注患者且无明显缺血半暗带存在,而MRI+3DASL扫描发现梗死区微出血灶及大脑中动脉内低信号血栓(图2)。结论:全脑MRI+3DASL能够评价急性脑梗死区的血流灌注特点、是否存在缺血半暗带或高灌注脑损伤状态,评价梗死区责任动脉是否存在血栓及梗死区、是否存在出血风险,二者联合检查既能评价急性脑梗死患者的脑血流灌注特点、责任动脉内血栓,还能够评价患者潜在出血风险,对急性脑梗死患者溶栓治疗具有重要的指导价值。Objective:To investigate the diagnostic value of magnetic resonance(MRI) and three-dimensional arterial spin labeling(3DASL) in patients with super-cerebral infarction in hyperacute cerebral infarction.Methods:Forty-seven patients with hyperacute cerebral infarction admitted to our hospital from February 2016 to January 2018 were selected as subjects. Forty-seven patients underwent MRI scan. For patients with abnormal MRI scan and increased scan without enhancement, the 3D-ASL scan was used to statistically analyze the blood perfusion status and signal of 47 patients with clinically diagnosed super-cerebral infarction. Characteristics and other conditions.Results:The perfusion was divided into high attention and low perfusion. In the experimental group, 40 patients were diagnosed with low blood perfusion in the infarct area by MRI and 3DASL scanning, and 7 patients showed high perfusion of hemorrhage, 5 of which were hypoperfused. High perfusion, 2 cases of marginal hyperinfusion. Among the patients with hypoperfusion, 32 cases of hypoperfusion area were significantly larger than the DWI diffusion high signal range, and there was an ischemic penumbra(Fig. 1);12 cases of low perfusion area were almost the same as DWI high signal range, no obvious deficiency. In the penumbra of blood(Fig. 2), 10 patients with high perfusion were significantly larger than the DWI range(Fig. 3). In the MRI+3DASL scan, 14 patients with acute cerebral infarction detected patchy low signal in the infarct or margin(Fig. 2, 3), suggesting microhemorrhage in the infarct area. These microhemorrhages were not in the MRI scan sequence. Found;10 of them were patients with hypoperfusion(Figure 2) and 4 were patients with high blood perfusion(Figure 3). There was one patient with low-perfusion ASL and no obvious ischemic penumbra, while the MRI+3DASL scan revealed micro-bleeding in the infarct zone and low-signal thrombosis in the middle cerebral artery(Fig. 2).Conclusion:Whole brain MRI+3DASL can evaluate the characteristics of blood perfusion

关 键 词：磁共振3DASL灌注成像 超急性脑梗塞 溶栓疗法 脑血流灌注 

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]