磁敏感加权血管成像对脑微出血的诊断及对急性脑梗死预后的评估  

Magnetic Susceptibility-weighted Angiography in the Diagnosis of Cerebral Microbleeds and Prognosis Assessment of Acute Cerebral Infarction

作　　者：马永青 尹喜[2] 王成伟[2] MA Yongqing;YIN Xi;WANG Chengwei(CT/MRI Room,the First Hospital Affiliated to Medical College of Shihezi University,Shihezi 832000,China)

机构地区：[1]石河子大学医学院,新疆石河子832000 [2]石河子大学医学院第一附属医院CT/MRI室,新疆石河子832000

出　　处：《中国医学影像学杂志》2019年第8期584-588,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨磁敏感加权血管成像(SWAN)在诊断脑微出血及评估急性脑梗死预后中的应用价值,为脑梗死的临床治疗提供理论依据。资料与方法对47例发病6~72h内未溶栓治疗的急性脑梗死患者行CT、常规MRI、梯度回波T2^*加权成像(GRE-T2^*WI)、SWAN扫描并复查。分析脑微出血(CMBs)级别与出血性转化(HT)的关系。记录患者入院时美国国立卫生研究院卒中量表(NIHSS)评分,随访3个月时预后情况,分析影响患者预后的危险因素。结果GRE-T2^*WI、SWAN分别检出CMBs病灶115枚、185枚,检出率差异有统计学意义(Z=-4.673,P<0.05);47例患者中,5例发生HT,CMBs0级与2级、1级与2级HT发生率差异均有统计学意义(P<0.05)。在预后单因素分析中,年龄、NIHSS评分、CMBs分级与预后有关;多因素分析中,NIHSS评分(OR=1.503,95%CI1.065~2.122,P=0.021)、多发CMBs(>10枚)(OR=26.662,95%CI1.949~364.664,P=0.014)是影响患者预后的独立危险因素。结论SWAN对CMBs的敏感性优于GRE-T2*WI。CMBs数目与HT的发生及急性脑梗死患者的预后相关。利用SWAN检测CMBs对脑梗死患者临床治疗方案的制订及预后评估具有指导价值。Purpose To explore the application value of magnetic sensitivity-weighted angiography (SWAN) in the diagnosis of cerebral microbleeds and the assessment of acute cerebral infarction prognosis,thus to provide theoretical basis for the clinical treatment of cerebral infarction.Materials and Methods Forty-seven patients with acute cerebral infarction and without thrombolysis within 6- 72 hours of onset were treated with CT,conventional MRI,gradient-echo T2^*-weighted imaging (GRE-T2^*WI) and SWAN scan. Reexamination was also performed.The relationship between cerebral microbleeds (CMBs) and hemorrhagic transformation (HT) was analyzed.The national institute of health stroke scale (NIHSS) score was recorded at the time of admission.The prognosis was followed up at 3 months.The risk factors affecting the prognosis of patients were also anlyzed.Results Lesions of CMBs were detected in GRET2^*WI and SWAN,with the number being 115 and 185,respectively;the difference in detection rates was statistically significant (Z=-4.673,P<0.05).Among the 47 patients,HT occurred in 5 patients,and the occurrence rates between CMBs grade 0 and grade 2, grade 1 and grade 2 were of statistically significant difference (P<0.05).In prognostic univariate analysis,age,NIHSS score and CMBs classification were associated with prognosis.In the multivariate analysis,NIHSS score and multiple CMBs (>10) were independent risk factors (OR=1.503,95% CI 1.065-2.122,P=0.021;OR=26.662,95% CI 1.949-364.664,P=0.014).Conclusion The sensitivity of SWAN to CMBs is better than that to GRE-T2^*WI.The number of CMBs is related to the occurrence of HT and the prognosis of acute cerebral infarction.The detection of CMBs by SWAN sequence is of guiding value in the development of clinical treatment plan and prognosis assessment of patients with cerebral infarction.

关 键 词：脑出血 微循环 脑梗死 体层摄影术 X线计算机 磁共振成像 磁共振血管造影术 脑血管造影术 图像增强 图像处理 计算机辅助 预后 危险因素 

分 类 号：R445.2[医药卫生—影像医学与核医学] R540.4[医药卫生—诊断学]