磁敏感加权血管成像在指导急性脑梗死溶栓治疗及评估预后中的临床价值  

Clinical value of SWAN in guiding thrombolysis and evaluating prognosis in acute cerebral infarction

作　　者：马永青 尹喜[2] 王成伟[2] MA Yongqing;YIN Xi;WANG Chengwei(Shihezi University School of Medicine,Shihezi 832000;CT/MRI Room,the First Affiliated Hospital of the Medical College,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：《实用放射学杂志》2019年第9期1389-1394,共6页Journal of Practical Radiology

摘　　要：目的探讨磁敏感加权血管成像(SWAN)显示的不对称性皮质静脉征(ACVS)在指导急性脑梗死溶栓治疗及评估预后中的临床价值。方法选取临床和影像证实的发病6 h内急性脑梗死患者65例,在治疗前均行常规MRI、SWAN扫描,根据有无ACVS分为ACVS组和ACVS阴性组,ACVS组发病至溶栓时间<4.5 h患者11例、4.5~6 h溶栓患者9例、非溶栓患者15例,ACVS阴性组<4.5 h溶栓患者9例、4.5~6 h溶栓患者7例、非溶栓患者14例,应用Rankin修订量表(mRS)比较2组患者在不同〖JP4〗溶栓时间和非溶栓治疗下发病3个月时的预后情况。结果2组在<4.5 h溶栓治疗下预后良好的差异无统计学意义(P=1.0>0.05),在4.5~6 h溶栓治疗下预后良好的差异有统计学意义(P=0.041<0.05),在非溶栓治疗下预后不良的差异有统计学意义(P=0.016<0.05)。有ACVS的患者在<4.5 h溶栓、4.5~6 h溶栓治疗下预后良好的差异无统计学意义(P=0.566>0.012 5),ACVS阴性的患者在<4.5 h溶栓、4.5~6 h溶栓治疗下预后良好的差异有统计学意义(P=0.009<0.012 5)。急性脑梗死患者在发病4.5 h内有无ACVS均可在溶栓中获益;发病4.5~6 h内显示有ACVS的患者比ACVS阴性患者更能在溶栓中获益;发病6 h内有ACVS的患者在非溶栓治疗下比ACVS阴性的患者预后差;发病6 h内有ACVS的患者溶栓治疗比非溶栓治疗预后好。结论运用SWAN技术对急性脑梗死ACVS的显示,可早期识别脑组织缺血状态,为是否进行溶栓治疗及评估预后提供理论基础。Objective To investigate the clinical value of asymmetrical cortical vein sign (ACVS) on susceptibility-weighted angiography (SWAN) in guiding thrombolysis and evaluating prognosis of acute cerebral infarctioa.Methods Sixty-five patients with acute cerebral infarction within 6 hours of onset confirmed by clinical and imaging data were cnrollcd.All patients underwent routine MRI and SWYN scan before treatment. According to the presence or absence of ACVS, the patients were divided into ACVS group and ACVS-negative group.There were 11 ACVS patients with time from onset to thrombolytic therapy less than 4.5 hours,9 patients with 4.5 - 6 h thrombolytic therapy, 15 patients with non-thrombolytic therapy,ACVS-negative group had 9 patients with thrombolysis time <4.5 h,7 patients with 4.5-6 h thrombolytic therapy, and 14 patients with non-thrombolytic therapy.The Modfied Rankin Scale (mRS) was used to compare the prognosis of the two groups at 3 months after onset under different thrombolysis times and non-thrombolytic therapy.Results There was no significant difference in good prognosis between the two groups (P = 1.0>0.05) after thrombolytic therjapy for less than 4.5 hours,and there was significant difference in good prognosis between the two groups (P =0.041<0.05) after thrombolytic therapy for 4.5 - 6 hours, and there was significant difference in poor prognosis between the two groups under non-thrombolytic therapy (P = 0.016<0.05 ). There was no significant difference in good prognosis between ACVS patients treated with <4.5 h thrombolysis and 4.5 - 6 h thrombolysis (P =0. 566> 0.012 5). There was significant difference in good prognosis between ACVS negative patients treated with <4.5 h thrombolysis and 4.5 - 6 h thrombolysis (P = 0.009<0.012 5).Patients with acute cerebral infarction could benefit from thrombolysis with or without ACVS within 4.5 hours of onset,patients with ACVS within 4.5 hours to 6 hours of onset could benefit more from thrombolysis than patients with ACVS-ncgative, patients with ACVS within

关 键 词：磁敏感加权血管成像 不对称性皮质静脉征 溶栓治疗 预后 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]