磁共振弥散加权成像联合灌注加权成像预测肿瘤样脑梗死最终梗死体积的价值  

Value of magnetic resonance diffusion weighted imaging combined with perfusion weighted imaging in predicting final infarct volume of tumor-like cerebral infarction

作　　者：徐海峰[1] 陈克敏[2] 张永利[2] 文峰[1] 钱帮伟[1] XU Haifeng;CHEN Kemin;ZHANG Yongli;WEN Feng;QIAN Bangwei(Department of Radiology,People′s Hospital of Pudong New Area in Shanghai City,Shanghai,201299;Department of Radiology,Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai,200025)

机构地区：[1]上海市浦东新区人民医院放射科,上海201299 [2]上海交通大学医学院附属瑞金医院放射科,上海200025

出　　处：《实用临床医药杂志》2021年第11期4-7,38,共5页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金项目(30860266)。

摘　　要：目的分析磁共振弥散加权成像(DWI)联合灌注加权成像(PWI)预测肿瘤样脑梗死最终梗死体积的价值。方法回顾性分析31例经追踪磁共振成像(MRI)确诊的肿瘤样脑梗死患者的DWI和PWI,测量并计算梗死中心、预测误差区和缺血半暗带的相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)和相对表观扩散系数(rADC),比较预测梗死中心体积与实际梗死中心体积的差异。结果Tukey法事后功效检验显示,rCBF、rCBV在最终梗死、预测误差区、缺血半暗带间两两比较,差异均有统计学意义(P<0.01),rADC在最终梗死与缺血半暗带间的差异有统计学意义(P<0.01)。PWI预测肿瘤样脑梗死不可逆损伤的敏感度高于DWI,其中rCBF的敏感度最高。追踪MRI显示出血转化(HT)和含铁血黄素沉着27例(87.10%)。最终梗死体积均值为(20.8±11.9)cm 3,小于预测梗死体积的(25.9±10.6)cm 3,差异有统计学意义(t=7.682,P<0.001)。相关性检验显示最终梗死体积与预测梗死体积呈正相关(r=0.953,P<0.001)。结论肿瘤样脑梗死的最终梗死体积小于预测梗死体积,原因可能与HT高发生率或再灌注有关。采用DWI和PWI多参数预测不可逆性损伤时,rCBF的敏感度最高。Objective To analyze the value of magnetic resonance diffusion weighted imaging(DWI)combined with perfusion weighted imaging(PWI)in predicting the final infarct volume of tumor-like cerebral infarction.Methods DWI and PWI of 31 patients with tumor-like cerebral infarction confirmed by tracking magnetic resonance imaging(MRI)were retrospectively analyzed.The indexes such as relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean transit time(rMTT)and relative apparent diffusion coefficient(rADC)of infarction center,prediction error area and ischemic penumbra were measured and calculated,and the differences between predicted infarction center volume and actual infarction center volume were compared.Results Tukey post-event efficacy test showed that there were significant differences in rCBF and rCBV between final infarction,predicted error area and ischemic penumbra(P<0.01),and there was a significant difference in rADC between final infarction and ischemic penumbra(P<0.01).PWI was more sensitive than DWI in predicting irreversible injury of tumor-like cerebral infarction,and sensitivity of rCBF was the highest.Tracking MRI showed that there were 27 cases with hemorrhagic transformation(HT)and hemosiderosis(87.10%).The mean final infarction volume was(20.8±11.9)cm 3,which was significantly lower than(25.9±10.6)cm 3 of predicted infarction volume(t=7.682,P<0.001).Correlation test showed that thefinal infarction volume was positively correlated with the predicted infarction volume(r=0.953,P<0.001).Conclusion The final infarction volume of tumor-like cerebral infarction is smaller than the predicted infarction volume,which may be related to the high incidence of HT or reperfusion.The sensitivity of rCBF is the highest when DWI and PWI are used to predict irreversible damage.

关 键 词：磁共振成像 缺血性中风 脑梗死体积 弥散加权成像 灌注加权成像 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]