SWI对急性缺血性脑卒中梗死增长及早期预后的预测价值  

Predictive value of SWI on infarct growth and early prognosis in patients with acute ischemic stroke

作　　者：穆丽颖 张乐[1] 王维平[1] 魏元豪 王静 李又洁 MU Li-ying;ZHANG Le;WANG Wei-ping;WEI Yuan-hao;WANG Jing;LI You-jie(Department of Radiology,Tianjin 5th Central Hospital,Tianjin 300450,China;Department of Neurosurgery,the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]天津市第五中心医院放射科,天津300450 [2]海军军医大学第一附属医院放射科,上海200433

出　　处：《中国临床医学影像杂志》2021年第8期569-573,共5页Journal of China Clinic Medical Imaging

基　　金：上海市卫生健康委员会科研课题计划(20194Y0141)。

摘　　要：目的:评估磁敏感加权成像(Susceptibility weighted imaging,SWI)预测急性缺血性脑卒中患者的梗死增长和早期临床预后的价值。方法:回顾性分析38例天津市第五中心医院收治的急性缺血性脑卒中患者的资料。在发病72 h内对患者进行MRI检查,在发病7 d后对患者进行液体衰减反转恢复(Fluid-attenuated inversion recovery,FLAIR)或CT检查。神经损伤的严重程度由NIHSS评分来判断。根据阿尔伯塔卒中计划早期CT评分(Alberta stroke program early CT score,ASPECTS)评估各影像学参数之间的关系。结果:梗死增长组SWI-弥散加权成像(Diffusion-weighted imaging,DWI)及平均通过时间(Mean transit time,MTT)-DWI不匹配明显高于非梗死增长组。SWI-ASPECTS与FLAIR-ASPECTS呈显著正相关(r=0.785,P<0.001),与入院NIHSS评分(r=-0.619,P<0.001)、出院NIHSS评分(r=-0.502,P=0.001)及3月时改良Rankin量表(Modified rankin scale,mRS)评分呈负相关(r=-0.375,P=0.02)。27例患者显示突出血管征(Prominent vessel sign,PVS),15例患者发现磁敏感血管征(Susceptibility vessel sign,SVS),PVS及SVS的存在与出院NIHSS评分相关。结论:SWI-DWI不匹配提示梗死增长风险,SWI可能是最终梗死面积和早期结局的有用预测指标。Objective:To evaluate the value of susceptibility weighted imaging(SWI)in predicting infarct growth and early prognosis in patients with acute ischemic stroke.Methods:Thirty-eight patients with acute ischemic stroke in Tianjin 5 th central hospital were retrospectively analyzed.MRI was performed within 72 hours after onset,and fluid-attenuated inversion recovery(FLAIR)or CT was performed at least 7 days after onset.The severity of neurological damage was adjudged with NIHSS scores and the relationship between the imaging parameters was evaluated according to Alberta stroke program early CT score(ASPECTS).Results:The SWI-Diffusion-weighted imaging(DWI)and mean transit time(MTT)-DWI mismatch in infarct growth group were significantly higher than those in non infarction growth group.The SWI-ASPECTS was positively correlated with FLAIR-ASPECTS(r=0.785,P<0.001),but negatively correlated with entry NIHSS(r=-0.619,P<0.001),discharge NIHSS(r=-0.502,P=0.001)and modified rankin scale(mRS)at 3 months(r=-0.375,P=0.02).A total of 27 patients showed prominent vessel sign(PVS),and susceptibility vessel sign(SVS)was found in 15 patients.The presence of PVS and SVS was significantly correlated with discharge NIHSS.Conclusion:SWI-DWI mismatch indicat the risk of infarct growth.SWI may be a useful predictor of final infarct size and early outcome.

关 键 词：卒中 脑梗死 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R743.33[医药卫生—临床医学]