恶性大脑中动脉梗死出血性转化的临床与MRI序列诊断分析  

Clinical and MRI Sequences Analysis of Hemorrhagic Transformation in Malignant Middle Cerebral Artery Infarction

作　　者：代兰兰 丁长青[2] 李绍东 DAI Lan-lan;DING Chang-qing;LI Shao-dong(School of Graduate,Xuzhou Medical College,Jiangsu 221004,China;Department of Imaging,People’s Hospital of Fengxian,Jiangsu 221700,China;Department of Imaging,the Affiliated Hospital of Xuzhou Medical College,Jiangsu 221002,China)

机构地区：[1]徐州医科大学研究生院,江苏221004 [2]江苏省徐州市丰县人民医院影像科,江苏221700 [3]徐州医科大学附属医院影像科,江苏221002

出　　处：《影像技术》2021年第5期8-16,共9页Image Technology

基　　金：江苏省卫生科研基金项目(YG32014019)。

摘　　要：目的:分析恶性大脑中动脉梗死的临床特征、出血性转化的相关危险因素、MRI磁敏感加权序列对出血性转化的诊断优势。方法:回顾性分析2014年8月-2019年8月240例MMI患者的临床及影像学资料。分为出血组(HT组,n=56)及非出血组(NHT组,n=184),采用单因素及多变量Logistic回归模型进行多因素分析以确定MMI发生HT的危险因素。对其中同时采用MRI常规序列及SWI序列扫描的50例在HT检出率及检出体积大小方面进行统计学比较。结果:①两组临床上均表现为严重的大脑半球综合征;②单因素分析结果显示,两组在性别、年龄、血压水平、心房颤动、既往脑出血病史、占位效应(中线移位程度)、美国国立卫生研究院卒中量表(NHISS)评分方面比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,既往脑出血病史(OR=4.222,95%CI:1.445-12.334)、心房颤动(OR=3.452,95%CI:1.275-9.349)、中线明显移位(OR=0.156,95%CI:0.038-0.641)及较高的NHISS评分(OR=0.475,95%CI:0.345-0.656)是MMI发生HT的独立危险因素(P<0.05);③影像学上均可见典型急性MCA供血区大面积梗死征象,部分病例可见大脑中动脉高密度征(Hyperdense middle cerebral artery sign,HMCAS,n=63)、FLAIR大脑中动脉血管高信号征(hyperintense vessel sign,HVS,n=79)、梗死区域FLAIR序列可见血管高信号征(FLAIR vascular hyperintensity,FVH,n=65)及SWI图像上可见到突出血管征(prominent vessel sign,PVS,n=9);④SWI与MRI常规T1WI、T2WI、FLAIR及DWI序列分别检出HT50例、20例、34例、40例及46例,SWI与MRI常规序列在HT的检出率方面有统计学差异(P<0.05);在20例SWI与MRI常规序列均能检出的HT出血灶大小方面,SWI与MRI常规T1WI、T2WI、FLAIR及DWI序列检出的出血灶体积有统计学差异(P<0.05)。结论:既往脑出血病史、心房颤动、中线移位≥2.5cm及较高的NHISS评分是MMI发生HT的独立危险因素;SWI相比常规MRI序列在MMI的HT检出率及对�Objective:To analyze the clinical features,risk factors of hemorrhagic transformation in malignant middle cerebral artery infarction(MMI)and the diagnostic advantages of susceptibility weighted imaging(SWI)in hemorrhagic transformation(HT).Methods:The clinical and image data of 240 patients with MMI from August 2014 to August 2019 were retrospectively analyzed.The patients were divided into bleeding group(HT group,n=56)and non-hemorrhagic group(NHT group,n=184).Univariate analysis and multiple logistic regression analysis were performed to reveal the statistically significant risk factors for HT.The detection rate and volume of HT in those 50 patients underwent both conventional MRI sequences and SWI sequence were statistically compared.Results:①The clinical manifestations in both groups were severe cerebral hemisphere syndrome.②Univariate analysis showed that there were significant differences in gender,age,blood pressure level,atrial fibrillation,past history of cerebral hemorrhage,occupancy effect(degree of midline shift)and National Institutes of Health Stroke Scale(NHISS)score between the two groups(P<0.05).Multivariate logistic regression analysis showed a history of previous cerebral hemorrhage(OR=4.222,95%CI:1.445~12.334),atrial fibrillation(OR=3.452,95%CI:1.275~9.349),a conspicuous midline shift(OR=0.156,95%CI:0.038~0.641)and a higher NHISS score(OR=0.475,95%CI:0.345~0.656)were independent risk factors for HT in MMI(P<0.05).(3)The large-area infarct signs of the typical acute MCA blood supply area could be seen in the imaging,accompanied by hyperdense middle cerebral artery sign(HMCAS,n=63),hyperintense vessel sign(HVS,n=79),FLAIR vascular hyperintensity(FVH,n=65)and prominent vessel sign(PVS,n=9)on SWI images.(4)For the detection rates of HT,50cases,20cases,34cases,40cases and 46cases were detected respectively in SWI and conventional T1WI,T2WI,FLAIR and DWI sequences,and there were significantly different between SWI and conventional MRI sequences(P<0.05).For the 20 cases detected by both SWI and c

关 键 词：脑梗死 恶性大脑中动脉梗死 脑水肿 危险因素 磁共振成像 磁敏感加权序列 

分 类 号：R445.2[医药卫生—影像医学与核医学]