大脑中动脉不同部位急性脑梗死的DKI表现特点  

DKI appearance of acute infarctions at different locations of middle cerebral artery territory

作　　者：孙海珍 吴亚琳 何澈 倪红艳[4] 尹建忠[4] SUN Haizhen;WU Yalin;HE Che;NI Hongyan;YIN Jianzhong(Department of Radiology,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;NHC Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases;The First Central Clinical College of Tianjin Medical University;Department of Radiology,Tianjin First Central Hospital,Tianjin Medical Imaging Institution.)

机构地区：[1]天津医科大学朱宪彝纪念医院放射科,天津市内分泌研究所,天津300134 [2]国家卫生健康委员会激素与发育重点实验室,天津市代谢性疾病重点实验室 [3]天津医科大学一中心临床学院 [4]天津市第一中心医院放射科,天津市影像医学研究所

出　　处：《国际医学放射学杂志》2021年第5期551-555,565,共6页International Journal of Medical Radiology

摘　　要：目的比较DKI各峰度参数与扩散参数早期诊断急性脑梗死的能力,评估大脑中动脉供血区不同部位急性脑梗死后DKI峰度参数的变化特点,探究早期诊断不同部位脑梗死的优势参数图。方法回顾性收集单侧大脑中动脉供血区的急性脑梗死病人62例(共84个病灶),男37例,女25例,年龄43~71岁,平均(57.26±6.27)岁。行DKI扫描并获得轴向扩散率(AD)、平均扩散率(MD)、径向扩散率(RD)、轴向扩散峰度(AK)、平均扩散峰度(MK)、径向扩散峰度(RK)图。按梗死部位将所有病灶分为3组,包括皮质(28个)、皮质下白质(25个)和基底节区(31个)组。采用配对t检验比较各参数值患侧与健侧的差异,采用秩和检验比较各峰度参数变化率(Δ参数值%)的差异,采用单因素方差分析比较3组间各峰度参数健侧绝对值的差异。结果与健侧对照区相比,所有梗死灶的扩散参数(AD、MD、RD)值均减低,而峰度参数(AK、MK、RK)值均增高(均P<0.05)。其中,扩散参数的变化率均小于其对应峰度参数的(均P<0.05)。健侧对照区中,皮质下白质区和基底节区的MK、RK值均高于皮质区,而基底节区的RK值也高于皮质下白质区(均P<0.05)。皮质、皮质下白质、基底节区病灶的ΔAK%依次增大(P<0.05)。皮质组的ΔAK%、ΔMK%、ΔRK%的差异无统计学意义(P>0.05);皮质下白质组的ΔAK%与ΔMK%均大于ΔRK%(均P<0.05);基底节区组的ΔAK%、ΔMK%、ΔRK%数值呈降序分布(均P<0.05)。结论DKI峰度参数较扩散参数更易检出梗死病灶。缺血状态下,皮质下白质及基底节区的组织微结构改变较皮质更为复杂,且AK、MK较RK更有评估不同部位缺血损伤的潜力。对位于皮质、皮质下白质的脑梗死评估,MK图具有优势,而对基底节区的脑梗死早期评估,AK图更具优势。Objective To explore the abilities of DKI kurtosis parameters and diffusion parameters in early diagnosis of acute cerebral infarction,to evaluate the characteristics of DKI kurtosis parameters in different parts of the middle cerebral artery territory after acute cerebral infarction,and to assess the advantages in early diagnosis of cerebral infarction with kurtosis parameter maps.Methods All of 62 patients(37 males and 25 females)with 84 acute infarctions in the middle cerebral artery territory were retrospectively selected,aged from 43 to 71 years old,with an average age of 57.26±6.27 years.DKI sequence was used to obtain the axial diffusion(AD),mean diffusion(MD),radial diffusion(RD),axial kurtosis(AK),mean kurtosis(MK),radial kurtosis(RK)maps.According to the lesions’sites,all the lesions were divided into three groups:cortex(n=28),subcortical white matter(n=25),and basal ganglia area(n=31).The paired t test was used to compare the difference in each parameter between the affected side and the healthy side,and the rank sum test was used to compare the difference in the change rate(Δparameter%)of each kurtosis parameter.The ANOVA was used to compare the differences in parameter values of the healthy side among the three groups.Results Compared to contra-lateral side,the diffusion parameters AD,MD,and RD were all decreased,while the kurtosis parameters AK,MK,and RK were all increased in the infarcted groups(all P<0.05),and theΔparameter%of each diffusion parameter was less than that of kurtosis parameters(all P<0.05).In the contra-lateral side,the MK and RK values of the subcortical white matter and basal ganglia control regions were higher than the values of the cortical control region,and the RK value of the basal ganglia control region was also higher than that of the subcortical white matter control region(all P<0.05).TheΔAK%vales differed significantly among the cortical,subcortical basal white matter,and basal ganglia lesions,showing the smallest in the cortical lesions,and the highest in the basal

关 键 词：脑梗死 扩散峰度成像 轴向扩散峰度 径向扩散峰度 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]