磁共振弥散峰度成像联合非时变CT血管成像在缺血性脑卒中诊疗中的应用观察  

Application of magnetic resonance diffusion kurtosis imaging combined with time-invariant CT angiography in the diagnosis and treatment of ischemic stroke

作　　者：吴良龙 高翔[1] 曾艳妮 刘良进 毕俊英 Wu Lianglong;Gao Xiang;Zeng Yanni;Liu Liangjin;Bi Junying(Department of Radiology,The Third People's Hospital of Hubei Province,Jianghan University,Wuhan 430033,China)

机构地区：[1]江汉大学附属湖北省第三人民医院放射科,武汉430033

出　　处：《国际医药卫生导报》2021年第20期3189-3194,共6页International Medicine and Health Guidance News

摘　　要：目的研究磁共振弥散峰度成像(DKI)联合非时变CT血管成像(CTA)在缺血性脑卒中(IS)诊疗中的应用效果。方法选取2018年6月至2020年6月江汉大学附属湖北省第三人民医院IS患者158例,男性83例,女性75例,年龄(67.43±12.09)岁,分别进行非时变CTA和DKI检查,观察脑血管狭窄程度和侧支循环情况,测量平均弥散峰度(MK)最大处、与病灶边界连线中点、病灶边界和横线正常区域脑组织MK和平均扩散率(MD)值,计为MK1、MK2、MK3、MK4和MD1、MD2、MD3、MD4,然后测量对侧相应区域MK和MD并计算各位置相对值rMK和rMD,根据入院后美国国立卫生研究院卒中量表(NIHSS)评分将患者分为早期神经功能恶化(END)组和非END组,分析非时变CTA和DKI参数对END的诊断价值。结果Kappa一致性检验结果显示非时变CTA诊断脑血管狭窄程度和侧支循环的灵敏度分别为91.97%和90.38%,特异度分别为95.24%和96.23%,准确度分别为92.41%和94.30%;不同脑血管狭窄程度和侧支循环IS患者rMK1、rMK2、rMK3、rMK4、rMD1、rMD2、rMD3和rMD4比较差异均无统计学意义(均P>0.05)。END组非时变CTA显示脑血管重度狭窄15例(32.61%),侧支循环良好21例(45.65%),且END组rMK2高于非END组,差异有统计学意义(P<0.05)。脑血管狭窄程度、侧支循环以及rMK2诊断IS患者END的AUC分别为0.585、0.610和0.812,灵敏度分别为34.78%、47.83%和67.39%,特异度分别为82.14%、74.11%和84.82%,三者联合诊断AUC为0.843,灵敏度为86.96%,特异度为67.75%。结论非时变CTA对脑血管狭窄程度和侧支循环具有良好诊断价值,DKI测量rMK2对评估END具有重要参考价值,两者联合应用可为IS诊断和治疗提供详细依据。Objective To study the application effect of magnetic resonance diffusion kurtosis imaging(DKI)combined with time-invariant CT angiography(CTA)in the diagnosis and treatment of ischemic stroke(IS).Methods A total of 158 patients with IS in The Third People's Hospital of Hubei Province were selected between June 2018 and June 2020,including 83 males and 75 females,with an age of(67.43±12.09)years old.Time-invariant CTA and DKI were performed,and the cerebrovascular stenosis degree and collateral circulation status were observed.The mean kurtosis(MK)and mean diffusivity(MD)values of maximum MK,the midpoint of the line with the lesion boundary,the lesion boundary,and horizontal line of the normal brain tissue were measured and counted as MK1,MK2,MK3,MK4,MD1,MD2,MD3,and MD4.Then the MK and MD values of the corresponding regions of the contralateral side were measured,and the rMK and rMD values of each location were calculated.According to the National Institute of Health Stroke Scale(NIHSS)score after admission,the patients were divided into a early neurological deterioration(END)group and a non-END group,and the diagnostic values of time-invariant CTA and DKI parameters on END were analyzed.Results Kappa consistency test showed that the sensitivities of time-invariant CTA in diagnosing cerebrovascular stenosis and collateral circulation were 91.97%and 90.38%,and the specificities were 95.24%and 96.23%,and the accuracies were 92.41%and 94.30%respectively.There were no statistically significant differences in rMK1,rMK2,rMK3,rMK4,rMD1,rMD2,rMD3,and rMD4 among IS patients with different degrees of cerebrovascular stenosis and collateral circulation(all P>0.05).Time-invariant CTA showed there were 15 cases of severe cerebrovascular stenosis(32.61%)and 21 cases of good collateral circulation(45.65%)in the END group,and the rMK2 in the END group was higher than that in the non-END group(P<0.05).The AUC values of cerebrovascular stenosis degree,collateral circulation,and rMK2 in diagnosing END in patients with IS were 0.58

关 键 词：缺血性脑卒中 磁共振弥散峰度成像 非时变CT血管成像 脑血管狭窄 侧支循环 早期神经功能恶化 平均弥散峰度 平均扩散率 诊断 

分 类 号：R743.3[医药卫生—神经病学与精神病学]