MRI增强在急性缺血性脑卒中脑灌注状态中的评估价值  

The value of enhanced MRI in evaluating cerebral perfusion in acute ischemic stroke

作　　者：凌志宇 夏英意 胡灵芝 舒红格 LING Zhiyu;XIA Yingyi;HU Lingzhi;SHU Hongge(Department of Radiology,the First People's Hospital of Yongkang,321300,Zhejiang,China;Department of Neurology,the First People's Hospital of Yongkang,321300,Zhejiang,China;Department of Radiology,Tongji Hospital Affiliated to Wuhan Huazhong University of Science and Technology,Wuhan 430000,Hubei,China)

机构地区：[1]浙江省永康市第一人民医院放射科,浙江永康321300 [2]浙江省永康市第一人民医院神经内科,浙江永康321300 [3]武汉华中科技大学附属同济医院放射科,湖北武汉430000

出　　处：《中国现代医生》2023年第3期36-41,共6页China Modern Doctor

摘　　要：目的分析磁共振成像(magnetic resonance imaging,MRI)增强评估急性缺血性脑卒中(acute ischemic stroke,AIS)患者脑灌注状态的应用价值。方法选取2017年9月至2020年1月53例AIS患者,根据病情控制情况分为病情进展组(n=19)与病情稳定组(n=34),均接受常规MRI、MRI增强扫描检查,比较病情进展组、病情稳定组的病灶中心与对侧灌注参数[脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)、平均通过时间(mean transit time,MTT)、达峰时间(time to peak,TTP)],并比较两组相对脑血流量(relative cerebral blood flow,rCBF)、相对脑血容量(relative cerebral blood volume,rCBV)、相对平均通过时间(relative mean transit time,rMTT)、相对达峰时间(relative time to peak,rTTP),分析两组患者的脑灌注状态MRI特征。结果病情进展组、病情稳定组的病灶中心CBF、CBV均低于对侧,MTT、TTP均长于对侧,差异有统计学意义(P<0.05)。病情进展组的rCBF、rCBV低于病情稳定组,差异有统计学意义(P<0.05)。根据两组的病灶周围相对正常区域灌注情况将脑灌注状态分为4种:①灌注不足,主要表现为TTP、MTT显著延长,局部CBV、CBF显著降低;②侧支循环形成,主要表现为MTT延长,局部CBV增加或正常;③血流再灌注,主要表现为MTT缩短或正常,局部CBV显著升高,局部CBF稍微升高或正常;④过度灌注,主要表现为局部CBV、CBF明显升高,其中病情进展组的脑灌注状态以灌注不足为主。结论MRI增强扫描可提供AIS患者缺血半暗带与脑灌注状态信息,有助于指导临床拟定个性化治疗方案,促进预后改善。Objective To analyze the value of magnetic resonance imaging(MRI)enhancement scans for assessing cerebral perfusion status in patients with acute ischemic stroke(AIS).Methods Fifty-three patients with AIS from September 2017 to January 2020 were selected and divided into progressive disease group(n=19)and stable disease group(n=34)according to disease control,all of whom received conventional MRI and MRI-enhanced scans.The perfusion parameters[cerebral blood flow(CBF),cerebral blood volume(CBV),mean passage time(MTT),and time to peak(TTP)]between the center of the lesion and the contralateral side in the progressive and stable groups were compared,and compared the relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean passage time(rMTT),and relative time to peak(rTTP)between the two groups to analyze the MRI characteristics of cerebral perfusion status.Results CBF and CBV in the center of the lesion were lower in the progressive and stable groups than in the contralateral side,and MTT and TTP were longer than in the contralateral side,with statistically significant differences(P<0.05).The rCBF and rCBV in the group with progressive disease were lower than those in the group with stable disease,and the difference was statistically significant(P<0.05).The cerebral perfusion status was classified into four categories according to the perfusion of relatively normal areas around the lesions in both groups:①insufficient perfusion,mainly manifested by significantly prolonged TTP and MTT and significantly reduced local CBV and CBF.②Formation of collateral circulation,mainly manifested by prolonged MTT and increased or normal local CBV.③Reperfusion,mainly manifested by shortened or normal MTT,significantly elevated local CBV and slightly elevated or normal local CBF.④Hyperperfusion,mainly manifested by significantly elevated local CBV and CBF,in which the cerebral perfusion status in the progressive group was dominated by underperfusion.Conclusion MRI-enhanced scans can provide infor

关 键 词：磁共振成像增强扫描 脑血流量 脑血容量 表观扩散系数 急性缺血性脑卒中 脑灌注状态 

分 类 号：R446.1[医药卫生—诊断学]