APTw-MRI对亚急性期脑梗死梗死核心及缺血半暗带酸碱度变化的评估价值  

The value of APTw-MRI in evaluating the changes of pH in the infarct core and ischemic penumbra of subacute cerebral infarction

作　　者：曹冠杰[1] 王彩华[1] 史志涛[1] 于昊 秦元林 陈月芹[1] CAO Guanjie;WANG Caihua;SHI Zhitao;YU Hao;QIN Yuanlin;CHEN Yueqin(Medical Imaging Department,Affiliated Hospital of Jining Medical College,Jining 272029,China;Jining Medical College,School of Clinical Medicine,Jining 272029,China)

机构地区：[1]济宁医学院附属医院医学影像科,山东济宁272029 [2]济宁医学院临床医学院,山东济宁272029

出　　处：《医学影像学杂志》2023年第5期741-744,共4页Journal of Medical Imaging

基　　金：国家自然科学基金项目(编号:82001805)。

摘　　要：目的探讨酰胺质子转移加权(APTw)MRI用于评估亚急性期脑梗死梗死核心(IC)和缺血半暗带(IP)有关酸碱度(pH)改变的临床价值。方法选取亚急性期脑梗死91例患者为观察组,另选取同时间段健康志愿者90例为对照组,均予以常规MRI、DWI和APTw检查,其中观察组26例患者开展灌注加权成像(PWI),将DWI、PWI以及APTw图像当作基础明确观察组IC区域、PWI-DWI不匹配区域和APT-DWI不匹配区域,将观察组的梗死侧和对侧、对照组两侧IC区域、PWI-DWI不匹配区域以及APT-DWI不匹配区域的APTw值开展对比。结果两组各个区域的APTwmax、APTwmin、APTwmax-min相比差异有统计学意义(P<0.05)。观察组IC区和IC对侧的各个APTw值和对照组相比差异无统计学意义(P>0.05);IC区域内各个APTw数值和对侧相比差异无统计学意义(P>0.05)。PWI-DWI不匹配区域、APT-DWI不匹配区域有关APTwmax、APTwmin、APTwmax-min均较对侧低差异有统计学意义(P<0.05)。PWI-DWI不匹配区域、APT-DWI不匹配区域有关APTwmax、APTwmin、APTwmax-min值相比差异无统计学意义(P>0.05)。IC区的APTwmax、APTwmin、APTwmax-min均较PWI-DWI不匹配区域、APT-DWI不匹配区域低差异有统计学意义(P<0.05)。观察组IC区的APTwmean和ADC值之间为正相关关系(r=0.530,P<0.05)。结论亚急性期脑梗死患者IC酸碱代谢改变不明显,但IP局部伴随酸碱代谢失衡现象。Objective To analyze the value of amide proton transfer weighted(APTw)-magnetic resonance imaging(MRI) in evaluating the changes of pH in the infarct core(IC) and ischemic penumbra(IP) at subacute stage of cerebral infarction.Methods From January 2019 to July 2022,a total of 91 patients with subacute cerebral infarction admitted by our hospital were selected as the observation group, and 90 healthy volunteers in the same period were selected as the control group. Routine MRI, diffusion weighted imaging(DWI), and APTw examinations were performed. In the observation group, 26 patients underwent perfusion weighted imaging(PWI). DWI, PWI, and APTw images were used as the basis to identify IC regions, PWI-DWI mismatched regions, and APT-DWI mismatched regions in the observation group. APTw values of IC regions, PWI-DWI mismatched regions, and APT-DWI mismatched regions on the infarcted side and the opposite side of the observation group, both sides of the control group were compared. Results APTwmax, APTwmin and APTwmax min in each region of the two groups were significantly different(P<0.05). There was no difference in APTw values of IC region and contralateral IC between the observation group and the control group(P>0.05);There was no difference between the APTw values in the IC region and those on the opposite side(P>0.05). APTwmax, APTwmin and APTwmax min in PWI-DWI mismatch area and APT-DWI mismatch area were lower than those in the opposite side(P<0.05). There was no difference in APTwmax, APTwmin and APTwmax min values between PWI-DWI mismatched areas and APT-DWI mismatched areas(P>0.05). APTwmax, APTwmin and APTwmax min in IC area were lower than those in PWI-DWI mismatch area and APT-DWI mismatch area (P<0.05).There was a positive correlation between APTwmean and ADC values in IC region of the observation group (r=0.530,P<0.05).Conclusion In patients with subacute cerebral infarction,the acid-base metabolism of IC is not significantly changed,but the IP is accompanied by acidbase metabolism imbalance locally,

关 键 词：脑梗死 亚急性期 缺血半暗带 梗死核心 磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]