DWI结合IVIM评估中青年脑梗死病情程度及预测溶栓治疗后出血转化的价值  

The value of DWI combined with IVIM in assessing the severity of cerebral infarction in young and middle-aged people and predicting hemorrhagic transformation after thrombolytic therapy

作　　者：薛明琛 陈志天 丁超 辛奕[1] XUE Ming-chen;CHEN Zhi-tian;DING Chao;XIN Yi(Department of Medical Imaging,the First People′s Hospital of Lianyungang City,Jiangsu Province,Lianyungang 222000,China)

机构地区：[1]江苏省连云港市第一人民医院医学影像科,江苏连云港222000

出　　处：《河北医科大学学报》2024年第7期785-790,共6页Journal of Hebei Medical University

基　　金：连云港市卫生科技项目(ZD202202)。

摘　　要：目的 探究磁共振弥散加权成像(diffusion weighted imaging, DWI)结合体素内不相干运动(introvoxel incoherent motion, IVIM)评估中青年脑梗死病情程度及预测溶栓治疗后出血转化(hemorrhagic transformation, HT)的价值,以期为临床早期针对性制定干预方案提供参考。方法 回顾性选取中青年急性缺血性脑卒中患者96例,入院时均行DWI、IVIM检查,获取健侧和患侧表观扩散系数(apparent diffusion coefficient, ADC)、灌注分数(perfusion fraction, f)、快速表观扩散系数(pseudo-diffusion coefficient, D^(*))、慢速表观扩散系数(diffusion coefficient of pure diffusion, D),并对各参数进行标准化处理。比较不同病情程度患者rADC、rf、rD^(*)、rD,分析各参数与中青年脑梗死病情程度的相关性。静脉溶栓治疗后比较发生与未发生HT患者入院时rADC、rf、rD^(*)、rD及HT相关生物学指标[胱抑素C(cystatin C,Cys-C)、纤维胶凝蛋白3(fibrinolytic protein 3,Ficolin-3)、补体C1q/肿瘤坏死因子相关蛋白3(complement C1q/tumor necrosis faction-associated protein-3,CTRP-3)]水平,采用ROC曲线评价各参数预测中青年脑梗死溶栓治疗后发生HT的价值。结果 中青年脑梗死患者入院时患侧ADC、f、D^(*)、D均低于健侧(P<0.05)。重度患者入院时rADC、rf、rD^(*)、rD均低于中度、轻度患者,中度患者入院时rADC、rf、rD^(*)、rD均低于轻度患者(P<0.05)。入院时rADC、rf、rD^(*)、rD与中青年AIS病情程度呈负相关(P<0.05)。发生HT患者rADC、rf、rD^(*)、rD及血清Ficolin-3、CTRP-3水平均低于未发生HT患者低,Cys-C水平高于未发生HT患者(P<0.05)。发生HT患者入院时rADC、rf、rD^(*)、rD与血清Cys-C水平呈负相关,与血清Ficolin-3、CTRP-3水平呈正相关(P<0.05)。入院时rADC、rf、rD^(*)、rD联合预测中青年AIS患者溶栓治疗后发生HT的AUC为0.943,大于血清Cys-C、Ficolin-3、CTRP-3联合预测的AUC(Z=0.195,P=0.043)。结论 DWI结合IVIM可用于中青年脑�Objective To investigate the value of magnetic resonance diffusion weighted imaging(MR-DWI)combined with intravoxel incoherent motion(IVIM)in assessing the severity of cerebral infarction in young and middle-aged people and predicting hemorrhagic transformation(HT)after thrombolytic therapy,with the aim of providing a reference for early clinical targeting and intervention planning.Methods A retrospective study was conducted on 96 middle-aged and young patients with acute ischemic stroke(AIS).DWI and IVIM examinations were performed on admission,apparent diffusion coefficient(ADC),perfusion fraction(f),pseudo-diffusion coefficient(D^(*)),diffusion coefficient of pure diffusion(D)were obtained from healthy and affected side,and all parameters were standardized.rADC,rf,rD^(*)and rD of patients with different disease severity were compared to analyze the correlation between each parameter and the disease severity of AIS in young and middle-aged people.After intravenous thrombolytic therapy,rADC,rf,rD^(*),rD and HT-related biological indicators[cystatin C(Cys-C),fibrinolytic protein 3(Ficolin-3),complement C1q/tumor necrosis faction-associated protein-3(CTRP-3)]were compared between patients with and without HT at admission.Receiver operating characteristic(ROC)curve was used to evaluate the value of each parameter in predicting HT after thrombolytic therapy for AIS in young and middle-aged adults.Results ADC,f,D^(*)and D on the affected side were all lower than those on the healthy side at admission(P<0.05).The rADC,rf,rD^(*)and rD of severe patients were all lower than those of moderate and mild patients at admission,and lower in moderate patients than in mild patients at admission(P<0.05).rADC,rf,rD^(*),rD were negatively correlated with AIS severity at admission(P<0.05).The levels of rADC,rf,rD^(*),rD and serum Ficolin-3 and CTRP-3 levels in patients with HT were lower than those without HT,while the levels of Cys-C were higher than those without HT(P<0.05).rADC,rf,rD^(*)and rD were negatively correlated with ser

关 键 词：脑梗死 磁共振成像 体素内不相干运动 

分 类 号：R743.33[医药卫生—神经病学与精神病学]