功能性磁共振成像联合灌注成像定量参数评估急性脑梗死溶栓后血管再通的应用价值  

The value of fMRI combined withPWI in assessing vascular recanalization after thrombolysis in patients with acute cerebral infarction

作　　者：韦章林 赵静 WEI Zhanglin;ZHAO Jing(No.2 Department of Neurology,Yingshang County People's Hospital,Fuyang Anhui 236200,China)

机构地区：[1]安徽省颍上县人民医院神经内二科,安徽阜阳236200

出　　处：《中国急救复苏与灾害医学杂志》2024年第9期1197-1201,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省自然科学基金项目(编号:1908085QH3312)。

摘　　要：目的探究功能性磁共振成像(fMRI)联合磁共振灌注成像(PWI)定量参数评估急性脑梗死(ACI)溶栓后血管再通的应用价值。方法回顾性随机选取颍上县人民医院在2020年5月—2023年5月收治的85例行溶栓治疗的急性脑梗死患者纳入研究。患者溶栓治疗前均进行fMRI和PWI检查,溶栓治疗后观察患者血管再通情况;将血管未再通患者纳入未再通组,血管再通患者纳入再通组。比较两组患者临床相关资料及fMRI、PWI参数。多因素分析影响患者溶栓治疗后血管再通的相关因素,用受试者工作特征(ROC)曲线分析fMRI联合PWI对ACI患者溶栓后血管再通的评估价值。结果ACI患者溶栓后血管再通率为65.88%(56/85)。两组速率常数相对值(rKep)、血浆容积相对值(rVp)、容量转移常数相对值(rKtrans)、性别、体质量指数(BMI)、合并基础疾病、吸烟、饮酒、梗死部位比较无统计学差异(P>0.05);再通组患者平均通过时间(MTT)、达峰时间(TTP)、年龄≥60岁患者占比、美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间低于未再通组,表观扩散系数(ADC)、脑血流量(CBF)、脑血容量(CBV)高于未再通组(P<0.05)。经二元Logistic回归法分析结果显示,MTT(OR=3.487)、TTP(OR=5.421)是ACI患者溶栓后血管再通的独立危险因素,ADC(OR=0.268)、CBF(OR=0.313)是独立保护因素(P<0.05)。ROC曲线结果显示,MTT、ADC、CBF、TTP及其联合预测ACI患者溶栓后血管再通的敏感度分别为73.80%、72.10%、75.40%、77.00%、83.60%,特异性分别为75.00%、70.80%、79.20%、75.00%、91.70%,曲线下面积(AUC)分别为0.768、0.807、0.781、0.796、0.936(P<0.05)。结论MTT、TTP是影响ACI患者溶栓后再通的独立危险因素,ADC、CBF是独立保护因素,fMRI和PWI联合检查可有效预测患者溶栓后血管再通情况。Objective To study the value of the functional magnetic resonance imaging(fMRI)combined with perfusionweighted imaging(PWI)in the evaluation of vascular recanalization after thrombolysis in patients with acute cerebral infarction(ACI).Methods A total of 85 patients with ACI who underwent thrombolytic therapy in Yingshang County People's Hospital from May 2020 to May 2023 were conducted on this study.fMRI and PWI were applied to all patients before and after thrombolytic therapy.Two groups of patients(non-recanalization group,and recanalization group)were compared.The clinical data,fMRI and PWI parameters of the patients were analyzed between the two groups.Multivariate analysis was used to analyze the related factors affecting vascular recanalization after thrombolysis.The receiver operating characteristic(ROC)curve was used to analyze the value of fMRI combined with PWI in evaluating vascular recanalization after thrombolysis inpatients with ACI.Results The recanalization rate after thrombolysis was 65.88%(56/85).There were no significant differences in the relative value of rate constant(rKep),plasma volume relative value(rVp),volume transfer constant relative value(rKtrans),gender,body mass index(BMI),combined with underlying diseases,smoking,drinking,and infarction location between the two groups(P>0.05).Mean transit time(MTT),time to peak(TTP),proportion of age≥60 years old,National Institutes of Health Stroke Scale(NIHSS)score,and time from onset to thrombolysis in the recanalization group were lower than those in the nonrecanalization group,and apparent diffusion coefficient(ADC),cerebral blood flow(CBF)and cerebral blood volume(CBV)were higher than those in the non-recanalization group(P<0.05).The results of multivariate Logistic regression analysis showed that MTT(OR=3.487)and TTP(OR=5.421)were independent risk factors for vascular recanalization after thrombolysis in patients with ACI,ADC(OR=0.268)and CBF(OR=0.313)were independent protective factors(P<0.05).ROC curve results showed that the sensitivit

关 键 词：急性脑梗死 静脉溶栓治疗 血管再通 功能性磁共振成像技术 CT灌注成像技术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]