DTI联合PWI定量参数对脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓治疗预后的评估价值  

Application of diffusion tensor imaging combined with perfusion weighted imaging quantitative parameters in prognosis assessment of rt-PA intravenous thrombolysis in cerebral infarction

作　　者：马瑜[1] 代允义[2] 代全德[1] 徐忠海[1] 杨红 孔羽[2] 林光耀[3] Ma Yu;Dai Yunyi;Dai Quande;Xu Zhonghai;Yang Hong;Kong Yu;Lin Guangyao(Department of Neurology,Shangqiu First People's Hospital,Shangqiu 476000,China;Department of Cognitive and Movement Disorders,Shangqiu First People's Hospital,Shangqiu 476000,China;Department of MRI Room,Shangqiu First People's Hospital,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院神经内科,商丘476000 [2]商丘市第一人民医院认知与运动障碍科,商丘476000 [3]商丘市第一人民医院核磁共振室,商丘476000

出　　处：《中华解剖与临床杂志》2024年第11期728-734,共7页Chinese Journal of Anatomy and Clinics

基　　金：河南省医学科技攻关计划(LHGJ20191489)。

摘　　要：目的:探讨磁共振弥散张量成像(DTI)联合灌注成像(PWI)定量参数对脑梗死重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗预后的评估价值。方法:回顾性队列研究。纳入2022年10月—2023年3月商丘市第一人民医院收治的脑梗死患者70例,其中男39例、女31例,年龄36~79(56.4±6.5)岁,体质量指数(BMI)21.16~30.87(24.93±2.11)kg/m^(2)。患者均采用rt-PA静脉溶栓治疗,治疗后行DTI与PWI检查。根据患者治疗后30 d的改良Rankin量表(mRS)评估结果进行分组,mRS评分0~2分的患者47例纳入预后良好组,mRS评分3~6分的患者23例纳入预后不良组。观察指标:(1)分析脑梗死rt-PA静脉溶栓治疗后DTI与PWI影像结果。(2)纳入患者的性别、年龄、BMI、合并基础病(高血压病、糖尿病、冠心病),以及治疗后的梗死区DTI定量参数[各向异性分数(FA)、表观弥散系数(ADC)]和PWI定量参数[相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对达峰时间(rTTP)、相对平均通过时间(rMTT)],采用单因素分析、多因素logistic回归分析筛选脑梗死患者rt-PA静脉溶栓治疗预后不良的预测因子。(3)绘制受试者操作特征(ROC)曲线,分析DTI定量参数、PWI定量参数以及二者联合检测对脑梗死患者rt-PA静脉溶栓治疗预后的评估价值。 结果:(1)与对侧大脑镜像区域相比,梗死区域的FA值与ADC值降低,rCBV、rCBF减少,rTTP、rMTT延迟。(2)预后不良组的FA、ADC、rCBV、rCBF值均低于预后良好组,rTTP、rMTT值均高于预后良好组,差异均有统计学意义( P值均<0.001);多因素logistic回归分析显示,FA( OR=1.791,95% CI:1.232~2.605)、ADC( OR=1.900,95% CI:1.242~2.908)、rCBV( OR=2.104,95% CI:1.282~3.455)、rCBF( OR=2.143,95% CI:1.221~3.760)、rTTP( OR=2.002,95% CI:1.298~3.087)及rMTT( OR=2.046,95% CI:1.283~3.262)均是脑梗死患者rt-PA静脉溶栓治疗预后不良的独立预测因子( P值均<0.05)。(3)ROC曲线分析显示,FA、ADC、rCBV、rCBF、rTTP、rMTT均能预测患�Objective This study aimed to investigate the value of diffusion tensor imaging(DTI)combined with magnetic resonance perfusion weighted imaging(PWI)quantitative parameters in evaluating the prognosis of cerebral infarction after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA).Methods This retrospective cohort study included 70 patients with cerebral infarction admitted to the First People's Hospital of Shangqiu City from October 2022 to March 2023.The patients included 39 males and 31 females,aged 36-79(56.4±6.5)years.Body mass index was 21.16-30.87(24.93±2.11)kg/m^(2).rt-PA intravenous thrombolytic therapy and DTI and PWI examination were performed.According to the evaluation results of the modified Rankin Scale(mRS)after 30 days of treatment,47 patients with mRS Scores of 0-2 were included in the good prognosis group,and 23 patients with mRS Scores of 3-6 were included in the poor prognosis group.Observation indicators:(1)The DTI and PWI imaging results of cerebral infarction after rt-PA intravenous thrombolysis were analyzed.(2)Gender,age,BMI,and previous medical history(hypertension,diabetes,coronary heart disease)were evaluated.DTI parameters(anisotropy fraction[FA],apparent diffusion coefficient[ADC])and PWI quantitative parameters(relative cerebral blood volume[rCBV]),relative cerebral blood flow[rCBF],relative peak time[rTTP],relative mean transit time[rMTT]of the infarction area after treatment were tested.Univariate and multivariate logistic regression analysis were used to screen the predictors of poor prognosis in patients with cerebral infarction treated with rt-PA intravenous thrombolysis.(3)An receiver operator characteristic(ROC)curve was drawn to analyze the parameters of DTI and PWI and the value of combined detection in evaluating the prognosis of patients with cerebral infarction treated with rt-PA intravenous thrombolytic therapy.Results(1)Compared with the contralateral brain mirror region,FA and ADC values in the infarct region were decreased,rCBV and rCBF we

关 键 词：脑梗死 弥散张量成像 磁共振灌注成像 重组组织型纤溶酶原激活剂 静脉溶栓 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]