FLAIR-DWI不匹配在引导发病时间未知的急性缺血性脑卒中患者静脉溶栓中的应用价值  

The Application Value of FLAIR-DWI Mismatch in Guiding Intravenous Thrombolysis in Patients with Acute lschemic Stroke with Unknown Onset Time

作　　者：丁杰[1] 郭群[1] 陆小妍 吴含[1] DING Jie;GUO Qun*;LU Xiao-yan;WU Han(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,Jiangsu Province,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,江苏南京210006

出　　处：《中国CT和MRI杂志》2024年第12期9-11,共3页Chinese Journal of CT and MRI

摘　　要：目的探讨MR液体衰减反转恢复序列(fluid-attenuated inversion-recovery,FLAIR)-扩散加权成像序列(diffusion-weighted imaging,DWI)不匹配指导发病时间未知的急性缺血性脑卒中患者静脉溶栓治疗的应用价值。方法回顾性分析2021年1月至2023年12月就诊的发病时间未知的急性缺血性脑卒中患者73例。在进行溶栓前,每个患者都进行头颅MR检查,FLAIR-DWI不匹配者进入溶栓组,无FLAIR-DWI不匹配者进入未溶栓组进行对照研究,并分析预后转归的影响因素。结果溶栓组的神经功能好转(NIHSS≥4分,54.83%vs28.57%,χ^(2)=7.432,P=0.016)以及3个月后的mRS评分,较未溶栓组有显著差异(2.39±1.74 vs 4.43±1.81,χ^(2)=-5.382,P=0.031)。多因素回归分析的结果发现静脉溶栓(OR=1.271,95%CI:1.026~1.451,P=0.005)和神经功能好转(NIHSS≥4分,OR=1.131,95%CI:0.548~2.113,P=0.019)为预测发病时间未知的急性缺血性脑卒中患者预后的预测因子。结论对于发病时间未知的急性缺血性脑卒中患者,FLAIR-DWI不匹配可指导静脉溶栓,且具有重要的临床意义。Objective To explore the fluid-attenuated inversion recovery(FLAIR)and diffusion-weighted imaging(DWI)of MR Imaging mismatch in guiding intravenous thrombolytic therapy in patients with acute ischemic stroke with unknown onset time.MethodsA total of 73 patients with acute ischemic stroke with unknown onset time were retrospectively analyzed from January 2021 to December 2023.before thrombolytic therapy,each patient underwent MR Examination,patients with FLAIR-DWI mismatch were divided into the thrombolysis group for intravenous thrombolysis,and patients without FLAIR-DWI mismatch were divided into the non-thrombolysis group for control study,and the influencing factors of prognosis were analyzed.Results There were significant differences in neurological improvement(NIHSS≥4,54.83%vs 28.57%,χ^(2)=7.432,P=0.016)and mRS Score at 3 months(2.39±1.74 vs 4.43±1.81,χ^(2)=-5.382,P=0.016)between the thrombolysis group and the non-thrombolysis group.P=0.031.The results of multiple logistic regression analysis showed that intravenous thrombolysis(OR=1.271,95%CI:1.026-1.451,P=0.005)and neurological improvement(NIHSS≥4,OR=1.131,95%CI:0.548-2.113,P=0.019)were independent predictors of prognosis in patients with acute ischemic stroke with unknown onset time.ConclusionIt is of great significance to use FLAIR-DWI mismatch to guide intravenous thrombolysis in patients with acute ischemic stroke with unknown onset time.

关 键 词：缺血性卒中 液体衰减反转恢复序列 扩散加权成像 静脉溶栓 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.32[医药卫生—诊断学]