头颅3.0T MRI评估急性脑梗死神经功能损伤的价值及预测出血转化的临床研究  

Clinical Study on the Value of 3.0T MRI in Assessing Neurological Impairment and Hemorrhagic Transformation in Acute Cerebral Infarction

作　　者：张楠 史智超 王菁 王进才 王伟翰 ZHANG Nan;SHI Zhichao;WANG Jing(Shijiazhuang People's Hospital,Hebei Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄市人民医院,河北石家庄050000

出　　处：《河北医学》2024年第12期2096-2102,共7页Hebei Medicine

基　　金：河北省重点研发计划项目,(编号:22007311813D)。

摘　　要：目的:探究头颅3.0T磁共振成像(MRI)评估急性脑梗死(ACI)神经功能损伤的价值,并分析对出血转化(HT)的预测价值,为临床改善预后提供参考。方法:选取2022年1月至2023年3月我院收治的104例ACI患者,入组后均接受头颅3.0T MRI检查,根据NIHSS评分评估神经功能损伤程度分为轻度组(<7分,34例)、中度组(7~14分,44例)、重度组(>14分,26例)3个亚组,又依据发病7~10d后头颅3.0T MRI检查评估结果分为HT组(31例)、未HT组(73例)2个亚组。比较不同各亚组ACI患者头颅3.0T MRI参数,并分析与神经功能损伤、HT情况的关系,进一步评估神经功能损伤程度、预测HT风险。结果:VRA、FA比较,轻度组(0.15±0.03、0.30±0.08)>中度组(0.13±0.03、0.24±0.06)>重度组(0.06±0.02、0.12±0.03)(F=82.774、63.120,P<0.05);Vp、Kep、Ve、ktrans比较,轻度组(0.19±0.06、0.57±0.17、0.29±0.08、0.43±0.13)<(0.32±0.09、0.78±0.22、0.47±0.14、0.69±0.18)中度组<重度组(0.45±0.11、0.93±0.24、0.75±0.17、0.83±0.20)(F=65.855、22.384、88.892、43.605,P<0.05);HT组VRA、FA(0.08±0.02、0.19±0.06)低于未HT组(0.13±0.03、0.31±0.09)(t=9.972、7.978,P<0.05);HT组Vp、Kep、Ve、ktrans(0.38±0.11、0.85±0.25、0.56±0.14、0.72±0.21)高于未HT组(0.16±0.05、0.52±0.16、0.28±0.08、0.44±0.21)(t=14.065、8.063、12.881、6.220,P<0.05);头颅3.0T MRI参数VRA、FA与ACI患者神经功能损伤、HT情况均呈负相关(r1=-0.641、-0.627,r2=-0.625、-0.611,P<0.05),Vp、Kep、Ve、ktrans与ACI患者神经功能损伤、HT情况均呈正相关(r1=0.701、0.579、0.754、0.688,r2=0.673、0.589、0.670、0.583,P<0.05);VRA、FA、Vp、Kep、Ve、ktrans联合预测神经功能重度损伤的AUC最大,为0.913(95%CI:0.841~0.959),敏感度为84.62%,特异度为87.18%(P<0.05),上述头颅3.0T MRI参数联合预测ACI患者HT发生的AUC最大,为0.925(95%CI:0.857~0.968),敏感度为90.32%,特异度为79.45%(P<0.05)。结论:头颅3.0T MRI检查参数与ACI患者神经功能损伤、HT密切相�Objective:To explore the value of 3.0T magnetic resonance imaging(MRI)in assessing neurological injury in acute cerebral infarction(ACI)and to analyze its predictive value for hemorrhagic transformation(HT),providing a reference for clinical improvement of prognosis.Methods:A total of 104 ACI patients admitted to our hospital from January 2022 to March 2023 were selected.All subjects underwent 3.0T MRI examination of the head.According to the NIHSS score,the degree of neurological impairment was divided into three subgroups:mild group(<7 points,34 cases),moderate group(7-14 points,44 cases),and severe group(>14 points,26 cases).Additionally,based on the results of the 3.0T MRI examination 7-10 days after onset,the patients were divided into two subgroups:HT group(31 cases)and non-HT group(73 cases).The 3.0T MRI parameters of ACI patients in different subgroups were compared,and their relationship with neurological impairment and HT was analyzed to further assess the degree of neurological impairment and predict the risk of HT.Results:The VRA and FA in the mild group(0.15±0.03,0.30±0.08)were greater than in the moderate group(0.13±0.03,0.24±0.06),which in turn were greater than in the severe group(0.06±0.02,0.12±0.03)(F=82.774,63.120,P<0.05);the Vp,Kep,Ve,and ktrans in the mild group(0.19±0.06,0.57±0.17,0.29±0.08,0.43±0.13)were less than in the moderate group(0.32±0.09,0.78±0.22,0.47±0.14,0.69±0.18),which in turn were less than in the severe group(0.45±0.11,0.93±0.24,0.75±0.17,0.83±0.20)(F=65.855,22.384,88.892,43.605,P<0.05);the VRA and FA in the HT group(0.08±0.02,0.19±0.06)were lower than in the non-HT group(0.13±0.03,0.31±0.09)(t=9.972,7.978,P<0.05);the Vp,Kep,Ve,and ktrans in the HT group(0.38±0.11,0.85±0.25,0.56±0.14,0.72±0.21)were higher than in the non-HT group(0.16±0.05,0.52±0.16,0.28±0.08,0.44±0.21)(t=14.065,8.063,12.881,6.220,P<0.05);the 3.0T MRI parameters VRA and FA were negatively correlated with neurological impairment and HT in ACI patients(r1=-0.641,-0.627,r2=-0.625,-0

关 键 词：急性脑梗死 3.0T MRI 神经功能损伤 出血转化 

分 类 号：R743.33[医药卫生—神经病学与精神病学]