MRI检查DTI序列联合螺旋CT成像对老年急性脑梗死患者预后的评估价值  

The value of MRI with DTI sequence combined with spiral CT imaging in evaluating the prognosis of elderly patients with acute cerebral infarction

作　　者：王方旭 赵志军 徐明露 姚仲欣 王倩 WANG Fangxu;ZHAO Zhijun;XU Minglu;YAO Zhongxin;WANG Qian(Department of Radiology,Dongfang Hospital of Beijing University of Chinese Medicine,Qinhuangdao Hospital(Qinhuangdao Traditional Chinese Medicine Hospital),Qinhuangdao Hebei 066000,China)

机构地区：[1]北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)放射科,河北秦皇岛066000

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期212-216,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省自然科学基金资助项目(编号:H2020206632)。

摘　　要：目的探讨磁共振成像(MRI)检查弥散张量成像(DTI)序列联合螺旋计算机断层扫描(CT)成像对老年急性脑梗死(ACI)患者预后的评估价值。方法选择医院2021年9月—2023年3月就诊的老年ACI患者153例,根据美国国立卫生院卒中量表(NIHSS)评分分为轻度组(58例,NIHSS评分<5分)、中度组(49例,NIHSS评分5~15分)与重度组(46例,NIHSS评分>15分)。所有患者均接受DTI序列检查与螺旋CT成像检查,随访3个月,根据老年ACI患者预后情况分为预后不良组与预后良好组。对比不同病情严重程度患者DTI序列、螺旋CT成像参数,对比预后不良组与预后良好组DTI序列、螺旋CT成像参数及临床资料,分析老年ACI患者预后不良的影响因素,分析DTI序列、螺旋CT成像参数对老年ACI患者预后不良的预测价值。结果重度组特异性指标(FA)、容积比各项异性(VRA)、脑血流量(CBF)低于轻度组、中度组(P<0.05),中度组FA、VRA、CBF低于轻度组(P<0.05);重度组峰值时间长于轻度组、中度组(P<0.05),中度组峰值时间长于轻度组(P<0.05)。三组平均弥散系数(DCavg)衰减指数(Exat)比较差异无统计学意义(P>0.05)。随访3个月,153例患者中预后不良41例,预后良好112例。预后不良组FA、VRA、CBF低于预后良好组(P<0.05),预后不良组峰值时间比预后良好组长(P<0.05),两组Exat、DCavg对比无明显差异(P>0.05)。预后不良组NIHSS评分、合并高血压、心房颤动史例数占比、高于预后良好组(P<0.05)。Logistic多因素回归分析结果显示,合并高血压(OR=3.618,95%CI:1.670~7.838)、FA降低(OR=0.366,95%CI:0.155~0.862)、NIHSS评分升高(OR=4.293,95%CI:1.823~10.110)、VRA降低(OR=0.305,95%CI:0.130~0.719)、CBF降低(OR=0.256,95%CI:0.109~0.603)、峰值时间延长(OR=4.272,95%CI:1.816~10.050)为老年ACI患者预后不良的影响因素(P<0.05)。受试者工作特征曲线(ROC)结果显示,FA、VRA、CBF、峰值时间及四者联合预测老年ACI患者预后不良的曲线下Objective To evaluate the value of magnetic resonance imaging(MRI)with diffusion tensor imaging(DTI)sequence combined with spiral computed tomography(CT)imagingin the prognosis of elderly patients with acute cerebral infarction(ACI).Methods A total of 153 elderly ACI patients who were admitted toDongfang Hospital of Beijing University of Chinese Medicine between September 2021 and March 2023conducted on this study.All patients were divided into mild group(58 cases,NIHSS score<5),moderate group(49 cases,NIHSS score 5-15)and severe group(46 cases,NIHSS score>15)based upon the National Institutes of Health Stroke Scale(NIHSS)score.DTI sequence and spiral CT imaging were performed.All patients were divided into poor prognosis group and good prognosis group according to the 3-month follow-up.The parameters of DTI and spiral CT were analyzed and compared between the groups.The risk factors and the predictive value of DTI sequence and spiral CT imaging parameters in elderly ACI patients were analyzed.Results The specific index(FA),volume ratio anisotropy(VRA)and cerebral blood flow(CBF)in severe group were lower than those in mild and moderate groups(P<0.05).The FA,VRA and CBF in moderate group were lower than those in mild and moderate groups(P<0.05).The peak time in severe group was longer than that in mild and moderate groups(P<0.05);the peak time of moderate group was longer than that of mild group(P<0.05).There were no differences in the mean dispersion coefficient(DCavg)and exact attenuation(Exat)among the three groups(P>0.05).41/153 patients had poor prognosis and 112/153 had good prognosis.FA,VRA and CBF in poor prognosis group were lower than those of good prognosis group(P<0.05).The peak timeof poor prognosis group was longer than that of good prognosis group(P<0.05).There were no differences in Exat and DCavgbetween the two groups(P>0.05).TheNIHSS score and hypertension history and atrial fibrillation in poor prognosis group were higher than those in good prognosis group(P<0.05).Logistic multivariate regressi

关 键 词：磁共振 弥散张量成像序列 螺旋计算机扫描成像 老年 急性脑梗死 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]