PWI-DWI评估超急性脑梗死缺血半暗带指导静脉溶栓的价值分析  

Analysis of the value of PWI-DWI in evaluating the ischemic penumbra in guiding intravenous thrombolysis in hyperacute cerebral infarction

作　　者：张春海[1] 刘扬 闫坤[1] 顾敦星 李少轩[1] ZHANG Chunhai;LIU Yang;YAN Kun;GU Dunxing;LI Shaoxuan(Department of Imaging,The Second Hospital of North China University of Science and Technology,Zhangjiakou 075100,China)

机构地区：[1]河北北方学院附属第二医院影像科,河北张家口075100

出　　处：《医学影像学杂志》2025年第2期6-10,共5页Journal of Medical Imaging

基　　金：河北省张家口市重点研发计划项目(编号:2121131D)。

摘　　要：目的分析磁共振灌注加权-弥散加权成像(PWI-DWI)不匹配评估超时间窗急性脑梗死(ACI)缺血半暗带(IP)指导静脉溶栓的价值。方法选取本院收治的86例经PWI-DWI不匹配技术评估的超时间窗ACI患者的临床资料,根据其静脉溶栓后血管再通情况将其分为血管再通组(50例)和血管未通组(36例)。对比两组患者IP的脑血容量(CBV)、脑血流量(CBF)和平均通过时间(MTT),并以健侧作为对照计算各参数相对值rCBV、rCBF和rMTT;采用ROC分析各参数对超时间窗ACI患者静脉溶栓后血管再通的预测价值。结果溶栓治疗后血管未通组患者IP区域CBV、CBF、rCBV和rCBF均低于血管再通组,MTT和rMTT高于血管再通组,差异有统计学意义(P<0.05)。ROC曲线分析结果表明,MTT(AUC=0.639)、CBV(AUC=0.689)、CBF(AUC=0.689)、rMTT(AUC=0.669)、rCBV(AUC=0.757)和rCBF(AUC=0.771)均对超时间窗ACI患者静脉溶栓后血管再通具有良好的预测价值,联合检测(AUC=0.777)对超时间窗ACI患者静脉溶栓后血管再通具有良好的预测价值,差异有统计学意义(P<0.05)。结论PWI-DWI不匹配评估超时间窗ACI患者IP区域能有效指导患者静脉溶栓,且相关参数对超时间窗ACI患者静脉溶栓后血管再通具有良好的预测价值。Objective To analyze the guidance value of perfusion weighted imaging-diffusion weighted imaging(PWI-DWI)mismatch in evaluating ischemic penumbra(IP)for intravenous thrombolysis in acute cerebral infarction(ACI)beyond time window.Methods A retrospective analysis was performed on the clinical data of 86 patients with ACI beyond time window who were assessed by PWI-DWI mismatch technique in the hospital.According to vascular recanalization after intravenous thrombolysis,patients were divided into recanalization group(50 cases)and non-recanalization group(36 cases).The cerebral blood volume(CBV),cerebral blood flow(CBF)and mean transit time(MTT)in IP were compared between the two groups.Taking healthy side as the control,relative values of the three parameters(rCBV,rCBF,rMTT)were calculated.The predictive value of different parameters for vascular recanalization in patients with ACI beyond time window after intravenous thrombolysis was analyzed by ROC curves.Results After thrombolysis,CBV,CBF,rCBV and rCBF of IP in non-recanalization group were lower than those in recanalization group,while,MTT and rMTT were higher than those in recanalization group(P<0.05).The results of ROC curves analysis showed that MTT(AUC=0.639),CBV(AUC=0.689),CBF(AUC=0.689),rMTT(AUC=0.669),rCBV(AUC=0.757)and rCBF(AUC=0.771)were all of good predictive value for vascular recanalization,and predictive value of combined detection was higher(AUC=0.777,P<0.05).Conclusion PWI-DWI mismatch in evaluating IP can effectively guide intravenous thrombolysis in patients with ACI beyond time window,and the relevant parameters have good predictive value for vascular revascularization after intravenous thrombolysis.

关 键 词：超时间窗急性脑梗死 缺血半暗带 静脉溶栓 磁共振成像 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]