探讨磁共振DWI序列在老年急性脑梗死不同时期的诊断价值  

Diagnostic Value of Magnetic Resonance DWI Sequence in Aged Patients with Acute Cerebral Infarction at Different Stages

作　　者：杨洋 孙勇[2] 曹君洁 杨明[2] 赵丹蕾 蒿景龙 杨议涵 YANG Yang;SUN Yong;CAO Jun-jie;YANG Ming;ZHAO Dan-lei;HAO Jing-long;YANG Yi-han(Neurological Intensive Care Unit,Zhoukou Central Hospital,Zhoukou 466000,Henan Province,China;Magnetic Resonance Laboratory,Zhoukou Central Hospital,Zhoukou 466000,Henan Province,China;Surgery Room,Zhoukou Central Hospital,Zhoukou 466000,Henan Province,China)

机构地区：[1]周口市中心医院神经重症监护室,河南周口466000 [2]周口市中心医院磁共振室,河南周口466000 [3]周口市中心医院手术室,河南周口466000

出　　处：《中国CT和MRI杂志》2025年第4期10-13,共4页Chinese Journal of CT and MRI

基　　金：河南省科学技术厅2022年科技发展计划(222102310520)。

摘　　要：目的探讨磁共振弥散加权成像(DWI)结合常规序列在老年急性脑梗死诊断中的价值。方法选取2020年1月至2023年5月医院收治疑似急性脑梗死患者188例,均行磁共振DWI及常规序列检查,以临床诊断结果为“金标准”,观察磁共振DWI与常规序列检查对急性脑梗死的诊断机制,针对急性脑梗死患者,根据来院检查时间分为3期:①超急性期(发病时间为6小时以内);②急性期(发病时间为6~24小时);③亚急性期(发病时间为24~72小时)。比较不同时期脑梗死病灶的表观扩散系数(ADC)、感兴趣区病灶中心各向异性指数(FA)、平均弥散系数(DCavg)及病灶大小,并分析ADC、FA、DCavg、病灶大小与NIHSS评分相关性。结果经临床诊断,120例患者确诊为急性脑梗死,其中超急性期48例,急性期62例,亚急性期10例。磁共振DWI诊断急性脑梗死的灵敏度、特异度均高于常规序列(P<0.05)。DWI序列在三个时期检出率均高于常规序列,且差异有统计学意义(P<0.05)。在磁共振DWI序列中,病灶中心ADC、病灶面积:亚急性期>急性期>超急性期(P<0.05);FA:亚急性期<急性期<超急性期(P<0.05);不同分期DCavg差异无统计学意义(P>0.05)。ADC、病灶面积与NIHSS评分正相关(P<0.05),FA与NIHSS负相关(P<0.05),ADC、FA及两者联合诊断超急性期急性脑梗死的灵敏度分别为75.10%、73.69%、80.36%。特异度分别为65.23%、64.23%、69.61%,联合诊断的效能高于单独诊断。结论磁共振DWI序列在不同时期老年急性脑梗死诊断中的价值较高,ADC联合FA诊断超急性期急性脑梗死的效能较高。Objective To investigate the value of DWI combined with conventional sequences in the diagnosis of acute cerebral infarction in the elderly.Methods A total of 188 suspected patients with acute cerebral infarction admitted to the hospital from January 2020 to May 2023 were selected,all of which underwent MRI DWI and routine sequence examination.Clinical diagnosis results were used as the gold standard to observe the diagnostic mechanism of MRI DWI and routine sequence examination for acute cerebral infarction.Patients with acute cerebral infarction were divided into 3 stages according to the examination time:①Hyperacute stage(the onset time is less than 6 hours);②Acute stage(onset time is 6-24 hours);③Subacute stage(onset time is 24 to 72 hours).The apparent diffusion coefficient(ADC),central anisotropy index(FA),mean dispersion coefficient(DCavg)and lesion size of cerebral infarction lesions in different periods were compared,and the correlation between ADC,FA,DCavg,lesion size and NIHSS score was analyzed.Results 120 patients were clinically diagnosed as acute cerebral infarction,including 48 cases of hyperacute stage,62 cases of acute stage and 10 cases of subacute stage.The sensitivity and specificity of MRI DWI in the diagnosis of acute cerebral infarction were higher than those of conventional sequences(P<0.05).The detection rate of DWI sequence in the three periods was higher than that of conventional sequence,and the difference was statistically significant(P<0.05).In Mr DWI sequence,focal ADC and focal area were subacute stage>acute stage>hyperacute stage(P<0.05).FA:subacute stage<acute stage<hyperacute stage(P<0.05);There was no significant difference in DCavg among different stages(P>0.05).ADC and lesion area were positively correlated with NIHSS score(P<0.05),and FA was negatively correlated with NIHSS score(P<0.05).The sensitivity of ADC,FA and their combination in diagnosing hyperacute acute cerebral infarction was 75.10%,73.69%and 80.36%,respectively.The specificity was 65.23%,64.23%and 69.61%

关 键 词：磁共振 弥散加权成像 急性脑梗死 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学]