磁共振灌注加权成像在急性进展性穿支动脉疾病型脑梗死中的应用价值研究  

The Value of Magnetic Resonance Perfusion-Weighted Imaging in Cerebral Infarction with Acute Progressive Perforator Artery Disease

作　　者：王景凤 王景泰 毕鹏翔 郭艳芹 WANG Jing-feng(Nanyang Central Center Hospital,Nanyang 47300,Henan,China)

机构地区：[1]南阳市中心医院,河南南阳473000 [2]平顶山学院,河南平顶山467000 [3]牡丹江医科大学附属红旗医院,黑龙江牡丹江157011

出　　处：《牡丹江医科大学学报》2025年第2期100-105,共6页Journal of Mudanjiang Medical University

基　　金：牡丹江医学院附属红旗医院科研基金项目(2019HQ-08)。

摘　　要：目的探讨磁共振灌注加权成像(perfusion weighted imaging,PWI)技术在急性进展性穿支动脉疾病(penetrating artery disease,PAD)型脑梗死中的应用价值。方法收集于牡丹江医科大学附属红旗医院神经内一科住院的确诊为急性PAD型脑梗死的患者56例,按是否出现早期神经功能恶化(early neurological deterioration,END)将PAD型脑梗死分为:PAD-END组32例与PAD-非END组24例;记录并分析患者临床资料、实验室检查、PWI检查指标(相对血容量、相对血流量、平均通过时间、达峰时间),比较PAD-END组和PAD-非END组之间的差异性。结果END组既往高血压史、入院收缩压、超敏C反应蛋白(hypersensitive C-reaction protein,hs-CRP)、糖化血红蛋白(glycated hemoglobin,HbAlc)、同型半胱氨酸(homocysteine,Hcy)、患侧平均通过时间(mean transit time,MTT)及患侧达峰时间(time to peak,TTP)高于非END组(P<0.05);END组相对脑血容量(relative cerebral blood volume,rCBV)、相对脑血流量(relative cerebral blood flow,rCBF)低于非END组(P<0.05);Logistic回归方程进行分析,END组入院时收缩压、HbAlc、Hcy、hs-CRP显著高于非END组,组间比较P<0.05,OR值分别为0.846、0.227、0.716、0.474,END组rCBV、rCBF显著低于非END组,组间比较P<0.05,OR值分别为8.543、15.300;受试者工作特征曲线(ROC)分析,rCBV预测END的最佳截断值为0.99,此时的灵敏度为0.875,特异性为0.844,曲线下面积(Area under curve,AUC)值为0.846;rCBF预测END的最佳截断值为0.848,此时的灵敏度为0.917,特异性为0.687,AUC值为0.868;结论rCBV、rCBF降低和入院收缩压、HbAlc、Hcy、hs-CRP升高可能是急性PAD患者出现END的独立危险因素,PWI技术可用于预测急性PAD患者END的发生。Objective To investigate the value of magnetic resonance perfusion-weighted imaging(PWI)in cerebral infarction associated with acute advanced perforator artery disease(PAD).Methods Fifty-six patients diagnosed with acute PAD in the neurology department of Hongqi Hospital were divided into two groups:32 cases in the PAD-END group and 24 cases in the PAD-non-END group.Clinical data,laboratory tests,and PWI parameters(relative blood volume,relative blood flow,mean passage time,and peak time)were recorded and analyzed.The differences between the PAD-END and PAD-non-END groups were then compared.Results The previous history of hypertension,admission systolic blood pressure,Hs-CRP,HbA1c,Hcy,average transit time(MTT)of the affected side,and peak time to peak(TTP)of the affected side were significantly higher in the PAD-END group compared to the non-END group(P<0.05).Relative cerebral blood volume(rCBV)and relative cerebral blood flow(rCBF)were significantly lower in the END group than in the non-END group(P<0.05).Logistic regression analysis revealed that SBP,HbA1c,Hcy,and hs-CRP were significantly higher in the END group compared to the non-END group(P<0.05),with OR values of 0.846,0.227,0.716,and 0.474,respectively.Lower rCBV and rCBF in the END group were also significantly different from the non-END group(P<0.05),with OR values of 8.543 and 15.300,respectively.Receiver operating characteristic(ROC)curve analysis showed that the optimal cut-off value for rCBV in predicting END was 0.99,with a sensitivity of 0.875 and specificity of 0.844,yielding an area under the curve(AUC)of 0.846.The optimal cut-off value for rCBF in predicting END was 0.848,with a sensitivity of 0.917 and specificity of 0.687,yielding an AUC of 0.868.Conclusion Reduced rCBV,rCBF,and admission systolic blood pressure,along with elevated HbA1c,Hcy,and hs-CRP,may be independent risk factors for END in patients with acute PAD.The PWI technique can be used to predict the occurrence of END in these patients.

关 键 词：磁共振灌注加权成像 急性穿支动脉疾病型脑梗死 早期神经功能恶化 

分 类 号：R743[医药卫生—神经病学与精神病学]