磁敏感加权成像在急性缺血性脑卒中方面的临床应用价值
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摘要
目的探讨磁敏感加权成像(susceptibility weighted imaging,SWI)在急性期缺血性脑卒中(acute ischemic stroke,AIS)缺血半暗带(ischemic penumbra,IP)、责任动脉血栓以及出血转化(hemorrhagic transformation,HT)显示方面的临床应用价值。方法选取2016年1月-2018年12月于我院脑病科收治入院的单侧颈内动脉或大脑中动脉供血区缺血性脑卒中患者80例,发病时间为72 h以内,均给予MRI检查,序列包括T_1WI、T_2WI、DWI、MRA、SWI及(aterial spin labeling,ASL)。选取发病24 h内患者30例,测量并比较SWI与ASL显示缺血梗死区范围;观察80例患者SWI序列对于责任动脉血栓以及缺血梗死区HT显示。结果 SWI和ASL对于发病24 h内缺血梗死区范围显示无统计学意义(t=-2. 865,P=0. 08)。SWI对该组责任动脉血栓即磁敏感血管征(susceptibility vessel sign,SVS)显示率为61. 25%(49/80),HT显示率为28. 75%(23/80)。结论 SWI能够快速、无创评估IP范围、责任动脉血栓及HT,对于临床治疗及预后评估具有重要临床应用价值。
Objective To investigate the clinical value of magnetic sensitive weighted imaging( SWI) in ischemic cerebral ischemic penumbra( IP),artery thrombosis and HT( hemorrhage transformation) in acute ischemic stroke.Methods A total of 80 patients with ischemic stroke who had unilateral internal carotid artery or middle cerebral artery blood supply within 72 h were selected. All patients underwent DWI,MRA,SWI and ASL examination. 30 cases of hyperacute phase within 24 hours of onset were selected to measure and compare the range of ischemic infarct area between SWI and ASL,and 80 cases of SWI sequence were displayed for the HT of the responsible artery thrombosis and the ischemic infarct area. Results SWI and ASL showed no significant difference in the extent of hyperacute ischemic infarct area( t =-2. 865,P = 0. 08). SWI showed a 61. 25%( 49/80) display of the sensitive artery thrombosis( SVS) and a HT showing rate of 28. 75%( 23/80). Conclusion SWI can quickly and noninvasive evaluate IP range,artery thrombosis and HT,which is of important clinical value for clinical treatment and prognosis evaluation.
Objective To investigate the clinical value of magnetic sensitive weighted imaging( SWI) in ischemic cerebral ischemic penumbra( IP),artery thrombosis and HT( hemorrhage transformation) in acute ischemic stroke.Methods A total of 80 patients with ischemic stroke who had unilateral internal carotid artery or middle cerebral artery blood supply within 72 h were selected. All patients underwent DWI,MRA,SWI and ASL examination. 30 cases of hyperacute phase within 24 hours of onset were selected to measure and compare the range of ischemic infarct area between SWI and ASL,and 80 cases of SWI sequence were displayed for the HT of the responsible artery thrombosis and the ischemic infarct area. Results SWI and ASL showed no significant difference in the extent of hyperacute ischemic infarct area( t =-2. 865,P = 0. 08). SWI showed a 61. 25%( 49/80) display of the sensitive artery thrombosis( SVS) and a HT showing rate of 28. 75%( 23/80). Conclusion SWI can quickly and noninvasive evaluate IP range,artery thrombosis and HT,which is of important clinical value for clinical treatment and prognosis evaluation.
引文
[1]杜俊秋,董万利害.SWI与ASL对超急性期脑梗死缺血半暗带显示和溶栓疗效的对比研究[J].脑与神经疾病杂志,2018,26(11):704-707.
[2]中国卒中学会脑血流与代谢分会.缺血性卒中脑侧支循环评估与干预中国指南(2017)[J].中华内科杂志,2017,56(6):460-471.
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[7]李虹易,段阳.3T磁敏感加权成像技术对脑深部髓质静脉的新认识[J].中风与神经疾病杂志,2016,33(6):574-576.
[8]祁宇,薛静,高培毅,等.磁敏感加权成像突出血管征对急性缺血性卒中缺血半暗带的评估价值[J].国际医学放射学杂志,2017,40(5):651-655.
[9]张丽君,邢伟,邢飞,等.动脉自旋标记灌注成像在急性脑梗死中的临床应用[J].江苏医药,2014,40(20):2490-2492.
[10]朱丽,王天乐,龚沈初,等.SWI/DWI融合图像对进行缺血性脑卒中患者缺血半暗带的评估价值[J].实用放射学杂志,2016,32(10):1494-1497.
[11]夏倩倩,王希明,胡春洪.MRI评价缺血半暗带的研究进展[J].国际医学放射学杂志,2018,41(3):303-307.
[12]梅文丽,刘慧勤,张杰文.磁敏感加权成像对急性脑梗死缺血半暗带的预测价值[J].中华实用诊断与治疗杂志,2017,31(1):57-61.
[13]Verma RK,Hsieh K,Gratz PP,et al.Leptomeningeal collateralization in acute ischemic stroke:impact on prominent cortical veins in susceptibility-weighted imaging[J].Eur J Radiol,2014,83(8):1448-1454.
[14]葛祖峰,龚向阳,朱莉莉,等.比较SWI技术与传统MRI序列在区分不同性质血栓中的作用[J].现代实用医学,2017,29(7):955-958.
[15]刘慧勤,梅文丽,王聪,等.磁敏感血管征对急性前循环缺血性脑卒中患者预后的预测价值[J].中华神经医学杂志,2017,16(12):1218-1224.
[16]Sillanpaa N,Saarinen JT,Rusanen H,et al.Location of the clot and outcome fo perfusion defects in acute anterior circulation stroke treated with intravenous thrombolysis[J].AJNR,2013,34(1):100-106.
[17]曹鑫,史浩.磁敏感加权成像技术的最新临床应用及发展前景[J].中华神经科杂志,2018,51(7):555-558.
[18]杨志宏,李鑫,王昕光,等.磁敏感加权成像在大面积脑梗死患者中的应用[J].大连医科大学学报,2015,37(2):137-141.
[19]周菲,郑家庆,沈志勇,等.磁敏感加权成像在出血性脑梗死诊断中的应用[J].中国CT和MRI杂志,2016,14(12):112-115.
[20]戴晓蓉,魏青,张瑞,等.原发性脑出血与脑微出血相关因素分析[J].中国临床神经科学,2018,26(2):217-221.
[21]张有为,舒龙,汪应瑞,等.SWI对急性脑梗死静脉溶栓治疗决策的价值[J].实用放射学杂志,2017,33(8):1171-1173.
[2]中国卒中学会脑血流与代谢分会.缺血性卒中脑侧支循环评估与干预中国指南(2017)[J].中华内科杂志,2017,56(6):460-471.
[3]Nael K,Meshksar A,Liebeskind DS,et al.Quantitative analysis of hypoperfusion in acute stroke:arterial spin labeling versus dynamic susceptibility contrast[J].Stroke,2013,44(11):3090-3096.
[4]高培毅.脑卒中影像学评估[M].北京:人民卫生出版社,2016.239-249.
[5]中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组.急性缺血性卒中血管内治疗中国指南2015[J].中国卒中杂志,2015,10(7):590-606.
[6]沈芳,刘康永,孙晓江.急性缺血性脑卒中血管内治疗进展[J].中国临床神经科学,2015,23(3):331-337.
[7]李虹易,段阳.3T磁敏感加权成像技术对脑深部髓质静脉的新认识[J].中风与神经疾病杂志,2016,33(6):574-576.
[8]祁宇,薛静,高培毅,等.磁敏感加权成像突出血管征对急性缺血性卒中缺血半暗带的评估价值[J].国际医学放射学杂志,2017,40(5):651-655.
[9]张丽君,邢伟,邢飞,等.动脉自旋标记灌注成像在急性脑梗死中的临床应用[J].江苏医药,2014,40(20):2490-2492.
[10]朱丽,王天乐,龚沈初,等.SWI/DWI融合图像对进行缺血性脑卒中患者缺血半暗带的评估价值[J].实用放射学杂志,2016,32(10):1494-1497.
[11]夏倩倩,王希明,胡春洪.MRI评价缺血半暗带的研究进展[J].国际医学放射学杂志,2018,41(3):303-307.
[12]梅文丽,刘慧勤,张杰文.磁敏感加权成像对急性脑梗死缺血半暗带的预测价值[J].中华实用诊断与治疗杂志,2017,31(1):57-61.
[13]Verma RK,Hsieh K,Gratz PP,et al.Leptomeningeal collateralization in acute ischemic stroke:impact on prominent cortical veins in susceptibility-weighted imaging[J].Eur J Radiol,2014,83(8):1448-1454.
[14]葛祖峰,龚向阳,朱莉莉,等.比较SWI技术与传统MRI序列在区分不同性质血栓中的作用[J].现代实用医学,2017,29(7):955-958.
[15]刘慧勤,梅文丽,王聪,等.磁敏感血管征对急性前循环缺血性脑卒中患者预后的预测价值[J].中华神经医学杂志,2017,16(12):1218-1224.
[16]Sillanpaa N,Saarinen JT,Rusanen H,et al.Location of the clot and outcome fo perfusion defects in acute anterior circulation stroke treated with intravenous thrombolysis[J].AJNR,2013,34(1):100-106.
[17]曹鑫,史浩.磁敏感加权成像技术的最新临床应用及发展前景[J].中华神经科杂志,2018,51(7):555-558.
[18]杨志宏,李鑫,王昕光,等.磁敏感加权成像在大面积脑梗死患者中的应用[J].大连医科大学学报,2015,37(2):137-141.
[19]周菲,郑家庆,沈志勇,等.磁敏感加权成像在出血性脑梗死诊断中的应用[J].中国CT和MRI杂志,2016,14(12):112-115.
[20]戴晓蓉,魏青,张瑞,等.原发性脑出血与脑微出血相关因素分析[J].中国临床神经科学,2018,26(2):217-221.
[21]张有为,舒龙,汪应瑞,等.SWI对急性脑梗死静脉溶栓治疗决策的价值[J].实用放射学杂志,2017,33(8):1171-1173.