磁共振弥散加权与灌注加权成像对早期脑梗死的研究
|
摘要
目的：
研究磁共振弥散加权成像(diffusion-weighted imaging，DWI)和灌注加权成像(perfusion-weighted imaging，PWI)技术，对早期脑梗死(发病时间≤24h)的诊断以及在判断缺血半暗带演变中的价值。具体为探讨：早期脑梗死患者在MTT(mean transit time)和CBV(cerebral blood volume)图上的不同表现；MTT-DWI、CBV-DWI不匹配程度对预测梗死灶增大程度及最终脑梗死区大小的作用；ADC、rCBV及MTT比值对缺血半暗带的诊断价值；DWI、PWI在二维质子磁共振波谱成像技术(2D hydrogen proton magnetic resonance spectroscopy imaging，2D ~1H-MRSI)及磁共振血管成像(MR angiography，MRA)技术协助下，对早期脑梗死病变位置作准确显示及对缺血半暗带及脑损伤程度的作较为准确判断，并用于对急性脑梗死患者行急诊血管内支架治疗的可能性。
材料与方法：
本研究包括42例早期脑梗死患者(超急性期6例，急性期36例)，男22例，女20例，年龄为36-80岁，平均54.60岁。42例共进行88次常规MRI及DWI检查，其中30例(除一例发病3h的患者接受静脉溶栓治疗，其余29例均未接受溶栓治疗)共进行35次PWI及76次MRA检查，21例共进行23次2D-~1H MRSI检查，其中9例患者同时进行11次常规MRI、DWI、PWI、2D-~1HMRSI及MRA检查。一例患者接受血管内支架治疗，并对治疗前后的灌注情况进行比较。
扫描完成后，使用functool软件包后处理获得表观弥散系数(Apparent
Purpose of the study:
To study the roles of isotropic diffusion weighted imaging(DWI) and perfusion weighted imaging(PWI) in diagnosing early cerebral infarction(the time after onset of stroke: ≤24 hours), and in monitoring the development of cerebral ischemic penumbra. The major investigations including: evaluate the differences in cerebral perfusion seen on mean transit time(MTT) and cerebral blood volume(CBV) maps and to assess the subsequent prognostic value of the MTT-DWI and CBV-DWI mismatch in the first day of infarction on lesion enlargement and in predicting final infarct size; evaluate the roles of rADC, rMTT and rrCBV in determining the ischemic penumbra; investigate the roles of DWI and PWI with the help of the techniques of 2D hydrogen proton magnetic resonance spectroscopy imaging(2D ~1H-MRSI) and MR angiography(MRA), in diagnosing early cerebral infarction and in the endovascular stent-assisted angioplasty treatment for patients with acute stroke. Material and Methods:
42 cases (6 hyperacute,36 acute) were studied, including 22 male and 20 female, ages from 36 to 80 years old and mean 54.60 years old. 88 work-ups of 42 patients were imaged with conventional MRI and single-shot echo-planar isotropic diffusion weighted imaging. Among the patients, 35 PWI and 76 MRA were performed successfully in 30 persons(Only one patient received
研究磁共振弥散加权成像(diffusion-weighted imaging，DWI)和灌注加权成像(perfusion-weighted imaging，PWI)技术，对早期脑梗死(发病时间≤24h)的诊断以及在判断缺血半暗带演变中的价值。具体为探讨：早期脑梗死患者在MTT(mean transit time)和CBV(cerebral blood volume)图上的不同表现；MTT-DWI、CBV-DWI不匹配程度对预测梗死灶增大程度及最终脑梗死区大小的作用；ADC、rCBV及MTT比值对缺血半暗带的诊断价值；DWI、PWI在二维质子磁共振波谱成像技术(2D hydrogen proton magnetic resonance spectroscopy imaging，2D ~1H-MRSI)及磁共振血管成像(MR angiography，MRA)技术协助下，对早期脑梗死病变位置作准确显示及对缺血半暗带及脑损伤程度的作较为准确判断，并用于对急性脑梗死患者行急诊血管内支架治疗的可能性。
材料与方法：
本研究包括42例早期脑梗死患者(超急性期6例，急性期36例)，男22例，女20例，年龄为36-80岁，平均54.60岁。42例共进行88次常规MRI及DWI检查，其中30例(除一例发病3h的患者接受静脉溶栓治疗，其余29例均未接受溶栓治疗)共进行35次PWI及76次MRA检查，21例共进行23次2D-~1H MRSI检查，其中9例患者同时进行11次常规MRI、DWI、PWI、2D-~1HMRSI及MRA检查。一例患者接受血管内支架治疗，并对治疗前后的灌注情况进行比较。
扫描完成后，使用functool软件包后处理获得表观弥散系数(Apparent
Purpose of the study:
To study the roles of isotropic diffusion weighted imaging(DWI) and perfusion weighted imaging(PWI) in diagnosing early cerebral infarction(the time after onset of stroke: ≤24 hours), and in monitoring the development of cerebral ischemic penumbra. The major investigations including: evaluate the differences in cerebral perfusion seen on mean transit time(MTT) and cerebral blood volume(CBV) maps and to assess the subsequent prognostic value of the MTT-DWI and CBV-DWI mismatch in the first day of infarction on lesion enlargement and in predicting final infarct size; evaluate the roles of rADC, rMTT and rrCBV in determining the ischemic penumbra; investigate the roles of DWI and PWI with the help of the techniques of 2D hydrogen proton magnetic resonance spectroscopy imaging(2D ~1H-MRSI) and MR angiography(MRA), in diagnosing early cerebral infarction and in the endovascular stent-assisted angioplasty treatment for patients with acute stroke. Material and Methods:
42 cases (6 hyperacute,36 acute) were studied, including 22 male and 20 female, ages from 36 to 80 years old and mean 54.60 years old. 88 work-ups of 42 patients were imaged with conventional MRI and single-shot echo-planar isotropic diffusion weighted imaging. Among the patients, 35 PWI and 76 MRA were performed successfully in 30 persons(Only one patient received
引文
1. James M,Provenzale,Reza Jahan,etal. Assessment of the patient with hyperacute stroke:Imaging and Therapy. Radiology, 2003; 229:347-359.
2. Erica C,Sa'de Camargo,Walter J,etal.Neuroimaging of ischemia and infarction.The Journal of the American Society for Experimental NeuroTherapeutics,2005; 2: 265-276.
3. Kazuo Minematsu. MR imaging in acute stroke. International Congress Series, 2003; 1252:309-314.
4. Louis R, Caplan. Treatment of acute stroke. JAMA, 2004;292:1883-1885.
5. S. Heiland. Diffusion-and perfusion-weighted MR imaging in acute stroke: principles,methods, and applications. Imaging decision,2003;4:4-12.
6．Charles M，Robert R，Patrick A编著，临床磁共振血管成像(祁吉，范占明，刘继生，译)，北京：人民卫生出版社，1998；141-145．
7．韩鸿宾，谢敬霞．MR扩散成像在脑梗死早期诊断中的应用．中华放射学杂志，1998；32：384-386．
8. J. M. Wild, J. M. Wardlaw, I. Marshall,etal. N-Acetylaspartate distribution in proton spectroscopic images of isehemie stroke:Relationship to infarct appearance on T2-weighted magnetic resonance imaging. Stroke,2000;31:3008-3014.
9．马风华，詹松华。急性缺血性脑梗死的~1H-磁共振波谱实验研究．上海医学，2004；27：863-865．
10．张玉梅，张宁，周筠，等．应用磁共振波谱观察脑卒中患者的脑内代谢变化．中国临床康复，2005；9：111-113．
11. Hahn El. Spin echoes. Physiocal Review, 1950;80:580-594.
12. Tayloy DG, Bushell MC. The spatial mapping of translational diffusion coefficients by NMR imaging technigue. Phys Med Biol, 1985;30:345-349.
13．黄力，王秀河，刘斯润，等．MR表观扩散系数图在脑梗死演变诊断中的价值．中华放射学杂志，2004；38：139-143．
14．徐子森，樊宽章，于天林．灌注、弥散、功能成像原理及应用．医疗设备信息，2004；19：34-37．
15．杨春敏，黄海东，宦怡，等．MR弥散加权成像在急性脑梗塞诊断中的扫描技术参数 选择探讨．实用放射学杂志，2004；20：1133-1135．
16. Turner R, Le Bihan D,Maier J,etal. Echo-planar imaging of intravoxel incoherent motion.Radiology, 1990; 177:407-414.
17. Edelman RR, Wielopolski P, Schmitt F.Echo-planar MR imaging. Radiology, 1994; 192: 600-612.
18. Sorensen AG, Buonanno FS,Gonzalez RG, etal.Hyperacnte stroke: Evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. Radiology, 1996;199:391-401.
19. Poh-Sien Loh, Ken S. Butcher, Mark W. Parsons, etal. Apparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis. Stroke,2005,36:2626-2631.
20．洪闻，张雪哲，黄振国，等．MR弥散成像在脑梗死诊断中的应用．中日友好医院学报，2005；19：340-343．
21．张勇，杨运俊，程敬亮．DWI和MRS诊断缺血性脑梗死的病理生理学基础．实用放射学杂志，2005；21：318-320．
22. GoldbergMP, ChoiDW. Combined oxygen and glucose deprivation in cortical cell culture: calcium dependent and calcium independent mechanisms of neuronal injury. J Neurosci, 1993; 13:3510-3524.
23. Benveniste H, Hedlund LW, Johnson A. Mechanism of detection of acute cerebral isehemia in rats by diffusion weighted magnetic resonance microscopy. Stroke, 1992;23:746-754.
24. Forbes K, Pipe JHeiserman J. Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. Am J Neuroradiol,2001;22:450-455.
25. Calabresi P, Marfia GA, Centonze D, et al. Sodium influx plays a major role in the membrane depolarization induced by oxygen and glucose deprivation in rat striated spiny neurons. Stroke, 1999;30:171-179.
26. Beauchamp NJ, Barker PB, Wang PY, et al. Imaging of acute cerebral ischemia. Radiology, 1999; 212:307-324.
27．张勇，张焱．早期缺血性脑梗死磁共振扩散加权成像的实验研究．河南大学学 报(医学版)，2004；23：5-7．
28．杨运俊，程敬亮，陈伟建．早期脑梗死缺血半暗带磁共振扩散和灌注加权成像的实验研究．临床医学，2005；25：1-3．
29．殷信道，冯晓源，王丽萍，等．超急性期脑梗死半影区弥散区弥散．灌注磁共振成像实验研究．临床放射学杂志，2004；23：243-248．
30．陈彦芳．急性脑梗塞的早期影像学诊断．国外医学临床放射学分册，1994；3：155-157．
31．董强．磁共振弥散加权成像和灌注加权成像在缺血性脑血管病中的诊断价值．中国实用内科杂志，2005；25：391-393．
32. Benceniste H. Mechanism of detection of acute cerebral ischemia in rats by diffusion weighted magnetic resonance imaging. Stroke, 1992; 23: 1304-1310.
33. Baird AT, Warch S. Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab, 1998;18:593-609.
34. Hasegawa Y, Fisher M,Latour LL,et al. MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia. Neurology, 1994;44:1484-1490.
35. Minematsu K, Fisher M, LI 1. Effects of a novel NMDA antagonist on experimental stroke rapidly and quantitativly assessed by diffusion-weighted MRI.Neurology, 1993; 43:397-403.
36．朱晓黎，丁乙．磁共振在缺血性脑卒中早期诊断中的应用新进展．国外医学临床放射学分册，1998；1：28-31．
37. Lo EH,Pierce AR,Mandeville JB,et al. Effects on ADC probability distribution functions and diffusion-perfusion relationships.Stroke, 1997;28:439-447.
38. Warach, Gaa J,Siewert B,et al. Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol, 1995;37:231-241.
39．王秀河，黄耀熊，黄力，等．超急及急性脑卒中患者三相同性扩散加权像和表观扩散系数的应用．中国临床康复，2005；9：70-72．
40. Piepao C,Righin A,Linfante I,et al. Histopathologic correlates of abnormal water diffusion in cerebral ischemia: diffusion-weighted MR imaging and light electron microscopic study. Radiology, 1993; 189:439-448.
41. Matsumoto K,Lo EH,Pieree AR, et al. Role of vasogenic edema and tissue cavitation in ischemic evolution on diffusion weighted imaging: Comparison With multiparameter MR and immunohistochemistry. AJNR, 1995; 16:1107-1115.
42. Gregory W.Diffusion-weighted MRI for evaluation of acute stroke. Neurology, 1998; 51 (supp13)S47-S49.
43．黄海东，杨春敏，宦怡，等．弥散加权MRI对急性和非急性脑梗死的鉴别诊断价值．放射学实践，2003；18：635-636．
44. Tong DC,Yenari MA,Albers GW, et al. Correlation of perfusion-and diffusion-weight MRI with NIHSS score in acute (＜6.5 hour)ischemic stroke. Neurology,1998;50: 864-870.
45. Chelsea S. Kidwell, Jeffry R,etal. Evolving paradigms in neuroimaging of the ischemic penumbra, Stroke,2004;35:2662-2665.
46. Wolf-Dieter Heiss,Jan Sobesky,Volker Hesselmann.Identifying thresholds for penumbra and irreversible tissue damage. Stroke, 2004;35:2671-2674.
47. Abdel-Dayem, et al. Changes in cerebral perfusion after acute head injury: comparison of CT with Tc-~(99)m HM-PAO SPECT. Radiology, 1987; 165: 221-226.
48．韩鸿宾，谢敬霞．MR扩散与灌注成像在脑缺血诊断中的应用．中华放射学杂志．1998；32：364-369．
49. Cecile B. Grandin, Thierry P. Duprez, Anne M. Smith,etal. Usefulness of magnetic resonance-derived quantitative measurements of cerebral blood flow and volume in prediction of infarct growth in hyperacute stroke. Stroke,2001 ;32:1147-1153.
50．邢伟．胡春洪，丁乙．脑MR灌注成像的技术与应用．国外医学临床放射学分册，2002；25：60-62．
51. Maeda M, Itoh S,Ide H,etal. Acute stroke in cats: Comparison of dynamicsusceptibility-contrast MR imaging with T2-and diffusion-weighted MR imaging.Radiology, 1993; 189:227-232.
52. K.S.Butcher, M.Parsons,L.MacGregor, etal. Refining the perfusion-diffusion mismatch hypothesis.Stroke,2005;36:1153-1159.
53．王建利，谢敬霞．对比增强磁共振脑血流灌注成像．临床放射学杂志，2000；9：1184-188．
54. Barber PA,Parsons MW, Darby DG, et al. Sensitivity and specificity of perfusion-weighted MRI in ischemic stroke. Stroke, 2002; 33 : 348.
55. Pamela W. Schaefer, George J. Hunter, Julian He,etal. Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging. AJNR,2002;23:1785-1794.
56．朱明旺，郁同庆，戴建平．脑灌注MRI与脑血管造影在评价脑缺血病变中的价值．中华放射学杂志，1998；32：375-379．
57．钱银锋，余永强．急性脑缺血的病理生理与灌注成像．国外医学临床放射学分册，2005；28：381-384．
58. C.S. Rivers, J.M. Wardlaw, MBChB,etal. Do acute diffusion-and perfusion-weighted MRI lesions identify final infarct volume in ischemic stroke? Stroke,2006;37:98-104.
59. Wittsack HJ, Ritzl A, Fink GR, et al. MR imaging in acute stroke:diffusion-weighted and perfusion imaging parameters for predicting infarct size. Radiology, 2002;222:397-403.
60. Ce'cile B.Grandin,Thierry P.Duprez,Anne M.Smith,etal. Which MR-derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology,2002;23:361-370.
61. Warach S, Dashe JF, Edelman RR. Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab,1996;16:53-59.
62．冯晓源，梁杰，殷信道．磁共振弥散加权成像和灌注成像界定急性脑梗死缺血半影区．中华医学杂志，2003；83：952-957．
63. V.N. Thijs, A. Adami, T. Neumann—Haefelin,etal. Relationship between severity of MR perfusion deficit and DWI lesion evolution. Neurology, 2001;57:1205-1211.
64. Albers GW. Expanding the window for thrombolytic therapy in acute stroke. The potential role of acute MRI for patient selection. Stroke,1999; 30 : 2230-2237.
65. Thijs VN, Adami A,Neumann2Haefelin T,et al. Relationship between severity of MR perfusion deficit and DWI lesion evolution. Neurology,2001;57:1205-1211.
66. J acobs MA,Zhang ZG, Knight RA. A Model for multiparametertric MRI tissue characterization in experimental cerebral ischemia with histological validation in rat. Stroke,2001 ;32:943-949.
67. Shih LC,Saver JL,Alger JR,et al. Perfusion-weighted magnetic resonance imaging thresholds identifying core,irreversibly infarcted tissue.Stroke,2003; 34:1425-1430.
68．刘梅丽，崔世民，张蕾莉．磁共振扩散加权和灌注成像对超急性期脑梗死影像半暗带的研究．中华放射学杂志，2002：36：1095-1100．
69．朱海英，冷振璞．灌注和弥散加权磁共振成像在超早期脑梗死中的应用．国外医学脑血管疾病分册，2004；12：409-412．
70. Neumann Haefelin T, Wittsack HJ, Wenserski F, et al. Diffusion and perfusion weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke, 1999; 30:1591-1597.
71. Bristow MS, Simon JE,Brown RA,etal. MR perfusion and diffusion in acute ischemic stroke: human gray and white matter have different thresholds for infarction. J Cereb Blood Flow Metab,2005;25:1280-1287.
72. Parsons MW, Yang Q, Barber PA, et al. Perfusion magnetic resonance imaging maps in hyperacute stroke:relative cerebral blood flow most accurately identifies tissue destined to infarct.Stroke.2001 ;32:1581-1587.
73. Y. Liu,J.O. Karonen,R.L. Vanninen,etal. Detecting the subregion proceeding to infarction in hypoperfused cerebral tissue: a study with diffusion and perfusion weighted MRI. Neuroradiology,2003 ;45: 345-351.
74. Pamela W. Schaefer, Yelda Ozsunar, Julian He,etal. Assessing tissue viability with MR diffusion and perfusion imaging. AJNR, 2003; 24:436-443.
75. Schlaug G, Benfield A, Baird AE, et al. The ischemic penumbra : operationally defined by diffusion and perfusion MRI. Neurology, 1999;53:1528-1537.
76．赵俊功，李明华，程英升．大鼠急性脑梗死后不同区域扩散和灌注成像的变化特点．介入放射学杂志，2005：14：516-522．
77. Grandin CB, Duprez TP, Smith AM, et al. Usefulness of magnetic resonance derived quantitative measurements of cerebral blood flow and volume in prediction of infarct growth in hyperacute stroke. Stroke, 2001;32:1147-1153.
78. Hermier M, Nighoghossian N, Adeleine P, et al. Early magnetic resonance imaging prediction of arterial recanalization and late infarct volume in acute carotid artery stroke. J Cereb Blood Flow Metab, 2003;23:240-248.
79. Butcher K, Parsons M, Baird T, et al. Perfusion thresholds in acute stroke thrombolysis. Stroke,2003;34:2159-2164.
80. Schellinger PD, Fiebach JB, HackeW. Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status.Stroke,2003;34: 575-583.
81．王宝军，李美琳．核磁共振弥散成像和血流灌注成像检查对超早期脑梗死溶栓治疗的意义．中国急救医学，2000；20：623-625．
82. Jansen O, Schellinger P, Fiebach J, et al. Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet,1999;353:2036-2037.
83. Uno M, Harada M, Yoneda K, et al. Can diffusion and perfusion weighted magnetic resonance imaging evaluate the efficacy of acute thrombolysis in patients with internal carotid artery or middle cerebral artery occlusion?Neurosurgery, 2002;50:28-34.
84. Tong D, Adami A,MarksM, et al. Can hemorrhagic transformation be predicted by initial DWI and PWI findings in acute stroke? National Stroke Association,North American Stroke Meeting, September 1-4 1999, SnowmassVillage,Aspen, Colorado.
85. Tong DC, Adami A, Moseley ME, et al. Prediction of hemorrhagic transformation following acute stroke: role of diffusion and perfusion weighted magnetic resonance imaging. Arch Neurol,2001 ;58:587-593.
86. Kidwell CS,Saver JL,Mattiello J,et al.A diffusion-perfusion MRI signature predicting hemorrhagic transformation following intra-arterial thrombolysis. Stroke,2001; 32:318.
87．王建伟，胡卫星．活体脑梗死前后脑代谢的磁共振波谱检查．国外医学脑血管疾病分册，2000；8：346-348．
88．田新英，王建华，吴晶．脑梗死患者磁共振质子波谱的变化．中华老年心脑血管病杂志，2003；5：30-32．
89. F. Nicoli, Y. Lefur, B. Metabolic counterpart of decreased apparent diffusion coefficient during hyperacute ischemic stroke: A bain proton magnetic resonance spectroscopic imaging study. Stroke 2003;34:82-87.
90．李坤成．磁共振波谱在中枢神经系统疾病中的应用价值．中国临床康复．2004：8：722-723．
91. Wardlaw JM,Marshall I,Wild J,etal.Studies of acute ischemic stroke with proton magnetic resonance spectroscopy: relation between time from onset, neurological deficit metabolite abnormalities in the infarct, blood flow, and clinical outcome.Stroke, 1998;29: 1618-1624.
92. AsanoT.Clinical application of ~1H nuclear magnetic resonance spectroscopy into patients with cerebral ischemia. Hokkaido Igaku Zassh 1998;73:581-597.
93. Federico F, Simone IL,Conte C,etal. Prognostic significance of metabolic changes detected by proton magnetic resonance spectroscopy in ischemic stroke. J Neurol, 1996; 243:241-247.
94．欧利民，庄伟端，林顺发，等．弥散加权磁共振与磁共振血管成像在急性脑梗死诊断中的临床应用．中国实用内科杂志，2003；23：111-113．
95. Yawu Liu, Jari O. Karonen,Ritva L. Vanninen,etal. Acute ischemic stroke: Predictive value of 2D phase-contrast MR angiography-serial study with combined diffusion and perfusion MR imaging. Radiology, 2004; 231:517-527.
96．王海东，许侃，徐松柏，等．颈动脉狭窄的血管内支架成形术治疗．中风与神经疾病杂志，2005；22：169-171．
97. Barr JD, Conno rs JJ, Sack s D, et al. Quality improvement guidelines for the performance of cervical carotid angioplasty and stent placement. Am J Neuroradiol, 2003; 24:2020-2034.
98. J M Wardlaw. Recent developments in imaging of stroke. Imaging,2002; 14:409-419.
99. Seitz RJ, Meisel S,Weller P, etal. Initial ischemic event: perfusion-weighted MR imaging and apparent diffusion coefficient for stroke evolution. Radiology, 2005;237:1020-1028.
100．焦力群，凌锋，卢洁，等．利用灌注MRI技术评价颈内动脉狭窄或闭塞的血流动力学状态．临床放射学杂志，2004；23：835-838．
101. Li TQ,Takhashi AM,Hindmarsh T, et al. ADC mapping by means of a single-shot spiral MRI technique with application in acute cerebral ischemia. MagnReson Med,1999;41:143-147.
102. Ulug AM, Beauchamp N Jr, Bryan RN,van Zijl PC. Absolute quantitation of diffusion constants in human stroke. Stroke, 1997;28:483-490.
103. Helenius J, Soinne L, Perkio J, et al Diffusion-weighted MR imaging in normal human brains in various age groups. AJNR, 2002;23: 194-199.
104．殷信道，顾建平，王丽萍．超急性脑梗死再灌注弥散加权-灌注磁共振成像实验研究．实用放射学杂志，2004；20：769-773．
105. Schlaug G, SiewertB, Benfield A, et al. Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology, 1997;49:113-119.
106．龚良庚，肖新兰，邢萍萍．弥散加权成像对超急性脑梗塞的诊断价值探讨．实用临床医学，2004；5：110-114．
107．韩鸿宾，谢敬霞．兔大脑中动脉阻塞模型局灶性脑缺血区超早期水分子扩散异常的病理基础研究．中华放射学杂志，1999；33：655-661．
108. Lansberg MG, Thijs VN, O'Brien MW, et al. Evolution of apparent diffusion coefficient, diffusion-weighted, and T_2-weighted signal intensity of acute stroke.AJNR, 2001; 22: 637-644.
109．鲁宏，孙善全．水通道蛋白-4在急性脑缺血组织中的表达与M R扩散加权成像的相关性研究．中华放射学杂志，2003；37：508-513．
110. Venero JL,Vizuete ML,Machado A,etal. Aquaporins in the central nervous system. Prog Neurobiol,2001;63:321-336.
111．张勇，韩仲岩．急性脑梗死患者脑脊液中抑制性氨基酸递质的动态观察．卒中与神经疾病，2000；7：78-80．
112. Calabresi P, Marfia GA, Centonze D, et al. Sodium influx plays a major role in the membrane depolarization induced by oxygen and glucose deprivation in rat striatal spiny neurons. Stroke, 1999;30:171-179.
113．张权，孙骏谟，田志雄，等．超早期脑梗塞及再灌注动物模型的磁共振弥散加权成像研究．临床放射学杂志，2001；20：466-470．
114. Rohl L,Ostergaard L,Simonsen CZ,etal.Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion weighted MRI and apparent diffusion coefficient. Stroke,2001;32:1140-1146.
115. Poh-Sien Loh, Ken S. Butcher, Mark W. Parsons,etal. Apparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis.Stroke, 2005;36: 2626-2631.
116. Dong Gyu Na, Vincent N. Thijs, Gregory W. Albers,etal. Diffusion-weighted MR imaging in acute ischemia: Value of apparent diffusion coefficient and signal intensity thresholds in predicting tissue at risk and final infarct size. AJNR,2004; 25:1331-1336.
117. Jens Fiehler, Karina Knudsen, Thomas Kucinski, Predictors of apparent diffusion coefficient normalization in stroke patients. Stroke, 2004;35:514-519.
118. Duong TQ,Ackerman JJ, Ying HS, et al. Evaluation of extra-and intracellulax apparent diffusion in normal and globally ischemie rat brain via 19F NMR.MRM,1998;40:1-13.
119. Ueda T,Yuh T,Maley J, etal. Outcome of acute ischemic lesion evaluated by diffusion and perfusion MR imaging. AJNR, 1999;20:983-989.
120. Hamberg LM, Macfarlane R, Tasdemiroglu E, et al. Measurement of cerebrovascular changes in cats after transient ischemia using dynamic magnetic resonance imaging. Stroke. 1993 ;24:444-451.
121. Astrup J, Siesjo BK, Syxnon L. Thresholds in cerebral ischemia-the ischemic penumbra. Stroke, 1981; 12:723-725.
122. Hakim AM. The cerebral ischemic penumbra.Can J Neurol Sci. 1987;14:557-559.
123. Hossmann KA. Viability thresholds and the penumbra of focal ischemia. Ann Neurol., 1994;36:553-554.
124．杨运俊．早期脑梗死缺血半暗带磁共振扩散和灌注加权成像的实验研究．郑州大学硕士学位论文，2004：16-17．
125. Carter LP,Yamagata S, Erspamer R. Time limits of reversible cortical ischemia.Neurosurgery, 1983;12:620-623.
126. Osamu Abe,Shigeki Aoki,Ichiro Shirouzu,etal. MR imaging of ischemic penumbra. European Journal of Radiology,2003;46:67-78.
127．张芳，谢敬霞．早期脑梗死缺血半暗带MR扩散、灌注成像的研究进展．临床放射学杂志，2002；21：907-909．
128. Ken S. Butcher, Mark W. Parsons, Stephen Davis,etal. PWI/DWI mismatch: Better definition required*response. Stroke,2003,34:215-216.
129．赵恒宇，袁丽杰．MRI灌注成像技术在早期脑梗死中的应用．黑龙江医学．2005；29：419-420．
130. Rose SE, Janke AL, Griffin M, Finnigan S, Chalk JB. Improved prediction of final infarct volume using bolus delay-corrected perfusion weighted MRI: implications for the ischemic penumbra. Stroke, 2004; 35:2466-2471.
131. Pierce AR, Lo EH, Mandeville JB,Gonza' lez RG, Rosen BR, Wolf GL.MRI measurements of water diffusion and cerebral perfusion: their relationship in a rat model of focal cerebral ischemia. J Cereb Blood Flow Metab,1997;17: 183-190.
132. Li F, Liu KF, Silva MD, et al.Transient and permanent resolution of ischemic lesions on diffusion-weighted imaging after brief periods of focal ischemia in rats: correlation with histopathology.Stroke,2000;31:946-954.
133. Desmond PM,Lovell AC,Rawlinson AA,etal.The value of apparent diffusion coefficient maps in early cerebral ischemia.AJNR,2001 ;22:1260-1267.
134. Liu KF, Li F, Tatlisumak T, etal.Regional variations in the apparen diffusion coefficient and the intracellular distribution of water in rat brain during acute focal ischemia. Stroke,2001 ;32:1897-1905.
135. Powers W J.Cerebral hemodynamics in ischemic cerebrovascular disease.Ann Neurol, 1991 ;29:231-240.
136. Yamaur M,Katayma Y, Igarashi H,et al. ~1H and ~(31)p magnetic resonance spectroscopy of cerebral infarction in rats.Nipponika Daigaku Zasshi, 1997;64:131-138.
137. Patsons MW,Li T,Barber PA,et al. Combined ~1H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome. Neurology, 2000; 55:498-505.
138．叶滨宾，范国光，王丽君．MR弥散、灌注成像及~1H-MRS在判断脑肿瘤放疗后坏死与肿瘤复发诊断中的应用．中国医学影像学杂志，2002；10：247-251．
139．朱锡旭，郑玲，卢光明，等．多体素~1H MRS测定正常脑组织不同区域的代谢物分布．中国医学影像学杂志，2005；13：257-259．
140. Angelic E,Bonmartin A,Boudraa,A, etal. Regional differences and metabolic changes in normal aging of the human Brain : Proton MR spectroscopic imaging study. American Journal of Neuroradiology, 2001 ;22:119-127.
141. Urrila AS, Hakkarainen A, Heikkinen S, et al. Stimulus-induced brain lactate : effects of aging and prolonged wakefulness. J Sleep Res. 2004; 13:111-119.
142. Nelson S J.Multivoxel magnetic resonance spectroscopy of brain tumors.Molecular Cancer Therapeutics,2003;2:497-507.
143. Nelson SJ,Graves E,Pirzkall A,etal.In vivo molecular imaging for planning radiation therapy of gliomas:an application of HMRSI.Journal of Magnetic Resonance Imaging, 2002;16:464-476.
144．谢长青，卢曼丽，吴光耀．脑组织质子磁共振波谱成像．武汉大学学报(医学版)，2003；24：366-369．
145. Igarashi H, Kwee IL, Okubo S, et al. Predicting the pathological fate of focal cerebral ischemia using ~1H-magnetic resonance spectroscopic imaging. International Congress Series, 2003, 1252: 341-344.
146. Mathews VP,Barker PB, Blackband SJ,et al. Cerebral metabolites in patients with acute and subacute strokes: concentrations determined by quantitative proton MR spectroscopy. AJNR, 1995; 165:633-638.
147. Barker PB, Gillard J H, van Zijl PCM, et al. Acute stroke: Evaluation with serial proton MR spectroscopic imaging. Radiology, 1994; 192:723-732.
148. Federico F,Simone IL,lucivero V,et al. Prognostic value of proton magnetic resonance spectroscopy in ischemic strok.Arch Neurol, 1999;55:489-494.
149. Saunders DE,Franklyn A,Boogaart AD,et al. Continuing ischemic damage after acute middle cerebral artery infarction in human demonstrated by short-echo proton spectroscopy. Stroke, 1995 ;26:1007-1013.
150．张勇．早期缺血性脑梗死质子磁共振波谱的实验研究．郑州大学硕士学位论文，2004：21-22．
151. Sagera, TN,Toppb S,Torup L,et al. Evaluation of CA1 damage using single-voxel 1H-MRS and un-biased stereology: can non-invasive measures of N-acetyl-asparate following global ischemia be used as a reliable measure of neuronal damage. Brain Research, 2001 ;892:166-175.
152. Igarashi H, Kwee IL, Nakada T, et al. ~1H-magnetic resonance spectroscopic imaging of permanent focal cerebral ischemia in rat: longitudinal metabolic changes in ischemic core and rim. Brain Research, 2001;907(1-2): 208-221.
153. Demougeot C, Walker P, Beley A, et al. Spectroscopic following stroke reveal tissue abnormality beyond the regin of T2-weighted hyperintensity. J Neurol Sci., 2002; 199(1-2):73-78.
154. Fukuchi T, Katayama Y, Kamiya T, et al. The effect of duration of cerebral ischemia on brain pyruvate dehydrogenase activity,energy metabolites and blood flow during reperfusion in gerbil brain.Brain Res, 1998;792:59-65.
155. Petroff OAC, Graham GD,Blamire AM, et al. Spectroscopic imaging of stoke in humans : histopathology correlates of spectral changes. Neurology,1992;42:1349-1354.
156. Lanfermann H,Kugel H,Heindel W,etal.Metabolic changes in acute and subacute cerebral infarctions:Findings at pronton MR spectroscopic imaging.Radiology, 1995; 196: 203-210.
157. Gillard J H, Barker PB, Van Zijl PCM, et al. Proton MR spectroscopy in acute middle cerebral artery stroke. AJNR,1996; 17:873-886.
158. Duijn J H,Matson GB, Maudsley AA,et al. Human brain infarction:proton MR spectroscopy.Radiology, 1992; 183:711-718.
159. Chelsea S. Kidwell, Jeffry R. Alger, Jeffrey L. Saver. Evolving paradigms in neuroimaging of the ischemic penumbra.Stroke, 2004; 35 [supplⅠ]:2662-2665.
160. Turgut Tatlisumak,Daniel Strbian, Usama Abo Ramadan,etal. The Role of diffusion-and perfusion-weighted magnetic resonance imaging in drug development for ischemic stroke: from laboratory to clinics. Current Vascular Pharmacology, 2004;2:343-355.
161. Friedrich G, Luca R, Heinrich M, et al. Local intra-arterial thrombolysis in acute ischemic stroke. Stroke, 1998; 29 : 1894-1900.
162．黄清海，刘建民，洪波，等．血管内支架成形术治疗颅内动脉狭窄的临床疗效评价．中华医学杂志，2003；83：18-20．
163. Ballotta E, Da Giau G, Baracchini, et al. Carotid angioplasty and stenting in high-risk patients with severe symptomatic carotid stenosis. Stroke, 2003; 34:834-835.
164. Toshihiro U, Saburo S, Ichiro N, et al. Angioplasty after intra-arterial thrombolysis for acute occlusion of intracranial arteries. Stroke, 1998;29:2568-2574.
2. Erica C,Sa'de Camargo,Walter J,etal.Neuroimaging of ischemia and infarction.The Journal of the American Society for Experimental NeuroTherapeutics,2005; 2: 265-276.
3. Kazuo Minematsu. MR imaging in acute stroke. International Congress Series, 2003; 1252:309-314.
4. Louis R, Caplan. Treatment of acute stroke. JAMA, 2004;292:1883-1885.
5. S. Heiland. Diffusion-and perfusion-weighted MR imaging in acute stroke: principles,methods, and applications. Imaging decision,2003;4:4-12.
6．Charles M，Robert R，Patrick A编著，临床磁共振血管成像(祁吉，范占明，刘继生，译)，北京：人民卫生出版社，1998；141-145．
7．韩鸿宾，谢敬霞．MR扩散成像在脑梗死早期诊断中的应用．中华放射学杂志，1998；32：384-386．
8. J. M. Wild, J. M. Wardlaw, I. Marshall,etal. N-Acetylaspartate distribution in proton spectroscopic images of isehemie stroke:Relationship to infarct appearance on T2-weighted magnetic resonance imaging. Stroke,2000;31:3008-3014.
9．马风华，詹松华。急性缺血性脑梗死的~1H-磁共振波谱实验研究．上海医学，2004；27：863-865．
10．张玉梅，张宁，周筠，等．应用磁共振波谱观察脑卒中患者的脑内代谢变化．中国临床康复，2005；9：111-113．
11. Hahn El. Spin echoes. Physiocal Review, 1950;80:580-594.
12. Tayloy DG, Bushell MC. The spatial mapping of translational diffusion coefficients by NMR imaging technigue. Phys Med Biol, 1985;30:345-349.
13．黄力，王秀河，刘斯润，等．MR表观扩散系数图在脑梗死演变诊断中的价值．中华放射学杂志，2004；38：139-143．
14．徐子森，樊宽章，于天林．灌注、弥散、功能成像原理及应用．医疗设备信息，2004；19：34-37．
15．杨春敏，黄海东，宦怡，等．MR弥散加权成像在急性脑梗塞诊断中的扫描技术参数 选择探讨．实用放射学杂志，2004；20：1133-1135．
16. Turner R, Le Bihan D,Maier J,etal. Echo-planar imaging of intravoxel incoherent motion.Radiology, 1990; 177:407-414.
17. Edelman RR, Wielopolski P, Schmitt F.Echo-planar MR imaging. Radiology, 1994; 192: 600-612.
18. Sorensen AG, Buonanno FS,Gonzalez RG, etal.Hyperacnte stroke: Evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar MR imaging. Radiology, 1996;199:391-401.
19. Poh-Sien Loh, Ken S. Butcher, Mark W. Parsons, etal. Apparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis. Stroke,2005,36:2626-2631.
20．洪闻，张雪哲，黄振国，等．MR弥散成像在脑梗死诊断中的应用．中日友好医院学报，2005；19：340-343．
21．张勇，杨运俊，程敬亮．DWI和MRS诊断缺血性脑梗死的病理生理学基础．实用放射学杂志，2005；21：318-320．
22. GoldbergMP, ChoiDW. Combined oxygen and glucose deprivation in cortical cell culture: calcium dependent and calcium independent mechanisms of neuronal injury. J Neurosci, 1993; 13:3510-3524.
23. Benveniste H, Hedlund LW, Johnson A. Mechanism of detection of acute cerebral isehemia in rats by diffusion weighted magnetic resonance microscopy. Stroke, 1992;23:746-754.
24. Forbes K, Pipe JHeiserman J. Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. Am J Neuroradiol,2001;22:450-455.
25. Calabresi P, Marfia GA, Centonze D, et al. Sodium influx plays a major role in the membrane depolarization induced by oxygen and glucose deprivation in rat striated spiny neurons. Stroke, 1999;30:171-179.
26. Beauchamp NJ, Barker PB, Wang PY, et al. Imaging of acute cerebral ischemia. Radiology, 1999; 212:307-324.
27．张勇，张焱．早期缺血性脑梗死磁共振扩散加权成像的实验研究．河南大学学 报(医学版)，2004；23：5-7．
28．杨运俊，程敬亮，陈伟建．早期脑梗死缺血半暗带磁共振扩散和灌注加权成像的实验研究．临床医学，2005；25：1-3．
29．殷信道，冯晓源，王丽萍，等．超急性期脑梗死半影区弥散区弥散．灌注磁共振成像实验研究．临床放射学杂志，2004；23：243-248．
30．陈彦芳．急性脑梗塞的早期影像学诊断．国外医学临床放射学分册，1994；3：155-157．
31．董强．磁共振弥散加权成像和灌注加权成像在缺血性脑血管病中的诊断价值．中国实用内科杂志，2005；25：391-393．
32. Benceniste H. Mechanism of detection of acute cerebral ischemia in rats by diffusion weighted magnetic resonance imaging. Stroke, 1992; 23: 1304-1310.
33. Baird AT, Warch S. Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab, 1998;18:593-609.
34. Hasegawa Y, Fisher M,Latour LL,et al. MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia. Neurology, 1994;44:1484-1490.
35. Minematsu K, Fisher M, LI 1. Effects of a novel NMDA antagonist on experimental stroke rapidly and quantitativly assessed by diffusion-weighted MRI.Neurology, 1993; 43:397-403.
36．朱晓黎，丁乙．磁共振在缺血性脑卒中早期诊断中的应用新进展．国外医学临床放射学分册，1998；1：28-31．
37. Lo EH,Pierce AR,Mandeville JB,et al. Effects on ADC probability distribution functions and diffusion-perfusion relationships.Stroke, 1997;28:439-447.
38. Warach, Gaa J,Siewert B,et al. Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol, 1995;37:231-241.
39．王秀河，黄耀熊，黄力，等．超急及急性脑卒中患者三相同性扩散加权像和表观扩散系数的应用．中国临床康复，2005；9：70-72．
40. Piepao C,Righin A,Linfante I,et al. Histopathologic correlates of abnormal water diffusion in cerebral ischemia: diffusion-weighted MR imaging and light electron microscopic study. Radiology, 1993; 189:439-448.
41. Matsumoto K,Lo EH,Pieree AR, et al. Role of vasogenic edema and tissue cavitation in ischemic evolution on diffusion weighted imaging: Comparison With multiparameter MR and immunohistochemistry. AJNR, 1995; 16:1107-1115.
42. Gregory W.Diffusion-weighted MRI for evaluation of acute stroke. Neurology, 1998; 51 (supp13)S47-S49.
43．黄海东，杨春敏，宦怡，等．弥散加权MRI对急性和非急性脑梗死的鉴别诊断价值．放射学实践，2003；18：635-636．
44. Tong DC,Yenari MA,Albers GW, et al. Correlation of perfusion-and diffusion-weight MRI with NIHSS score in acute (＜6.5 hour)ischemic stroke. Neurology,1998;50: 864-870.
45. Chelsea S. Kidwell, Jeffry R,etal. Evolving paradigms in neuroimaging of the ischemic penumbra, Stroke,2004;35:2662-2665.
46. Wolf-Dieter Heiss,Jan Sobesky,Volker Hesselmann.Identifying thresholds for penumbra and irreversible tissue damage. Stroke, 2004;35:2671-2674.
47. Abdel-Dayem, et al. Changes in cerebral perfusion after acute head injury: comparison of CT with Tc-~(99)m HM-PAO SPECT. Radiology, 1987; 165: 221-226.
48．韩鸿宾，谢敬霞．MR扩散与灌注成像在脑缺血诊断中的应用．中华放射学杂志．1998；32：364-369．
49. Cecile B. Grandin, Thierry P. Duprez, Anne M. Smith,etal. Usefulness of magnetic resonance-derived quantitative measurements of cerebral blood flow and volume in prediction of infarct growth in hyperacute stroke. Stroke,2001 ;32:1147-1153.
50．邢伟．胡春洪，丁乙．脑MR灌注成像的技术与应用．国外医学临床放射学分册，2002；25：60-62．
51. Maeda M, Itoh S,Ide H,etal. Acute stroke in cats: Comparison of dynamicsusceptibility-contrast MR imaging with T2-and diffusion-weighted MR imaging.Radiology, 1993; 189:227-232.
52. K.S.Butcher, M.Parsons,L.MacGregor, etal. Refining the perfusion-diffusion mismatch hypothesis.Stroke,2005;36:1153-1159.
53．王建利，谢敬霞．对比增强磁共振脑血流灌注成像．临床放射学杂志，2000；9：1184-188．
54. Barber PA,Parsons MW, Darby DG, et al. Sensitivity and specificity of perfusion-weighted MRI in ischemic stroke. Stroke, 2002; 33 : 348.
55. Pamela W. Schaefer, George J. Hunter, Julian He,etal. Predicting cerebral ischemic infarct volume with diffusion and perfusion MR imaging. AJNR,2002;23:1785-1794.
56．朱明旺，郁同庆，戴建平．脑灌注MRI与脑血管造影在评价脑缺血病变中的价值．中华放射学杂志，1998；32：375-379．
57．钱银锋，余永强．急性脑缺血的病理生理与灌注成像．国外医学临床放射学分册，2005；28：381-384．
58. C.S. Rivers, J.M. Wardlaw, MBChB,etal. Do acute diffusion-and perfusion-weighted MRI lesions identify final infarct volume in ischemic stroke? Stroke,2006;37:98-104.
59. Wittsack HJ, Ritzl A, Fink GR, et al. MR imaging in acute stroke:diffusion-weighted and perfusion imaging parameters for predicting infarct size. Radiology, 2002;222:397-403.
60. Ce'cile B.Grandin,Thierry P.Duprez,Anne M.Smith,etal. Which MR-derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology,2002;23:361-370.
61. Warach S, Dashe JF, Edelman RR. Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab,1996;16:53-59.
62．冯晓源，梁杰，殷信道．磁共振弥散加权成像和灌注成像界定急性脑梗死缺血半影区．中华医学杂志，2003；83：952-957．
63. V.N. Thijs, A. Adami, T. Neumann—Haefelin,etal. Relationship between severity of MR perfusion deficit and DWI lesion evolution. Neurology, 2001;57:1205-1211.
64. Albers GW. Expanding the window for thrombolytic therapy in acute stroke. The potential role of acute MRI for patient selection. Stroke,1999; 30 : 2230-2237.
65. Thijs VN, Adami A,Neumann2Haefelin T,et al. Relationship between severity of MR perfusion deficit and DWI lesion evolution. Neurology,2001;57:1205-1211.
66. J acobs MA,Zhang ZG, Knight RA. A Model for multiparametertric MRI tissue characterization in experimental cerebral ischemia with histological validation in rat. Stroke,2001 ;32:943-949.
67. Shih LC,Saver JL,Alger JR,et al. Perfusion-weighted magnetic resonance imaging thresholds identifying core,irreversibly infarcted tissue.Stroke,2003; 34:1425-1430.
68．刘梅丽，崔世民，张蕾莉．磁共振扩散加权和灌注成像对超急性期脑梗死影像半暗带的研究．中华放射学杂志，2002：36：1095-1100．
69．朱海英，冷振璞．灌注和弥散加权磁共振成像在超早期脑梗死中的应用．国外医学脑血管疾病分册，2004；12：409-412．
70. Neumann Haefelin T, Wittsack HJ, Wenserski F, et al. Diffusion and perfusion weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke, 1999; 30:1591-1597.
71. Bristow MS, Simon JE,Brown RA,etal. MR perfusion and diffusion in acute ischemic stroke: human gray and white matter have different thresholds for infarction. J Cereb Blood Flow Metab,2005;25:1280-1287.
72. Parsons MW, Yang Q, Barber PA, et al. Perfusion magnetic resonance imaging maps in hyperacute stroke:relative cerebral blood flow most accurately identifies tissue destined to infarct.Stroke.2001 ;32:1581-1587.
73. Y. Liu,J.O. Karonen,R.L. Vanninen,etal. Detecting the subregion proceeding to infarction in hypoperfused cerebral tissue: a study with diffusion and perfusion weighted MRI. Neuroradiology,2003 ;45: 345-351.
74. Pamela W. Schaefer, Yelda Ozsunar, Julian He,etal. Assessing tissue viability with MR diffusion and perfusion imaging. AJNR, 2003; 24:436-443.
75. Schlaug G, Benfield A, Baird AE, et al. The ischemic penumbra : operationally defined by diffusion and perfusion MRI. Neurology, 1999;53:1528-1537.
76．赵俊功，李明华，程英升．大鼠急性脑梗死后不同区域扩散和灌注成像的变化特点．介入放射学杂志，2005：14：516-522．
77. Grandin CB, Duprez TP, Smith AM, et al. Usefulness of magnetic resonance derived quantitative measurements of cerebral blood flow and volume in prediction of infarct growth in hyperacute stroke. Stroke, 2001;32:1147-1153.
78. Hermier M, Nighoghossian N, Adeleine P, et al. Early magnetic resonance imaging prediction of arterial recanalization and late infarct volume in acute carotid artery stroke. J Cereb Blood Flow Metab, 2003;23:240-248.
79. Butcher K, Parsons M, Baird T, et al. Perfusion thresholds in acute stroke thrombolysis. Stroke,2003;34:2159-2164.
80. Schellinger PD, Fiebach JB, HackeW. Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status.Stroke,2003;34: 575-583.
81．王宝军，李美琳．核磁共振弥散成像和血流灌注成像检查对超早期脑梗死溶栓治疗的意义．中国急救医学，2000；20：623-625．
82. Jansen O, Schellinger P, Fiebach J, et al. Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet,1999;353:2036-2037.
83. Uno M, Harada M, Yoneda K, et al. Can diffusion and perfusion weighted magnetic resonance imaging evaluate the efficacy of acute thrombolysis in patients with internal carotid artery or middle cerebral artery occlusion?Neurosurgery, 2002;50:28-34.
84. Tong D, Adami A,MarksM, et al. Can hemorrhagic transformation be predicted by initial DWI and PWI findings in acute stroke? National Stroke Association,North American Stroke Meeting, September 1-4 1999, SnowmassVillage,Aspen, Colorado.
85. Tong DC, Adami A, Moseley ME, et al. Prediction of hemorrhagic transformation following acute stroke: role of diffusion and perfusion weighted magnetic resonance imaging. Arch Neurol,2001 ;58:587-593.
86. Kidwell CS,Saver JL,Mattiello J,et al.A diffusion-perfusion MRI signature predicting hemorrhagic transformation following intra-arterial thrombolysis. Stroke,2001; 32:318.
87．王建伟，胡卫星．活体脑梗死前后脑代谢的磁共振波谱检查．国外医学脑血管疾病分册，2000；8：346-348．
88．田新英，王建华，吴晶．脑梗死患者磁共振质子波谱的变化．中华老年心脑血管病杂志，2003；5：30-32．
89. F. Nicoli, Y. Lefur, B. Metabolic counterpart of decreased apparent diffusion coefficient during hyperacute ischemic stroke: A bain proton magnetic resonance spectroscopic imaging study. Stroke 2003;34:82-87.
90．李坤成．磁共振波谱在中枢神经系统疾病中的应用价值．中国临床康复．2004：8：722-723．
91. Wardlaw JM,Marshall I,Wild J,etal.Studies of acute ischemic stroke with proton magnetic resonance spectroscopy: relation between time from onset, neurological deficit metabolite abnormalities in the infarct, blood flow, and clinical outcome.Stroke, 1998;29: 1618-1624.
92. AsanoT.Clinical application of ~1H nuclear magnetic resonance spectroscopy into patients with cerebral ischemia. Hokkaido Igaku Zassh 1998;73:581-597.
93. Federico F, Simone IL,Conte C,etal. Prognostic significance of metabolic changes detected by proton magnetic resonance spectroscopy in ischemic stroke. J Neurol, 1996; 243:241-247.
94．欧利民，庄伟端，林顺发，等．弥散加权磁共振与磁共振血管成像在急性脑梗死诊断中的临床应用．中国实用内科杂志，2003；23：111-113．
95. Yawu Liu, Jari O. Karonen,Ritva L. Vanninen,etal. Acute ischemic stroke: Predictive value of 2D phase-contrast MR angiography-serial study with combined diffusion and perfusion MR imaging. Radiology, 2004; 231:517-527.
96．王海东，许侃，徐松柏，等．颈动脉狭窄的血管内支架成形术治疗．中风与神经疾病杂志，2005；22：169-171．
97. Barr JD, Conno rs JJ, Sack s D, et al. Quality improvement guidelines for the performance of cervical carotid angioplasty and stent placement. Am J Neuroradiol, 2003; 24:2020-2034.
98. J M Wardlaw. Recent developments in imaging of stroke. Imaging,2002; 14:409-419.
99. Seitz RJ, Meisel S,Weller P, etal. Initial ischemic event: perfusion-weighted MR imaging and apparent diffusion coefficient for stroke evolution. Radiology, 2005;237:1020-1028.
100．焦力群，凌锋，卢洁，等．利用灌注MRI技术评价颈内动脉狭窄或闭塞的血流动力学状态．临床放射学杂志，2004；23：835-838．
101. Li TQ,Takhashi AM,Hindmarsh T, et al. ADC mapping by means of a single-shot spiral MRI technique with application in acute cerebral ischemia. MagnReson Med,1999;41:143-147.
102. Ulug AM, Beauchamp N Jr, Bryan RN,van Zijl PC. Absolute quantitation of diffusion constants in human stroke. Stroke, 1997;28:483-490.
103. Helenius J, Soinne L, Perkio J, et al Diffusion-weighted MR imaging in normal human brains in various age groups. AJNR, 2002;23: 194-199.
104．殷信道，顾建平，王丽萍．超急性脑梗死再灌注弥散加权-灌注磁共振成像实验研究．实用放射学杂志，2004；20：769-773．
105. Schlaug G, SiewertB, Benfield A, et al. Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology, 1997;49:113-119.
106．龚良庚，肖新兰，邢萍萍．弥散加权成像对超急性脑梗塞的诊断价值探讨．实用临床医学，2004；5：110-114．
107．韩鸿宾，谢敬霞．兔大脑中动脉阻塞模型局灶性脑缺血区超早期水分子扩散异常的病理基础研究．中华放射学杂志，1999；33：655-661．
108. Lansberg MG, Thijs VN, O'Brien MW, et al. Evolution of apparent diffusion coefficient, diffusion-weighted, and T_2-weighted signal intensity of acute stroke.AJNR, 2001; 22: 637-644.
109．鲁宏，孙善全．水通道蛋白-4在急性脑缺血组织中的表达与M R扩散加权成像的相关性研究．中华放射学杂志，2003；37：508-513．
110. Venero JL,Vizuete ML,Machado A,etal. Aquaporins in the central nervous system. Prog Neurobiol,2001;63:321-336.
111．张勇，韩仲岩．急性脑梗死患者脑脊液中抑制性氨基酸递质的动态观察．卒中与神经疾病，2000；7：78-80．
112. Calabresi P, Marfia GA, Centonze D, et al. Sodium influx plays a major role in the membrane depolarization induced by oxygen and glucose deprivation in rat striatal spiny neurons. Stroke, 1999;30:171-179.
113．张权，孙骏谟，田志雄，等．超早期脑梗塞及再灌注动物模型的磁共振弥散加权成像研究．临床放射学杂志，2001；20：466-470．
114. Rohl L,Ostergaard L,Simonsen CZ,etal.Viability thresholds of ischemic penumbra of hyperacute stroke defined by perfusion weighted MRI and apparent diffusion coefficient. Stroke,2001;32:1140-1146.
115. Poh-Sien Loh, Ken S. Butcher, Mark W. Parsons,etal. Apparent diffusion coefficient thresholds do not predict the response to acute stroke thrombolysis.Stroke, 2005;36: 2626-2631.
116. Dong Gyu Na, Vincent N. Thijs, Gregory W. Albers,etal. Diffusion-weighted MR imaging in acute ischemia: Value of apparent diffusion coefficient and signal intensity thresholds in predicting tissue at risk and final infarct size. AJNR,2004; 25:1331-1336.
117. Jens Fiehler, Karina Knudsen, Thomas Kucinski, Predictors of apparent diffusion coefficient normalization in stroke patients. Stroke, 2004;35:514-519.
118. Duong TQ,Ackerman JJ, Ying HS, et al. Evaluation of extra-and intracellulax apparent diffusion in normal and globally ischemie rat brain via 19F NMR.MRM,1998;40:1-13.
119. Ueda T,Yuh T,Maley J, etal. Outcome of acute ischemic lesion evaluated by diffusion and perfusion MR imaging. AJNR, 1999;20:983-989.
120. Hamberg LM, Macfarlane R, Tasdemiroglu E, et al. Measurement of cerebrovascular changes in cats after transient ischemia using dynamic magnetic resonance imaging. Stroke. 1993 ;24:444-451.
121. Astrup J, Siesjo BK, Syxnon L. Thresholds in cerebral ischemia-the ischemic penumbra. Stroke, 1981; 12:723-725.
122. Hakim AM. The cerebral ischemic penumbra.Can J Neurol Sci. 1987;14:557-559.
123. Hossmann KA. Viability thresholds and the penumbra of focal ischemia. Ann Neurol., 1994;36:553-554.
124．杨运俊．早期脑梗死缺血半暗带磁共振扩散和灌注加权成像的实验研究．郑州大学硕士学位论文，2004：16-17．
125. Carter LP,Yamagata S, Erspamer R. Time limits of reversible cortical ischemia.Neurosurgery, 1983;12:620-623.
126. Osamu Abe,Shigeki Aoki,Ichiro Shirouzu,etal. MR imaging of ischemic penumbra. European Journal of Radiology,2003;46:67-78.
127．张芳，谢敬霞．早期脑梗死缺血半暗带MR扩散、灌注成像的研究进展．临床放射学杂志，2002；21：907-909．
128. Ken S. Butcher, Mark W. Parsons, Stephen Davis,etal. PWI/DWI mismatch: Better definition required*response. Stroke,2003,34:215-216.
129．赵恒宇，袁丽杰．MRI灌注成像技术在早期脑梗死中的应用．黑龙江医学．2005；29：419-420．
130. Rose SE, Janke AL, Griffin M, Finnigan S, Chalk JB. Improved prediction of final infarct volume using bolus delay-corrected perfusion weighted MRI: implications for the ischemic penumbra. Stroke, 2004; 35:2466-2471.
131. Pierce AR, Lo EH, Mandeville JB,Gonza' lez RG, Rosen BR, Wolf GL.MRI measurements of water diffusion and cerebral perfusion: their relationship in a rat model of focal cerebral ischemia. J Cereb Blood Flow Metab,1997;17: 183-190.
132. Li F, Liu KF, Silva MD, et al.Transient and permanent resolution of ischemic lesions on diffusion-weighted imaging after brief periods of focal ischemia in rats: correlation with histopathology.Stroke,2000;31:946-954.
133. Desmond PM,Lovell AC,Rawlinson AA,etal.The value of apparent diffusion coefficient maps in early cerebral ischemia.AJNR,2001 ;22:1260-1267.
134. Liu KF, Li F, Tatlisumak T, etal.Regional variations in the apparen diffusion coefficient and the intracellular distribution of water in rat brain during acute focal ischemia. Stroke,2001 ;32:1897-1905.
135. Powers W J.Cerebral hemodynamics in ischemic cerebrovascular disease.Ann Neurol, 1991 ;29:231-240.
136. Yamaur M,Katayma Y, Igarashi H,et al. ~1H and ~(31)p magnetic resonance spectroscopy of cerebral infarction in rats.Nipponika Daigaku Zasshi, 1997;64:131-138.
137. Patsons MW,Li T,Barber PA,et al. Combined ~1H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome. Neurology, 2000; 55:498-505.
138．叶滨宾，范国光，王丽君．MR弥散、灌注成像及~1H-MRS在判断脑肿瘤放疗后坏死与肿瘤复发诊断中的应用．中国医学影像学杂志，2002；10：247-251．
139．朱锡旭，郑玲，卢光明，等．多体素~1H MRS测定正常脑组织不同区域的代谢物分布．中国医学影像学杂志，2005；13：257-259．
140. Angelic E,Bonmartin A,Boudraa,A, etal. Regional differences and metabolic changes in normal aging of the human Brain : Proton MR spectroscopic imaging study. American Journal of Neuroradiology, 2001 ;22:119-127.
141. Urrila AS, Hakkarainen A, Heikkinen S, et al. Stimulus-induced brain lactate : effects of aging and prolonged wakefulness. J Sleep Res. 2004; 13:111-119.
142. Nelson S J.Multivoxel magnetic resonance spectroscopy of brain tumors.Molecular Cancer Therapeutics,2003;2:497-507.
143. Nelson SJ,Graves E,Pirzkall A,etal.In vivo molecular imaging for planning radiation therapy of gliomas:an application of HMRSI.Journal of Magnetic Resonance Imaging, 2002;16:464-476.
144．谢长青，卢曼丽，吴光耀．脑组织质子磁共振波谱成像．武汉大学学报(医学版)，2003；24：366-369．
145. Igarashi H, Kwee IL, Okubo S, et al. Predicting the pathological fate of focal cerebral ischemia using ~1H-magnetic resonance spectroscopic imaging. International Congress Series, 2003, 1252: 341-344.
146. Mathews VP,Barker PB, Blackband SJ,et al. Cerebral metabolites in patients with acute and subacute strokes: concentrations determined by quantitative proton MR spectroscopy. AJNR, 1995; 165:633-638.
147. Barker PB, Gillard J H, van Zijl PCM, et al. Acute stroke: Evaluation with serial proton MR spectroscopic imaging. Radiology, 1994; 192:723-732.
148. Federico F,Simone IL,lucivero V,et al. Prognostic value of proton magnetic resonance spectroscopy in ischemic strok.Arch Neurol, 1999;55:489-494.
149. Saunders DE,Franklyn A,Boogaart AD,et al. Continuing ischemic damage after acute middle cerebral artery infarction in human demonstrated by short-echo proton spectroscopy. Stroke, 1995 ;26:1007-1013.
150．张勇．早期缺血性脑梗死质子磁共振波谱的实验研究．郑州大学硕士学位论文，2004：21-22．
151. Sagera, TN,Toppb S,Torup L,et al. Evaluation of CA1 damage using single-voxel 1H-MRS and un-biased stereology: can non-invasive measures of N-acetyl-asparate following global ischemia be used as a reliable measure of neuronal damage. Brain Research, 2001 ;892:166-175.
152. Igarashi H, Kwee IL, Nakada T, et al. ~1H-magnetic resonance spectroscopic imaging of permanent focal cerebral ischemia in rat: longitudinal metabolic changes in ischemic core and rim. Brain Research, 2001;907(1-2): 208-221.
153. Demougeot C, Walker P, Beley A, et al. Spectroscopic following stroke reveal tissue abnormality beyond the regin of T2-weighted hyperintensity. J Neurol Sci., 2002; 199(1-2):73-78.
154. Fukuchi T, Katayama Y, Kamiya T, et al. The effect of duration of cerebral ischemia on brain pyruvate dehydrogenase activity,energy metabolites and blood flow during reperfusion in gerbil brain.Brain Res, 1998;792:59-65.
155. Petroff OAC, Graham GD,Blamire AM, et al. Spectroscopic imaging of stoke in humans : histopathology correlates of spectral changes. Neurology,1992;42:1349-1354.
156. Lanfermann H,Kugel H,Heindel W,etal.Metabolic changes in acute and subacute cerebral infarctions:Findings at pronton MR spectroscopic imaging.Radiology, 1995; 196: 203-210.
157. Gillard J H, Barker PB, Van Zijl PCM, et al. Proton MR spectroscopy in acute middle cerebral artery stroke. AJNR,1996; 17:873-886.
158. Duijn J H,Matson GB, Maudsley AA,et al. Human brain infarction:proton MR spectroscopy.Radiology, 1992; 183:711-718.
159. Chelsea S. Kidwell, Jeffry R. Alger, Jeffrey L. Saver. Evolving paradigms in neuroimaging of the ischemic penumbra.Stroke, 2004; 35 [supplⅠ]:2662-2665.
160. Turgut Tatlisumak,Daniel Strbian, Usama Abo Ramadan,etal. The Role of diffusion-and perfusion-weighted magnetic resonance imaging in drug development for ischemic stroke: from laboratory to clinics. Current Vascular Pharmacology, 2004;2:343-355.
161. Friedrich G, Luca R, Heinrich M, et al. Local intra-arterial thrombolysis in acute ischemic stroke. Stroke, 1998; 29 : 1894-1900.
162．黄清海，刘建民，洪波，等．血管内支架成形术治疗颅内动脉狭窄的临床疗效评价．中华医学杂志，2003；83：18-20．
163. Ballotta E, Da Giau G, Baracchini, et al. Carotid angioplasty and stenting in high-risk patients with severe symptomatic carotid stenosis. Stroke, 2003; 34:834-835.
164. Toshihiro U, Saburo S, Ichiro N, et al. Angioplasty after intra-arterial thrombolysis for acute occlusion of intracranial arteries. Stroke, 1998;29:2568-2574.