磁共振DWI与DTI在脑梗死中的应用研究
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摘要
目的
研究或探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)与弥散张量成像(diffusion tensor imaging,DTI)在脑梗死中的应用价值。明确脑梗死分期及责任病灶;并通过DTI图像,探讨白质纤维束的受累情况与患者运动功能损害的相互关系,为临床制定个体化治疗方案提供可靠的依据。
材料与方法
选取2008年4月—2009年1月泰安市中心医院急诊科和神经内科高度怀疑并有典型临床症状和体征经随诊观察确诊为脑梗死或既往有脑梗死病史的患者106例,其中男性65例,女性41例,年龄40～82岁,平均年龄63.5岁。根据患者发病时间将其分为4组,1组为超急性期,发病时间小于6小时,共15例;2组为急性期,发病时间介于7～72小时之间,共40例;3组为亚急性期,发病时间介于3天～2周,共28例;4组为慢性期,有脑梗死病史,距本次检查时间相隔较长,至少一月,共23例。所有病例均行常规磁共振成像及弥散加权成像DWI、弥散张量成像DTI。在不同序列的图像上对比观察病灶,并在ADC图及DTI图像上分别测量表观弥散系数ADC值(appearance diffusion coefficient)、rADC值(ratio of the ADC)与各向异性FA值(fractional anisotropy)。在绘制的三维扩散张量纤维束图像(diffution tensor tractography,DTT)上根据病灶与白质纤维束的关系,将病变区受累的白质纤维束分为3型。Ⅰ型:表现为周围纤维束受压、推移;Ⅱ型:部分纤维束被梗死灶浸润中断;Ⅲ型:大部分或全部纤维束被梗死灶浸润中断。
结果
磁共振DWI对急性期及超急性期脑梗死病灶敏感性高,病灶检出率为100%,图像显示病灶较常规磁共振成像清晰度高、显示病灶范围大,明显优于常规磁共振成像。对亚急性期与慢性期脑梗死灶的显示不如常规磁共振成像。超急性期脑梗死组至慢性期脑梗死组,病灶的ADC值依次升高,差异显著,P﹤0.05。DTI成像,通过FA图及绘制的三维DTT图像可观察病灶周围纤维束受累情况。在106例脑梗死患者中,Ⅰ型34例,FA值轻度减低或轻度升高,患者的运动功能障碍表现为无或轻微损害,肌力一般为4级或5级;Ⅱ型33例,FA值减低较明显,早期脑梗死组(1组和2组)患者运动功能出现受损的症状,亚急性期和慢性期脑梗死组患者的肌力相对较好,一般为4级;Ⅲ型39例,FA值减低最明显,各期脑梗死组患者运动功能障碍严重,肌力一般在3级以下。
结论
DWI提高了超急性及急性期脑梗死病灶的检出率,通过ADC值、rADC值定量分析,参考常规磁共振成像序列,进一步明确了脑梗死病理变化及期别;通过DTI成像,可评价白质纤维束的受累情况与患者运动功能损害的相互关系。二者结合对指导临床个体化治疗方案的确定有重要意义。
Objective
To explore the value of the diffusion-weighted MR imaging (DWI) and diffusion tensor MR imaging (DTI)in cerebral infarction.Conventional magnetic resonance imaging combined with DWI can help to determine the stage of the cerebral infarction clearly and the lesion which is responsible for this pathogenesis,and to explore the relationship between the white matter fiber bundles involved and the damage of the patients,motor function after DTI,in order to provide a reliable basis for clinical development of individual treatment programs.
Materials and Methods
106 cases of patients(65 males and 41 females,the age range from 40Y to 82Y,average age 63.5Y),in the Emergency Department and the Department of Neurology in Taian Central Hospital from April 2008 to January 2009 with typical clinical symptoms and signs are highly suspected and diagnosed with cerebral infarction in follow-up observation,or some patients had history of cerebral infarction.They are divided into 4 groups according to the history.There are 15 cases in the first group,onset time less than six hours,defined as hyperacute cerebral infarction;40 cases in the second group,onset time between 6 hours and 72 hours,defined as acute cerebral infarction;28 cases in the third group,onset time between 3 days and 2 weeks,defined as subacute cerebral infarction;and 23 cases in the fourth group,onset time at least one month,defined as chronic cerebral infarction.All patients underwent conventional magnetic resonance imaging as well as DWI and DTI.Lesions are observed in all the series of images and their ADC(appearance diffusion coefficient),rADC(ratio of the ADC) and FA(fractional anisotropy) are measured respectively in ADC and FA maps.The matter fiber bundles involved around the leisions are divided into three types according to the relationship between lesions and fiber bundles in DTT(diffution tensor tractography)images.Ⅰtype:the fiber bundles around the leision are compressed;Ⅱtype:some fiber bundles are interrupted by the leision;Ⅲtype:Most or all of fiber bundles are infiltrated or interrupted by the leision.
Result
DWI is much more sensitive to show hyperacute and acute cerebral infarction(display rate is 100%)than other series of images,and it is superior to conventional magnetic resonance imaging in showing the contrast and the boundary of lesions,but it is inferior to show subacute and chronic infarction.The ADC value of leisions from the first group to the fourth group gradually ascend and there is significant difference,P<0.05.The lesions and the fiber bundles involved around lesions can be observed in FA maps and in DTT after DTI.34 cases of typeⅠ,with FA reducing or increasing slightly,the motor dysfunction in patients with non-performance or minor damage,muscle strength of these patients is generally 4 or 5 rank;33 cases of typeⅡ,with FA reducing obviously,patients with hyperacute and acute infarction in this type appear impaired motor function,but patients with subacute and chronic infarction have relatively good muscle strength,usually 4 rank;39 cases of typeⅢ,with the most obvious reduction in FA value,patients with severe motor dysfunction,their muscle strength is usually under 3 rank.
Conclusion
DWI can increase the display rate of hyperacute and acute cerebral infarction.The change of cerebral infarction in pathology and its stage can be defined by measuring ADC、rADC and FA value combined with reviewing conventional magnetic resonance images.The relationship between white matter fiber bundles involved and the damage of patients, motor function can be evaluated with DTI.The combination of DWI and DTI is significant to guide the clinical doctors to determine programs of individual treatment.
研究或探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)与弥散张量成像(diffusion tensor imaging,DTI)在脑梗死中的应用价值。明确脑梗死分期及责任病灶;并通过DTI图像,探讨白质纤维束的受累情况与患者运动功能损害的相互关系,为临床制定个体化治疗方案提供可靠的依据。
材料与方法
选取2008年4月—2009年1月泰安市中心医院急诊科和神经内科高度怀疑并有典型临床症状和体征经随诊观察确诊为脑梗死或既往有脑梗死病史的患者106例,其中男性65例,女性41例,年龄40～82岁,平均年龄63.5岁。根据患者发病时间将其分为4组,1组为超急性期,发病时间小于6小时,共15例;2组为急性期,发病时间介于7～72小时之间,共40例;3组为亚急性期,发病时间介于3天～2周,共28例;4组为慢性期,有脑梗死病史,距本次检查时间相隔较长,至少一月,共23例。所有病例均行常规磁共振成像及弥散加权成像DWI、弥散张量成像DTI。在不同序列的图像上对比观察病灶,并在ADC图及DTI图像上分别测量表观弥散系数ADC值(appearance diffusion coefficient)、rADC值(ratio of the ADC)与各向异性FA值(fractional anisotropy)。在绘制的三维扩散张量纤维束图像(diffution tensor tractography,DTT)上根据病灶与白质纤维束的关系,将病变区受累的白质纤维束分为3型。Ⅰ型:表现为周围纤维束受压、推移;Ⅱ型:部分纤维束被梗死灶浸润中断;Ⅲ型:大部分或全部纤维束被梗死灶浸润中断。
结果
磁共振DWI对急性期及超急性期脑梗死病灶敏感性高,病灶检出率为100%,图像显示病灶较常规磁共振成像清晰度高、显示病灶范围大,明显优于常规磁共振成像。对亚急性期与慢性期脑梗死灶的显示不如常规磁共振成像。超急性期脑梗死组至慢性期脑梗死组,病灶的ADC值依次升高,差异显著,P﹤0.05。DTI成像,通过FA图及绘制的三维DTT图像可观察病灶周围纤维束受累情况。在106例脑梗死患者中,Ⅰ型34例,FA值轻度减低或轻度升高,患者的运动功能障碍表现为无或轻微损害,肌力一般为4级或5级;Ⅱ型33例,FA值减低较明显,早期脑梗死组(1组和2组)患者运动功能出现受损的症状,亚急性期和慢性期脑梗死组患者的肌力相对较好,一般为4级;Ⅲ型39例,FA值减低最明显,各期脑梗死组患者运动功能障碍严重,肌力一般在3级以下。
结论
DWI提高了超急性及急性期脑梗死病灶的检出率,通过ADC值、rADC值定量分析,参考常规磁共振成像序列,进一步明确了脑梗死病理变化及期别;通过DTI成像,可评价白质纤维束的受累情况与患者运动功能损害的相互关系。二者结合对指导临床个体化治疗方案的确定有重要意义。
Objective
To explore the value of the diffusion-weighted MR imaging (DWI) and diffusion tensor MR imaging (DTI)in cerebral infarction.Conventional magnetic resonance imaging combined with DWI can help to determine the stage of the cerebral infarction clearly and the lesion which is responsible for this pathogenesis,and to explore the relationship between the white matter fiber bundles involved and the damage of the patients,motor function after DTI,in order to provide a reliable basis for clinical development of individual treatment programs.
Materials and Methods
106 cases of patients(65 males and 41 females,the age range from 40Y to 82Y,average age 63.5Y),in the Emergency Department and the Department of Neurology in Taian Central Hospital from April 2008 to January 2009 with typical clinical symptoms and signs are highly suspected and diagnosed with cerebral infarction in follow-up observation,or some patients had history of cerebral infarction.They are divided into 4 groups according to the history.There are 15 cases in the first group,onset time less than six hours,defined as hyperacute cerebral infarction;40 cases in the second group,onset time between 6 hours and 72 hours,defined as acute cerebral infarction;28 cases in the third group,onset time between 3 days and 2 weeks,defined as subacute cerebral infarction;and 23 cases in the fourth group,onset time at least one month,defined as chronic cerebral infarction.All patients underwent conventional magnetic resonance imaging as well as DWI and DTI.Lesions are observed in all the series of images and their ADC(appearance diffusion coefficient),rADC(ratio of the ADC) and FA(fractional anisotropy) are measured respectively in ADC and FA maps.The matter fiber bundles involved around the leisions are divided into three types according to the relationship between lesions and fiber bundles in DTT(diffution tensor tractography)images.Ⅰtype:the fiber bundles around the leision are compressed;Ⅱtype:some fiber bundles are interrupted by the leision;Ⅲtype:Most or all of fiber bundles are infiltrated or interrupted by the leision.
Result
DWI is much more sensitive to show hyperacute and acute cerebral infarction(display rate is 100%)than other series of images,and it is superior to conventional magnetic resonance imaging in showing the contrast and the boundary of lesions,but it is inferior to show subacute and chronic infarction.The ADC value of leisions from the first group to the fourth group gradually ascend and there is significant difference,P<0.05.The lesions and the fiber bundles involved around lesions can be observed in FA maps and in DTT after DTI.34 cases of typeⅠ,with FA reducing or increasing slightly,the motor dysfunction in patients with non-performance or minor damage,muscle strength of these patients is generally 4 or 5 rank;33 cases of typeⅡ,with FA reducing obviously,patients with hyperacute and acute infarction in this type appear impaired motor function,but patients with subacute and chronic infarction have relatively good muscle strength,usually 4 rank;39 cases of typeⅢ,with the most obvious reduction in FA value,patients with severe motor dysfunction,their muscle strength is usually under 3 rank.
Conclusion
DWI can increase the display rate of hyperacute and acute cerebral infarction.The change of cerebral infarction in pathology and its stage can be defined by measuring ADC、rADC and FA value combined with reviewing conventional magnetic resonance images.The relationship between white matter fiber bundles involved and the damage of patients, motor function can be evaluated with DTI.The combination of DWI and DTI is significant to guide the clinical doctors to determine programs of individual treatment.
引文
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