急性期脑梗死患者CT及MRI影像学特点分析
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摘要
目的分析急性期脑梗死患者电子计算机断层扫描(computerized tomography,CT)及磁共振成像(magnetic resonance imaging,MRI)的影像学特点。方法按纳入排除标准选取我院自2016年1月-2018年4月收治的800例急性期脑梗死患者为研究对象,其中288例自发病至入院检查时间<6h(超急性期)、6-24h 240例(急性期)、1d-14d 272例(亚急性期);回顾性分析其CT、MRI影像学资料及临床病历,比较CT、MRI对急性期脑梗死的诊断价值,并分析其影像学特征。结果 MRI在急性期脑梗死任意时段,脑梗死检出率均显著高于CT(P<0.05);且超急性期CT常无明显异常表现,急性期及亚急性期可出现早期低密度影,皮质、白质边界不清,豆状核和脑岛带征,脑沟回、脑室及脑池改变,并在大血管闭塞后出现大脑中动脉或基底动脉高密度征等影像表现;超急性期MRI可见病变在弥散加权成像(diffusion weighted image,DWI)上呈明显高信号,但TIWI、T2WI、FLAIR均无明显异常信号;急性期MRI亦可见DWI高信号,且TIWI低信号,T2WI、FLAIR高信号,T2WI、FLAIR信号强度弱于DWI;亚急性MRI可见DWI高信号,TIWI低信号,T2WI、FLAIR高信号,且T2WI、FLAIR信号强度较DWI信号强。结论急性期脑梗死任意时间段行CT及MRI均可为其临床诊治提供更完整的影像学依据,值得临床重视。
Objective To analyze the features of computerized tomography(CT) and magnetic resonance imaging(MRI) in patients with acute cerebral infarction. Methods According to the inclusion exclusion criteria, 800 patients with acute cerebral infarction in our hospital from January 2016 to April 2018 were selected in the study. Among them,288 patients with the time from onset to admission less than 6 h(super acute phase), 240 cases(acute phase) with 6 to 24 h, 272 cases(subacute phase) with 1 d to 14 d. The imaging data of CT, MRI and clinical medical records were analyzed retrospectively, the diagnostic value of CT and MRI in the acute cerebral infarction was compared, the imaging features were analyzed. Results In any time of the acute cerebral infarction, the detection rate of cerebral infarction with MRI was significantly higher than that with CT(P<0.05).There was no obvious abnormality in CT influences at super acute period, there were early low density imaging, obscure boundary of cortical and white matter, lenticular and insular symptoms, changes of sulcular gyrus, ventricle and cerebral cistern in acute phase and subacute phase, there were high-density signs of middle cerebral artery or basilar artery after large vessel occlusion. There was significantly high signal expression of diffuse weighted image(DWI) in hyperacute phase MRI, there were no obvious signal changes of TIWI, T2WI, FLAIR. There was DWI high signal at acute period with MRI and low signal of TIWI, T2WI, FLAIR were high signal, the signal intensity of T2WI and FLAIR was weaker than DWI. There were DWI high signal, TIWI low signal, T2WI and FLAIR high signal, stronger signal intensity of T2WI FLAIR than DWI in subacute period with MRI. Conclusion CT and MRI in patients with acute cerebral infarction at any time can provide a more complete imaging basis for clinical diagnosis and treatment, which deserves clinical attention.
Objective To analyze the features of computerized tomography(CT) and magnetic resonance imaging(MRI) in patients with acute cerebral infarction. Methods According to the inclusion exclusion criteria, 800 patients with acute cerebral infarction in our hospital from January 2016 to April 2018 were selected in the study. Among them,288 patients with the time from onset to admission less than 6 h(super acute phase), 240 cases(acute phase) with 6 to 24 h, 272 cases(subacute phase) with 1 d to 14 d. The imaging data of CT, MRI and clinical medical records were analyzed retrospectively, the diagnostic value of CT and MRI in the acute cerebral infarction was compared, the imaging features were analyzed. Results In any time of the acute cerebral infarction, the detection rate of cerebral infarction with MRI was significantly higher than that with CT(P<0.05).There was no obvious abnormality in CT influences at super acute period, there were early low density imaging, obscure boundary of cortical and white matter, lenticular and insular symptoms, changes of sulcular gyrus, ventricle and cerebral cistern in acute phase and subacute phase, there were high-density signs of middle cerebral artery or basilar artery after large vessel occlusion. There was significantly high signal expression of diffuse weighted image(DWI) in hyperacute phase MRI, there were no obvious signal changes of TIWI, T2WI, FLAIR. There was DWI high signal at acute period with MRI and low signal of TIWI, T2WI, FLAIR were high signal, the signal intensity of T2WI and FLAIR was weaker than DWI. There were DWI high signal, TIWI low signal, T2WI and FLAIR high signal, stronger signal intensity of T2WI FLAIR than DWI in subacute period with MRI. Conclusion CT and MRI in patients with acute cerebral infarction at any time can provide a more complete imaging basis for clinical diagnosis and treatment, which deserves clinical attention.
引文
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[4]梁志鹏,姚立正,戴真煜,等.磁共振弥散张量成像鉴别诊断超急性与急性缺血性脑梗死[J].中国医学影像技术,2016,32(2):195-199.
[5]许开喜,丰广魁,陈新建,等.急性缺血性脑卒中C T、M R I诊断价值[J].实用放射学杂志,2018,34(3):339-343.
[6]张军,张天瑜,潘嘉伟,等.256层CT灌注成像监测急性缺血性脑卒中溶栓前后脑血流动力学变化[J].中国医学计算机成像杂志,2 0 1 6,22(5):393-397.
[7]林汉军,段大兵.MRI检测在老年多发性脑梗死病变检出率、病残率及病死率中的价值研究[J].中国CT和MRI杂志,2018,16(7):79-81.
[8]张小芬,闻彩云,李建策,等.急性脑梗死大脑皮、髓静脉的磁敏感加权成像解剖研究[J].中国临床解剖学杂志,2018,36(2):153-157.
[9]卢文杰.CT和MRI在脑血管疾病中的诊断有效性及效果观察[J].重庆医学,2017,46(A02):266-267.
[10]张明之.重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的疗效及安全性[J].罕少疾病杂志,2016,23(4):19-21.
[11]徐方元,陈晓荣,秦少华,等.多层螺旋CT脑灌注成像与平扫C T值差值的测量对诊断急性脑梗死的价值[J].中风与神经疾病杂志,2014,31(9):815-818.
[12]吕铁钢,刘挨师,杨晓光,等.MRI与颅脑CT在早期脑梗死诊断中的价值对比分析[J].中国地方病防治杂志,2017,32(9):1042-1045.
[13]刘希奇.C T灌注扫描对尤瑞克林治疗急性期脑梗死老年患者的效果[J].中国老年学杂志,2015,35(1):100-102.
[14]魏健强,李健,马剑,等.CT和MRI在脑血管疾病中的诊断有效性及效果观察[J].中国CT和MRI杂志,2016,14(7):18-20.
[15]中华医学会神经病学分会.中国脑血管病影像应用指南[J].中华神经科杂志,2016,49(3):164-181.
[2]Baradaran H,Gialdini G,Mtui E,et al.Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease[J].Journal of Vascular Surgery,2016,64(2):534-535.
[3]中国脑梗死急性期康复专家共识组.中国脑梗死急性期康复专家共识[J].中华物理医学与康复杂志,2016,38(1):39.
[4]梁志鹏,姚立正,戴真煜,等.磁共振弥散张量成像鉴别诊断超急性与急性缺血性脑梗死[J].中国医学影像技术,2016,32(2):195-199.
[5]许开喜,丰广魁,陈新建,等.急性缺血性脑卒中C T、M R I诊断价值[J].实用放射学杂志,2018,34(3):339-343.
[6]张军,张天瑜,潘嘉伟,等.256层CT灌注成像监测急性缺血性脑卒中溶栓前后脑血流动力学变化[J].中国医学计算机成像杂志,2 0 1 6,22(5):393-397.
[7]林汉军,段大兵.MRI检测在老年多发性脑梗死病变检出率、病残率及病死率中的价值研究[J].中国CT和MRI杂志,2018,16(7):79-81.
[8]张小芬,闻彩云,李建策,等.急性脑梗死大脑皮、髓静脉的磁敏感加权成像解剖研究[J].中国临床解剖学杂志,2018,36(2):153-157.
[9]卢文杰.CT和MRI在脑血管疾病中的诊断有效性及效果观察[J].重庆医学,2017,46(A02):266-267.
[10]张明之.重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的疗效及安全性[J].罕少疾病杂志,2016,23(4):19-21.
[11]徐方元,陈晓荣,秦少华,等.多层螺旋CT脑灌注成像与平扫C T值差值的测量对诊断急性脑梗死的价值[J].中风与神经疾病杂志,2014,31(9):815-818.
[12]吕铁钢,刘挨师,杨晓光,等.MRI与颅脑CT在早期脑梗死诊断中的价值对比分析[J].中国地方病防治杂志,2017,32(9):1042-1045.
[13]刘希奇.C T灌注扫描对尤瑞克林治疗急性期脑梗死老年患者的效果[J].中国老年学杂志,2015,35(1):100-102.
[14]魏健强,李健,马剑,等.CT和MRI在脑血管疾病中的诊断有效性及效果观察[J].中国CT和MRI杂志,2016,14(7):18-20.
[15]中华医学会神经病学分会.中国脑血管病影像应用指南[J].中华神经科杂志,2016,49(3):164-181.