核磁高分辨率颅内动脉分析与PWI联合评估缺血性脑卒中患者预后-东南大学学报医学版

核磁高分辨率颅内动脉分析与PWI联合评估缺血性脑卒中患者预后

单位：湖北医药学院附属人民医院放射科, 湖北十堰 442000

分类号：R743.3;R445.2

出版年·卷·期（页码）：2018·37·第五期（912-916）

摘要：

目的：探讨核磁高分辨率颅内动脉分析与灌注加权成像（PWI）联合评估缺血性脑卒中患者预后的价值。方法：选择2015年6月至2017年6月我院接收并确诊的120例缺血性脑卒中患者，按随机数字表法分为对照组和观察组，各60例。两组患者均采用口服阿司匹林肠溶片、静脉注射川芎嗪进行支持治疗；颅内压增高的患者静脉滴注20%甘露醇250 ml·（8 h）^-1，连续治疗1周。对照组患者采用核磁高分辨率颅内动脉分析，观察组采用核磁高分辨率颅内动脉分析联合PWI检测。治疗前、治疗后7 d，详细记录观察组患者PWI的平均通过时间（rMTT）、平均脑血容量（rCBV）、平均达峰时间（rPT）、平均脑血流量（rCBF）及缺血半暗带（IP）体积等数值，并对比两组患者的高分辨率核磁图像。3个月后统计两组患者的不良反应发生情况。结果：治疗前两组患者的NIHSS评分、Barthel指数及IP体积无明显差异（P>0.05）；与治疗前相比，两组患者治疗后的NIHSS评分、IP体积明显降低，Barthel指数明显升高，差异具有统计学意义（P<0.05）；但治疗后两组患者间NIHSS评分、Barthel指数及IP体积无明显差异（P>0.05）。观察组治疗前的血流参数rMTT、rPT明显高于治疗后，rCBV、rCBF明显低于治疗后，差异有统计学意义（P<0.05）。观察组不良反应发生率为3.33%（2/60），明显低于对照组的10%（6/60），差异有统计学意义（P<0.05）。结论：采用核磁高分辨率颅内动脉分析联合PWI评估缺血性脑卒中，能清楚显示微观血液循环情况，降低复发率，值得临床推广。

Objective:To evaluate the prognosis of patients with ischemic stroke by analyzing nuclear magnetic resonance high resolution intracranial angiography and perfusion weighted imaging (PWI). Methods:120 cases of ischemic stroke patients were randomly selected who received and confirmed in our hospital from June 2015 to June 2017. They were randomly divided into the control group and the observation group, each with 60 cases. 2 groups of patients were treated with oral Aspirin Enteric-coated Tablets and intravenous injection of Ligustrazine. The patients with increased intracranial pressure were given intravenous infusion of 20% mannitol 250 ml·(8 h) ^-1, and they were treated continuously for one week. The patients in the control group were analyzed by nuclear magnetic resonance high resolution intracranial artery, and the observation group was analyzed by nuclear magnetic resonance high resolution intracranial artery analysis combined with PWI. Before treatment and 7 d after treatment, the mean transit time (rMTT), mean cerebral blood volume (rCBV), mean peak time (rPT), mean cerebral blood flow (rCBF) and ischemic penumbra (IP) of the patients in the observation group were recorded in detail, and the volume of PWI in the observation group was recorded. The high resolution nuclear magnetic resonance images of the 2 groups were compared. 3 months later, the adverse reactions of the 2 groups were counted. Results:Before treatment, there was no significant difference between NIHSS scores and improvement in quality of life and the volume of IP in 2 groups (P>0.05). after treatment, the NIHSS score and the volume of IP decreased, and the Barthel index increased, the difference was statistically significant (P<0.05), but there was no significant difference in the NIHSS score, Barthel index and IP volume between the 2 groups (P>0.05). The blood flow parameters rMTT and rPT of the observation group before treatment were significantly higher than those after treatment, and the rCBV and rCBF were significantly lower than those after treatment (P<0.05). The incidence of adverse reaction in the observation group was 3.33% (2/60), which was lower than 10%(6/60) in the control group (P< 0.05). Conclusion:high resolution nuclear magnetic resonance analysis combined with PWI is useful for assessing ischemic stroke, it can clearly show the micro blood circulation and reduce the recurrence rate. So it is worthy of clinical popularization.

参考文献：

[1] 周峰,刘宇恺,周俊山,等.多模磁共振弥散加权成像-灌注加权成像不匹配在急性缺血性脑卒中溶栓时间窗内的评估作用[J].中华神经科杂志,2015,48(10):850-854.
[2] 高慧,谢春明,闫福岭.脑侧支循环建立的影像学评估方法研究进展[J].东南大学学报(医学版),2016,35(3):457-460.
[3] SOUILLARD-SCEMAMA R,TISSERAND M,CALVET D,et al.An update on brain imaging in transient ischemic attack[J].J Neuroradiol,2015,42(1):3-11.
[4] 何欢,高培毅,何欢,等.磁共振多层并采扩散峰度成像与传统扩散加权成像识别急性缺血性卒中梗死核心的研究[J].中国卒中杂志,2016,11(3):184-190.
[5] 古子文,周子英,赖秀醒.HUK对急性缺血性脑卒中患者神经功能、PWI、MRA和TCD检查结果的影响[J].临床急诊杂志,2016,17(7):516-520.
[6] 丁建.不同类型急性缺血性脑血管病患者脑微出血的对比研究[J].东南大学学报(医学版),2015,35(1):96-99.
[7] 杜万良,张心邈,李姝雅,等.DWI阴性的急性缺血性卒中患者的临床特点和原因分析[J].中国卒中杂志,2015,10(8):660-665.
[8] POWER S,MATOUK C,CASAUBON L K,et al.Vessel wall magnetic resonance imaging in acute ischemic stroke:effects of embolism and mechanical thrombectomy on the arterial wall[J].Stroke,2014,45(8):2330-2334.
[9] 何思锦,李颖彬,张燕婷,等.采用高分辨率核磁共振评价颅内动脉粥样硬化斑块稳定性与卒中复发风险的关系[J].中国脑血管病杂志,2017,14(7):351-355.
[10] 张雪凤,刘崎,陈士跃,等.复发急性缺血性脑卒中患者大脑中动脉斑块的高分辨率MRI研究[J].磁共振成像,2016,7(11):808-812.
[11] 杨万群,黄飚,梁长虹,等.缺血性卒中患者颅内动脉硬化斑块强化特征的高分辨MRI研究[J].中华放射学杂志,2014,18(6):462-466.
[12] ZHAO D L,DENG G,XIE B,et al.Wall characteristics and mechanisms of ischaemic stroke in patients with atherosclerotic middle cerebral artery stenosis:a high resolution MRI study[J].Neurol Res,2016,38(7):606-613.
[13] 高根善,卢祖能.高分辨率磁共振成像评估大脑中动脉粥样硬化性狭窄研究进展[J].卒中与神经疾病,2016,23(2):139-141.
[14] 刘宇嘉,刘嫚,丰宏林.缺血性卒中二级预防的抗血小板方案新进展[J].现代医学,2016,18(5):744-748.
[15] 韩莎,王亮.高分辨率磁共振成像在颅内动脉狭窄中的研究进展[J].中华老年心脑血管病杂志,2016,18(9):1006-1008.

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