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编号：11386096
弥散加权成像对超急性脑缺血的临床应用研究
http://www.100md.com 《实用医技杂志》 2006年第17期
磁共振成像；弥散加权成像；脑缺血；溶栓,,],磁共振成像；弥散加权成像；脑缺血；溶栓,1材料与方法,2结果,3讨论,参考文献：
     [摘要] 目的：运用磁共振弥散加权成像(DWI),研究超急性脑缺血及脑梗死前期的影像特征及细胞水肿的分子影像学基础,界定缺血半暗带(IP),评估其在临床治疗中的应用价值。方法：将在6 h内首次发病且疑似缺血性脑中风患者56例先行16层CT扫描，排除脑出血后再经MRI系列成像检查，判断有无超急性脑梗死，界定IP组织，将符合溶栓适应证的患者进行溶栓治疗，余皆进行神经保护治疗，并对照分析其疗效。结果：CT显示颅脑正常37例，脑出血5例，陈旧性梗死9例，具有超急性脑梗死征5例。MRI系列检查51例中,T1WI、T2WI显示轻微脑肿胀和脑动脉流空征消失7例；FLAIR显示缺血高信号灶9例；DWI除5例短暂性脑缺血发作(TIA)显示正常外，余46例均表现为与临床体征一致的高信号责任灶，ADC图呈低信号,其敏感性显著优于CT及MRI常规检查；MRA显示病灶区供血动脉阻塞、变细、局部狭窄或远端分支减少。磁共振灌注成像(PI)显示48例有异常灌注缺损，其异常灌注体积(vPI)与DWI异常信号体积(vDWI)不一致:30例vPI>vDWI，界定具有IP1组织；10例vPI＝vDWI及6例vPIvDWI梗死面积扩大，5例vCI＝vDWI，考虑缺乏IP2组织；追踪随访TIA患者有2例发展为脑梗死。结论：DWI能够在超急性脑梗死组织发生不可疑损伤之前明确诊断，并能在活体状态下深入到细胞毒性水肿分子水平，DWI与PI的联合应用对于IP的确定、临床溶栓治疗的选择以及挽救缺血脑组织具有重大的作用，且能一定程度反映脑梗死前期的影像特征。

    [关键词] 磁共振成像；弥散加权成像；脑缺血；溶栓

    Clinical Study of Hyperacute Cerebral Ischemia on MRDWI

    ZENG Wenbing，SHI Anbing，WANG Mingquan

    (Chongqing Three Gorges Central Hospital,Chongqing 404000,China)

    Abstract:Objective To study the imaging characteristics of superactue cerebral ischemia and molecular imaging basis of cytotoxic edema,to determine the ischemic penumbra (IP),and to assess the application value in the clinical treatment by using diffusionweighted imaging (DWI).Methods 56 patients who were suspected ischemic stroke within 6 hours were scanned CT,then routine MRI sequences,FLAIR,DWI and magnetic resonance perfusion imaging(PI).To compare the volume of vDWI,vPI,vCI and define the IP.Some match the indication were given the thrombolysis treatment and others were given only neuroprotective treatment.Results Imaging analysis:CT show 37 cases are normal,5 cases are cerebral hemorrhage,9 cases are chronic infarction,and 5 cases are hyperacute cerebral infarction.51 cases are taken MRI examination,and 7 cases show slightly cerebral swelling and artery flow void sign on routine T1WI and T2WI;9 cases show ischemic high signal intensity on FLAIR,9 cases of chronic infarction;on DWI except for 5 cases with transient ischemic attack(TIA) show normal appearance,other 46 cases show high signal intensity lesions which consistent with clinical signs,on ADC maps they show hypointensity,the sensibility of DWI superior to CT and routine MRI examinations.MRA show artery of the lesion is obstructed,tipped and focal stenosis or decreasing of distal branches;PI shows that 48 cases have abnormal perfusion defect,in which there are 2 patients with TIA,indicating that PI is more sensible to reflect perfusion status of microcirculation in ischemic cerebral tissue and can reflect the imaging characteristics of cerebral infarction in the early stage on a certain extant;contrast analysis of abnormal signal volume on DWI(vDWI) and PI(vPI):30 cases vPI>vDWI,considered to have IP1 tissues;10 cases vPI=VDWI and 6 cases vPIvDWI,which considered to have IP2 tissue,indicating hyperintensity may represent infarction core and IP tissue;6 cases show vCI>vDWI,which indicate that the areas of infarction are enlarged,5 cases vCI=vDWI,considered to lack of IP2 tissues;the followup of TIA patients demonstrate that 2 cases develop into cerebral infarction.Conclusion DWI enable us to make the diagnosis before irreversible injury of tissues in hyperacute cerebral infarction,and to study the molecular level of cytotoxic edema,the combinationDWI and PI is useful in the determination of IP,the choice of clinical treatment as well as a remedy of ischemic tissues,and it can reflect the imaging characteristics of cerebral infarction in the early stage. ......

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