[1]冯中全,钱伟军,李　杰,等.磁共振成像评估大面积脑梗死慢性期患者预后的临床价值[J].新乡医学院学报,2020,37(1):052-56.[doi:10.7683/xxyxyxb.2020.01.013]
　FENG Zhongquan,QIAN Weijun,LI Jie,et al.Clinical value of magnetic resonance imaging in evaluating the prognosis of patients with chronic large hemispheric infarction[J].Journal of Xinxiang Medical University,2020,37(1):052-56.[doi:10.7683/xxyxyxb.2020.01.013]
点击复制

磁共振成像评估大面积脑梗死慢性期患者预后的临床价值
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年1
页码:
052-56
栏目:
临床研究
出版日期:
2020-01-05

文章信息/Info

Title:
Clinical value of magnetic resonance imaging in evaluating the prognosis of patients with chronic large hemispheric infarction
作者:
冯中全1; 钱伟军1; 李　杰1; 张津华2; 韩新生3; 蒋忠仆1
（1.开封市中心医院影像科，河南　开封　475000；2.开封市中心医院康复科，河南　开封　475000；3.开封市中心医院神经内科，河南　开封　475000）
Author(s):
FENG Zhongquan1; QIAN Weijun1; LI Jie1; ZHANG Jinhua2; HAN Xinsheng3; JIANG Zhongpu1
(1.Department of Medical Imaging,the Central Hospital of Kaifeng City，Kaifeng 475000，Henan Province，China;2.Department of Rehabilitation Division，the Central Hospital of Kaifeng City，Kaifeng 475000，Henan Province，China;3.Department of Neurology，the Centra
关键词:
磁共振成像; 大面积脑梗死; 慢性期; 侧支循环; 靶血管; 预后
Keywords:
magnetic resonance imaging; large hemispheric infarction; chronic phase;  collateral circulation; target vessel; prognosis
分类号:
R743.3
DOI:
10.7683/xxyxyxb.2020.01.013
文献标志码:
A
摘要:
目的　探讨磁共振成像（MRI）在大面积脑梗死（LHI）慢性期患者预后评估中的价值。方法　选择2015年3月至2019年3月开封市中心医院收治的首次发病的LHI患者81例为观察对象。患者均于脑梗死发病后10~15 h首次行MRI检查，证实为单侧急性LHI，患侧靶血管重度狭窄或闭塞。采用抗凝+扩血管+改善微循环等治疗，并于慢性期（发病后16~18 d）复查常规MRI、弥散加权成像（DWI）、磁共振血管成像(MRA)、动态磁敏感对比增强灌注成像(DSC-PWI)、增强MRI检查。根据患者LHI区与健侧对照区的磁共振灌注成像参数值的比值计算相对脑血流量（rCBF）、相对脑血容量（rCBV）、相对平均通过时间（rMTT）和相对达峰时间（rTTP）。根据LHI慢性期DSC-PWI表现将81例患者分为低灌注组（n=47）和高灌注组（n=34），比较2组患者脑梗死区的DSC-PWI表现、治疗前后靶血管变化、美国国立卫生研究院率中量表（NIHSS）评分及慢性期介入治疗情况。结果　81例LHI慢性期患者中高灌注34例，低灌注47例。与低灌注组比较，高灌注组患者的梗死区rCBF、rCBV显著增高(P＜0.01)，rMTT、rTTP显著降低(P＜0.05)。高灌注组患者中靶血管改善30例（88.2%），无明显改善4例（11.8%）；低灌注组患者中靶血管改善11例（23.4%），无明显改善36例(76.6%)；高灌注组患者靶血管改善率显著高于低灌注组(χ2=33.173，P＜0.01) 。高、低灌注组患者入院当日NIHSS评分比较差异无统计学意义（P＞0.05），高灌注组患者慢性期NIHSS评分显著低于入院时（P＜0.05），低灌注组患者慢性期NIHSS评分与入院时比较差异无统计学意义（P＞0.05），高灌注组患者慢性期NIHSS评分显著低于低灌注组（P＜0.05）。低灌注组患者慢性期磁共振评估后行球囊扩张术或者裸支架植入术19例（40.4%），高灌注组患者均未行介入治疗。结论　MRI能评估LHI慢性期患者的脑血流灌注、侧支循环代偿能力及靶血管治疗效果，为临床后期合理治疗提供依据。
Abstract:
Objective　To discuss the value of magnetic resonance imaging（MRI） in evaluating the prognosis of patients with chronic large hemispheric infarction（LHI）.Methods　A total of 81 patients with first onset of LHI admitted to the Central Hospital of Kaifeng City from March 2015 to March 2019 were selected as subjects for observation,which were confirmed to be one-sided acute LHI with severe stenosis or occlusion of target blood vessels at 10-15 hours after cerebral infarction by MRI for the first time.All patients were given the same treatment such as anticoagulation，expansion of blood vessel，improving microcirculation and so on. Routine MRI、diffusion weighted imaging (DWI), magnetic resonance angiography (MRA),dynamic magnetic-sensitive contrast-enhanced perfusion imaging (DSC-PWI), and contrast-enhanced MRI scan were performed to 81 patients with LHI in chronic phase(16-18 days after cerebral infarction).Relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean passage time (rMTT) and relative peak arrival time (rTTP) were calculated based on the ratio of the parameters of magnetic resonance perfusion imaging (PWI) between the patient′s LHI region and the control region.According to the chronic DSC-PWI of LHI, 81 patients were divided into the low perfusion group (n=47) and the high perfusion group (n=34), and the DSC-PWI of cerebral infarction area，the changes of target blood vessels before and after treatment, the national institutes of health stroke scale (NIHSS) score and the chronic interventional treatment were compared between the two groups.Results　There were 34 cases with high perfusion and 47 cases with low perfusion among the 81 cases of patients with chronic-phase LHI. Compared with the low perfusion group, rCBF and rCBV of the infarction area in the high perfusion were higher(P＜0.01). rMTT、rTTP of the infarction area in the high perfusion were lower(P＜0.05). In the hyperperfusion group, there were 30 patients (88.2%) with target vascular improvement, and no significant improvement in 4 patients (11.8%).In the low perfusion group, target vascular improvement was observed in 11 patients (23.4%), while no significant improvement was observed in 36 patients (76.6%).The target vascular improvement rate in the high perfusion group was significantly higher than that in the low perfusion group(χ2=33.173，P＜0.01).There was no significant difference in the NIHSS score between the low perfusion group and the high perfusion group on the day of admission（P＞0.05）.The NIHSS score of the high perfusion group in the chronic stage was significantly lower than that of the low perfusion group at admission (P<0.05); the NIHSS score of the low perfusion group in the chronic stage was not significantly different from that of the low perfusion group at admission (P>0.05); the NIHSS score of the high perfusion group in the chronic stage was significantly lower than that of the low perfusion group (P<0.05).Balloon dilatation or bare-stent implantation were performed in 19 patients (40.4%) with low perfusion in the chronic stage after MRI evaluation, but no interventional therapy was performed in all patients with high perfusion.Conclusions　MRI can evaluate blood flow perfusion, collateral circulation compensation ability and treatment effect of target vascular in large area cerebral infarction in chronic phase，which can provide important basis for clinic to make reasonable treatment.

参考文献/References:

［1］　POWERS W J，RABINSTEIN A A，ACKERSON T，et al.2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American heart association/American stroke association［J］.Stroke，2018，49(3):e46-e110.
［2］　王梦琪，吴世政.急性缺血性脑卒中诊治延迟因素的研究进展［J］.世界最新医学信息文摘，2019，19(16):72-73，75.
［3］　巩超，金香兰.大面积脑梗死的治疗进展［J］.中华老年心脑血管病杂志，2019，21(3):334-336.
［4］　张建民.缺血性脑血管疾病手术治疗新进展［J］.浙江大学学报(医学版)，2019，48(3):223-240.
［5］　王玉东.静脉溶栓联合动脉取栓治疗急性缺血性脑卒中的疗效及安全性［J］.新乡医学院学报，2019，36(8):764-767.
［6］　雷云，丁里，任丽香，等.3.0 T MRI对颈动脉粥样硬化斑块成分分析及分型的研究［J］.磁共振成像，2015，6(6):430-436.
［7］　陈娟.青年脑梗死危险因素分析［J］.新乡医学院学报，2018，35(1):39-41.
［8］　彭斌，崔丽英.重视对脑侧支循环的深入研究［J］.中华神经科杂志，2018，51(1):4-6．
［9］　MARKS M P，LANSBERG M G，MLYNASH M，et al.Effect of collateral blood flow on patients undergoing endovascular therapy for acute ischemicstroke［J］.Stroke，2014，45(4):1035-1039.
［10］　罗传斌，罗虹宇.DWI联合动脉自旋标记技术对急性期脑缺血的诊断价值临床研究［J］.中国CT和MRI杂志，2019，17(7):19-21.
［11］　蔡青云.多层螺旋CT(MSCT)对超急性大面积脑梗死的诊断及鉴别价值［J］.中国CT和MRI杂志，2018，16(12):14-16.
［12］　焦晓园，曹春艳，张灿飞，等.进展性大动脉粥样硬化型脑梗死的危险因素分析［J］.卒中与神经疾病，2019，26(4):411-414.
［13］　张国胜.脑梗死出血性转化的多层螺旋CT表现及相关危险因素分析［J］.中国CT和MRI杂志，2017，15(5):21-24.

相似文献/References:

[1]尚伟,刘安龙,李保庆,等.口服钆喷酸葡胺溶液行磁共振泌尿系水成像的临床应用[J].新乡医学院学报,2009,26(01):059.
[2]钟凯华１,徐海斌１,白素平２. 腰椎间盘退行性变磁共振成像和病理学变化对照研究 [J].新乡医学院学报,2015,32(04):314.[doi:10.7683/xxyxyxb.2015.04.007]
[3]段芙红,白　洁,张　勇,等.颅内横纹肌样脑膜瘤的磁共振成像及病理学特征[J].新乡医学院学报,2018,35(11):991.[doi:10.7683/xxyxyxb.2018.11.011]
　DUAN Fu-hong,BAI Jie,ZHANG Yong,et al.Magnetic resonance imaging and pathological features of intracranial rhabdoid meningiomas[J].Journal of Xinxiang Medical University,2018,35(1):991.[doi:10.7683/xxyxyxb.2018.11.011]
[4]马　辉,张　燕.磁共振成像在宫颈癌分期及腹腔和盆腔淋巴结转移诊断中的价值[J].新乡医学院学报,2016,33(10):898.[doi:10.7683/xxyxyxb.2016.10.016]
　MA Hui,ZHANG Yan.Diagnostic value of magnetic resonance imaging in the staging of cervical cancer and the celiac and pelvic lymph node metastasis[J].Journal of Xinxiang Medical University,2016,33(1):898.[doi:10.7683/xxyxyxb.2016.10.016]
[5]薛生琦,王　磊,赵素亚,等.颅内血管网状细胞瘤的磁共振成像诊断及鉴别诊断[J].新乡医学院学报,2019,36(9):855.[doi:10.7683/xxyxyxb.2019.09.012]
　XUE Sheng-qi,WANG Lei,ZHAO Su-ya,et al.Magnetic resonance imaging diagnosis and differential diagnosis of intracranial angioreticuloma[J].Journal of Xinxiang Medical University,2019,36(1):855.[doi:10.7683/xxyxyxb.2019.09.012]
[6]闫　冰.彩色多普勒超声与磁共振成像检查对胎儿肺隔离症的诊断价值[J].新乡医学院学报,2021,38(3):278.[doi:10.7683/xxyxyxb.2021.03.015]
　YAN Bing.Diagnostic value of color Doppler ultrasonography and magnetic resonance imaging in fetal pulmonary sequestration[J].Journal of Xinxiang Medical University,2021,38(1):278.[doi:10.7683/xxyxyxb.2021.03.015]
[7]菅　超,陈维亮.磁共振弥散张量成像及动脉自旋标记成像在缺血性脑梗死诊断及分期中的应用价值[J].新乡医学院学报,2020,37(7):648.[doi:10.7683/xxyxyxb.2020.07.0012]
　JIAN Chao,CHEN Weiliang.Application value of magnetic resonance diffusion tensor imaging and arterial spin labeling in the diagnosis and staging of cerebral ischemic infarction[J].Journal of Xinxiang Medical University,2020,37(1):648.[doi:10.7683/xxyxyxb.2020.07.0012]
[8]毛光兰,吕　方,杨荣丽,等.膝关节前交叉韧带重建术后弥散张量成像观测[J].新乡医学院学报,2020,37(12):1173.[doi:10.7683/xxyxyxb.2020.12.016]
　MAO Guanglan,LYU Fang,YANG Rongli,et al.Diffusion tensor imaging of knee joint after anterior cruciate ligament reconstruction[J].Journal of Xinxiang Medical University,2020,37(1):1173.[doi:10.7683/xxyxyxb.2020.12.016]
[9]张成军.常规磁共振成像联合磁共振胰胆管成像对肝门部胆管癌的诊断价值[J].新乡医学院学报,2018,35(3):235.[doi:10.7683/xxyxyxb.2018.03.019]
　ZHANG Cheng-jun.Value of conventional magnetic resonance imaging combined with magnetic resonance cholangiopancreatography for the diagnosis of portal cholangiocarcinoma[J].Journal of Xinxiang Medical University,2018,35(1):235.[doi:10.7683/xxyxyxb.2018.03.019]
[10]吕　方.磁共振成像在面肌痉挛中的应用价值[J].新乡医学院学报,2018,35(5):421.[doi:10.7683/xxyxyxb.2018.05.017]
　LYU Fang.Application value of magnetic resonance imaging in hemifacial spasm[J].Journal of Xinxiang Medical University,2018,35(1):421.[doi:10.7683/xxyxyxb.2018.05.017]

更新日期/Last Update: 2020-01-05