摘要
目的:探讨三向同性扩散加权成像和表观扩散系数在早期脑梗死的诊断以及在判断脑梗塞的转归和分期中的应用价值。方法:以2001-06/2005-01暨南大学附属第一医院收治的100例脑梗死患者为观察对象,应用单次激发平面回波三向同性弥散加权成像和常规MRI对100例脑梗死患者共进行140次检查。其中超急性期(<6h)15次,急性期(7～24h)25次,亚急性期(2～7d)34次,稳定期(8～14d)28次,慢性期(15～135d)38次。测定各期病灶平均表观扩散系数值、相对表观扩散系数值及中心-边缘表观扩散系数值。分析各期梗死灶在弥散加权成像、T2WI及表观扩散系数图上的演变情况。结果:100例患者均完成了测试,进入结果分析。①超急性期15例均在弥散加权成像及表观扩散系数图上显示出缺血灶,但其在T2WI上表现正常。②各期病灶表观扩散系数值及在弥散加权成像上信号不同。超急性、急性期脑梗死在弥散加权成像上表现为高信号,其表观扩散系数值较对侧相应区域明显下降[(0.678±0.102)×10-3,(0.960±0.163)×10-3mm2/s,P<0.001]。④超急性、急性期病灶中心相对表观扩散系数最低,从中心往外逐渐升高呈梯度征。⑤超急性、急性期脑梗死灶平均相对表观扩散系数最低,随时间延长由低到高,于8～14d出现假性正常化,于慢性期高于正常水平,相对表观扩散系数与时间具有显著相关(r=0.926,P<0.001)。结论:三向同性弥散加权成像及表观扩散系数图对急性脑梗死,尤其是超急性脑梗死较常规T2WI具有更高的敏感性,能快速、准确地诊断超急性、急性脑梗死。梗死灶表观扩散系数值具有特征性演变规律,结合弥散加权成像及T2WI可以对脑梗死进行分期诊断,对临床个体化治疗有帮助,动态观察可以对疗效进行评价。
AIM： To study the roles of isotropic diffusion weighted imaging （DWI） and apparent diffusion coefficient （ADC） in diagnosing early cerebral infarction, and judge the application value in monitoring the development of cerebral infarction and defining the infarction stages. METHODS： 100 inpatients from First Affiliated Hospital, Jinan University from June 2001 to January 2005 were selected as observation objects. 140 work-ups of 100 patients with cerebral infarction were imaged with both conventional MRI and single-shot echo-planar DWI, including 15 hyperacute （〈 6 hours）, 25 acute （7-24 hours）, 34 suhacute （2-7 days）, 28 steady （8-14 days）, 38 chronic （15-135 days）. The average ADC, relative ADC （rADC） and the ADC from center to periphery of the lesion were calculated. The changes of the infarct lesion in DW1, T2W and ADC mapping were also analyzed. RESULTS： Totally 100 patients were performed the tests and involved in the result analysis. ① Fifteen cerebral ischemic regions in hyperacute stage were revealed at DW1 and ADC mapping, hut it was normal in the T2WI. ② The signals on ADC value and DWI of the focus were different in various stage. Hyperacute and acute infarcts appeared as areas of hyperintensity on DWI, and their ADC was significantly decreased compared with homologous contralateral tissue （0.678±0.102×10^-3, 0.960±0.163×10^-3 mm^2/s; P 〈 0.001）. ④ The rADC in hyperacute and acute stage of focus center was minimized, and increased progressively from center to periphery with gradient sign. ⑤ The average rADC in hyperacute and acute stage of cerebral infarction focus was the lowest, from low to high as time pass, and appeared as “pseudo-normal” values at 8 to 14 days, thereafter, rADC became greater than normal in chronic stage. There was markedly correlation between rADC and lime （r=0.926, P 〈 0,001）, CONCLUSION： The DWI and ADC mapping have greater sensitivity for acute, especially hyperacute cerebral infarction than conventional T2W1, can diagnose cerebral infarction rapidly in hyperacute and acute stages, and accurately ADC values have specific evolving rule on ADC mapping, combined with DWI and T2W1 can differentiate different stages of infarction and is helpful to the clinical individualized treatment. The dynamic observation can evaluate the efficacy.
出处
《中国临床康复》
CAS
CSCD
北大核心
2005年第33期70-72,F0003,共4页
Chinese Journal of Clinical Rehabilitation
基金
广东省卫生厅医学科研基金立项(A2002355)~~
