摘要
目的探讨磁共振扩散张量成像（DTI）和三维伪连续动脉自旋标记（3D-pcASL）灌注成像在鉴别超急性与急性缺血性脑梗死中的临床应用价值。方法回顾分析2015年2月至2017年10月期间东南大学医学院附属盐城医院确诊的42例单侧超急性期（14例，A组）和急性期（28例，B组）缺血性脑梗死患者的DTI和3D—pcASL图像。在扩散加权成像（DWI）病灶最大层面测量梗死面积（S嗍）和脑血流量（CBF）图上异常灌注面积（SCBF）。选取梗死核心（IC）、SCBF和SDWI不匹配区（MACD）及相应对侧为感兴趣区（ROI）。分析ScBF〉SDW1且梗死核心为低灌注的患者CBF、平均扩散系数（DCavg）和各项异性指数（FA）参数图。记录各ROI的参数值并计算梗死侧／对侧相对值（rCBF、rFA、rDCavg）。比较IC、MACD各参数值与对侧的差异，分析各参数相对值在两组中的差异。结果梗死核心的CBF和DC。值，MACD的CBF值在两组中均低于对侧（均P〈0．05）。A组MACD的DCavg值和B组梗死核心的FA值均低于对侧（均P〈0．05）。梗死核心的rFA、rDCavg和MACD的rFA值在B组均低于A组，MACD的rDCavg、rCBF则相反（P〈0．05）。受试者工作特征（ROC）曲线分析梗死核心的rFA、rDCavg和MACD的rCBF、rFA、rDCavg值鉴别两组的最佳诊断界值分别为0．890、0．541和1．139、0．902、0．455。结论临床可通过CBF、FA、Dcavg值及其相对值的改变规律判断脑梗死处于超急性或者急性期，为选择合理的治疗方案提供依据。
Objective To explore the clinical value of magnetic resonance diffusion tensor imaging （DTI） combined with 3D pseudo continuous arterial spin labeling （3D-pcASL） perfusion imaging in differential diagnosis of hyper-acute and acute ischemic cerebral infarction. Methods A total of 42 patients with confirmed unilateral ischemic cerebral infarction from February 2015 to October 2017 of Affiliated Yancheng Hospital of Southeast University Medical College were collected. DTI and 3D-pcASL images of hyper-acute （14 patients, group A） and acute （28 patients, group B） ischemic cerebral infarction were retrospectively analyzed. The slice with the biggest lesion on diffusion weighted imaging （DWI） was selected to measure the infarction area （ SDWI ） and abnormal cerebral blood flow （CBF） perfusion area （SCBF）. Regions of interest （ROIs） were set on the infarction core （IC） area, mismatch area of SCBF and SDWI （MACD）, and their corresponding contralateral regions. The values of CBF, average diffusion coefficient （DCavs）, and fractional anisotropy （FA） parameter images in these ROIs in patients with both ScBF 〉 SDW1 and lower perfusion in the IC were recorded. The relative values of each infarction lesion to its corresponding contralateral region （rCBF, rFA, and rDCavg） were calculated. Differences of each parameter value between the IC, MACD and their corresponding contralateral regions and of the relative values between group A and group B were investigated. Results The CBF and DCavg values in the IC and the CBF value in the MACD were lower than that of their corresponding contralateral regions in both groups （ P 〈0. 05）. The DCavg in the MACD in group A patients and the FA in the IC in group B patients were lower than that in their corresponding contralateral regions （ P 〈 0. 05 ）. Compared to group A patients, group B patients showed decreased rFA, rDCavg in the IC and rFA in the MACD, and increased rDCavg and rCBF in the MACD （P 〈 0. 05）. Receiver operating characteristics （ROC） curve analysis indicated that the best diagnosis cut off values of the rFA and rDCavg values in the IC and the rCBF, rFA, and rDCavg values in the MACD were 0. 890 and 0. 541 and 1. 139, 0. 902 and 0. 455, respectively, for identifying two groups. Conclusion The changes of the CBF, FA, and DCavg values and their relative values can be applied to differentially diagnose patients with hyper-acute and acute cerebral infarction, which could provide the basis for selecting more reasonable treatment protocols.
作者
戴真煜
陈飞
姚立正
董从松
侍海存
潘平雷
刘洋
张志平
Dai Zhenyu;Chen Fei;Yao Lizheng;Dong Congsong;Shi Haicun;Pan Pinglei;Liu Yang;Zhang Zhiping(Department of Radiology, Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng 224005, Chin)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2018年第17期1327-1332,共6页
National Medical Journal of China
基金
江苏省“六大人才高峰”资助计划（WSN-103）
盐城市医学科技发展计划（YK2015097,YK2017116）
关键词
磁共振成像
扩散张量成像
梗塞
大脑中动脉
动脉自旋标记
Magnetic resonance imaging
Diffusion tensor imaging
Infarction, middle cerebral artery： Arterial spin labeling
