摘要
目的探讨磁敏感加权血管成像(SWAN)在诊断脑微出血及评估急性脑梗死预后中的应用价值,为脑梗死的临床治疗提供理论依据。资料与方法对47例发病6~72h内未溶栓治疗的急性脑梗死患者行CT、常规MRI、梯度回波T2^*加权成像(GRE-T2^*WI)、SWAN扫描并复查。分析脑微出血(CMBs)级别与出血性转化(HT)的关系。记录患者入院时美国国立卫生研究院卒中量表(NIHSS)评分,随访3个月时预后情况,分析影响患者预后的危险因素。结果GRE-T2^*WI、SWAN分别检出CMBs病灶115枚、185枚,检出率差异有统计学意义(Z=-4.673,P<0.05);47例患者中,5例发生HT,CMBs0级与2级、1级与2级HT发生率差异均有统计学意义(P<0.05)。在预后单因素分析中,年龄、NIHSS评分、CMBs分级与预后有关;多因素分析中,NIHSS评分(OR=1.503,95%CI1.065~2.122,P=0.021)、多发CMBs(>10枚)(OR=26.662,95%CI1.949~364.664,P=0.014)是影响患者预后的独立危险因素。结论SWAN对CMBs的敏感性优于GRE-T2*WI。CMBs数目与HT的发生及急性脑梗死患者的预后相关。利用SWAN检测CMBs对脑梗死患者临床治疗方案的制订及预后评估具有指导价值。
Purpose To explore the application value of magnetic sensitivity-weighted angiography (SWAN) in the diagnosis of cerebral microbleeds and the assessment of acute cerebral infarction prognosis,thus to provide theoretical basis for the clinical treatment of cerebral infarction.Materials and Methods Forty-seven patients with acute cerebral infarction and without thrombolysis within 6- 72 hours of onset were treated with CT,conventional MRI,gradient-echo T2^*-weighted imaging (GRE-T2^*WI) and SWAN scan. Reexamination was also performed.The relationship between cerebral microbleeds (CMBs) and hemorrhagic transformation (HT) was analyzed.The national institute of health stroke scale (NIHSS) score was recorded at the time of admission.The prognosis was followed up at 3 months.The risk factors affecting the prognosis of patients were also anlyzed.Results Lesions of CMBs were detected in GRET2^*WI and SWAN,with the number being 115 and 185,respectively;the difference in detection rates was statistically significant (Z=-4.673,P<0.05).Among the 47 patients,HT occurred in 5 patients,and the occurrence rates between CMBs grade 0 and grade 2, grade 1 and grade 2 were of statistically significant difference (P<0.05).In prognostic univariate analysis,age,NIHSS score and CMBs classification were associated with prognosis.In the multivariate analysis,NIHSS score and multiple CMBs (>10) were independent risk factors (OR=1.503,95% CI 1.065-2.122,P=0.021;OR=26.662,95% CI 1.949-364.664,P=0.014).Conclusion The sensitivity of SWAN to CMBs is better than that to GRE-T2^*WI.The number of CMBs is related to the occurrence of HT and the prognosis of acute cerebral infarction.The detection of CMBs by SWAN sequence is of guiding value in the development of clinical treatment plan and prognosis assessment of patients with cerebral infarction.
作者
马永青
尹喜
王成伟
MA Yongqing;YIN Xi;WANG Chengwei(CT/MRI Room,the First Hospital Affiliated to Medical College of Shihezi University,Shihezi 832000,China)
出处
《中国医学影像学杂志》
CSCD
北大核心
2019年第8期584-588,共5页
Chinese Journal of Medical Imaging
关键词
脑出血
微循环
脑梗死
体层摄影术
X线计算机
磁共振成像
磁共振血管造影术
脑血管造影术
图像增强
图像处理
计算机辅助
预后
危险因素
Cerebral hemorrhage
Microcirculation
Brain infarction
Tomography,X-ray computed
Magnetic resonance imaging
Magnetic resonance angiography
Cerebral angiography
Image enhancement
Image processing,computer-assisted
Prognosis
Risk factors
