摘要
目的：运用动态磁敏感对比增强磁共振成像（DCS-MRI）技术，获取进展性及非进展性卒中患者部分血流动力学参数，初步探讨进展性卒中脑梗死前期的脑灌注机制，为临床提高疗效、改善预后提供理论基础。方法：发病24 h内急性脑卒中患者60例，入院时首先给予NISS评分，均进行DSC-MRI扫描。发病72 h内病情加重，NISS评分增加2分或以上者归入进展组（24例），未加重者归入非进展组（36例）；采用Functool软件进行图像后处理，得到CBV、CBF、MTT及TTP图；利用SPSS 17.0软件，对进展组和非进展组的梗死灶中心及周围CBF、CBV、MTT、TTP进行两独立样本均数比较的t检验；以对侧半球的镜像感兴趣区作为参考，自身对照，计算患侧与对侧灌注参数的相对值。结果：进展组及非进展组梗死中心CBF下降，CBV下降，MTT增加，TTP增加，提示低灌注，两组梗死中心大部分脑组织rCBF<0.5，MTT增加>1.63，TI>4 s，为严重低灌注，可能是缺血脑组织发展为梗死的相关危险因素。病灶周围相对正常区域灌注参数可归纳为4种类型：①低灌注，MTT明显增加，局部CBV下降，局部CBF明显下降；②侧支循环形成，MTT增加，局部CBV增加或尚可；③血流再灌注，MTT下降或正常，局部CBV增加，局部CBF正常或轻度增加；④过度灌注，局部CBV显著增加，局部CBF显著增加。其中，进展组灌注类型主要为低灌注，而非进展组包括以上4种。对病灶周围相对正常区域分析以上微循环的灌注类型，便于有效把握溶栓时间窗及制定个体化的治疗方案。结论：运用DCS-MRI，可提供超急性脑梗死前期缺血半暗带的代谢与超微形态学信息，指导临床治疗，预防和减少最终脑梗死的发生。
Abstract
Objective: To explore progressive stroke mechanism of early cerebral infarction by using dynamic susceptibility contrasted magnetic resonance imaging, to obtain and analyze the progressive and non-progressive patients’ hemodynamic parameters, provide valuable theory for improving clinical therapy and prognosis. Methods: Sixty patients with acute cerebral stroke during 24 h underwent dynamic susceptibility contrasted magnetic resonance imaging and were given NISS grading score on admission. The patients with exacerbation during 72 h as well as the NISS score adds 2 points or more were classified into the progressive group(24 cases), others were classified into the non-progressive group(36 cases). The diagram of rCBV, rCBF, MTT and TTP were calculated by post-processing of Functool software. The value of the CBF, CBV, MTT and TTP between the infarct center and surrounding tissue were compared and analyzed by two independent sample t test(SPSS 17.0 software). Using contralateral hemisphere as a reference area of interest(ROI), the relative value of the perfusion parameters between affected side and contralateral side was calculated. Results: In both of the progressive and non-progressive group, CBF and CBV values of infarction center were declined, MTT and TTP values were increased, which implied hypoperfusion. Severe hypoperfusion in two groups: brain infarction with the rCBF less than 0.5, MTT increasing more than 1.63, TI more than 4 s. This situation may be the related risk factors that the ischemic brain tissue develops into infarction. The perfusion parameters of relatively normal regional around the lesions can be divided into four types: Type 1, hypoperfusion, markedly increased MTT, the regional decreased CBV, dramatic declined regional CBF; Type 2, the collateral circulation formation, increased MTT, increased or normal regional CBV; Type 3, blood reperfusion, decreased or normal MTT, increased regional CBV, normal or slightly increased regional CBF; Type 4, excessive perfusion information, increased significantly regional CBV and CBF. The types of the progressive group is mainly hypoperfusion, but the non-progressive group includes the four kinds of above. It was convenient for effective master thrombolysis time window and individualized treatment plan to analyze above microcirculation perfusion type in the relative normal around the lesion area. Conclusion: Dynamic susceptibility contrasted magnetic resonance imaging(DSC-MRI) can provide ischemic penum’s brametabolism and superfine morphological information in the early stage of super acute cerebral infarction and guide the clinical treatment, so as to prevent or reduce the occurrence of cerebral infarction finally.
关键词
脑血管意外 /
磁共振成像
Key words
Cerebrovascular accident /
Magnetic resonance imaging
钱晶晶;吴卿杰;陆忠烈;张晓玲;刘 虎;马勤卫.
动态磁敏感对比增强磁共振成像对进展性卒中的脑灌注机制研究[J]. 中国临床医学影像杂志. 2015, 26(8): 533-538
QIAN Jing-jing;WU Qing-jie;LU Zhong-lie;ZHANG Xiao-ling;LIU Hu;MA Qin-wei.
The cerebral perfusion mechanism study of dynamic susceptibility contrasted magnetic resonance imaging for progressive stroke[J]. Journal of China Clinic Medical Imaging. 2015, 26(8): 533-538
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