目的：探讨急性脑梗塞时，FLAIR序列上高信号血管征（HVS）出现部位脑实质血流灌注状态，评估HVS变化对近期预后影响。方法：纳入大脑中动脉（MCA）供血区急性脑梗塞且未经溶栓治疗的患者67例，根据有无HVS分为HVS阴性组和阳性组。采用3D-PASL扫描方法获得“HVS-DWI”不匹配区域或梗塞灶周围CBF值，分析HVS与NIHSS评分、梗塞面积、rCBF关系。观察13例HVS阳性患者复查时HVS和病情变化关系。结果：HVS阳性组NIHSS评分、梗塞面积均大于阴性组（P＜0.05）。“HVS-DWI”不匹配区域rCBF多为减低状态（P=0.012＜0.05）。复查患者中，5例HVS范围无明显变化，患者新发梗塞灶，病情进展。结论：急性脑梗塞时，HVS的出现提示梗塞面积大、神经功能障碍重，“HVS-DWI”不匹配区域脑实质血流灌注不足，HVS持续存在需警惕新发梗塞。
Abstract
Objective: To investigate the cerebral parenchymal blood perfusion status in hyperintense vessel sign(HVS) area on fluid attenuated inversion recovery(FLAIR) sequence during acute cerebral infarction and to evaluate the relationship between HVS change and short-term prognosis. Methods: Sixty-seven patients with acute cerebral infarction in middle cerebral artery(MCA) blood supply area without thrombolysis treatment were divided into HVS negative group and HVS positive group according to the presence of HVS. Cerebral blood volume(CBF) value of “HVS-DWI” mismatch area or around the infarct was obtained by 3D-pulsed arterial spin labeling scan. The relationship between HVS and NIHSS score, infarction area, rCBF was analyzed. The relationship between HVS and the change of the disease was observed in 13 HVS positive patients. Results: HVS sign was observed 38(56.7%) of 67 enrolled cases. NIHSS score and the infarction area of HVS positive group were higher than those of HVS negative group(P<0.05). The rCBF value of mismatched areas of “HVS-DWI” was decreased(P=0.012<0.05). Among the re-examination patients, there was no significant change in the range of HVS in 5 patients, with new infarction and progressive disease. Conclusion: In acute cerebral infarction, the appearance of HVS suggests severe neurological dysfunction and large infarction area, and the cerebral parenchymal blood flow in the“HVS-DWI” mismatched areas is hypoperfusion, and the persistence of HVS needs to be vigilant for new infarction.
关键词
脑梗塞 /
磁共振成像 /
弥散
Key words
Brain infarction /
Diffusion magnetic resonance imaging
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