CT血管造影和弥散加权成像在不同起病时间急性期脑梗死诊断中的应用
|
摘要
目的分析CT血管造影(CTA)、MRI的弥散加权成像(DWI)在不同起病时间急性期脑梗死(ACI)临床诊断中的应用价值。方法我院收治的100例ACI患者,根据起病时间分为超急性期(<6 h) 20例、急性期(6～24 h) 38例、亚急性期(24～72 h) 42例,均自愿配合完成CTA或DWI检查及图像、相关数据采集,对比分析不同起病时间患者CTA、DWI检查结果。结果超急性期常规CT、MRI检查未发现明显异常,大部分急性期、亚急性期常规CT扫描提示存在早期脑梗死,常规MRI扫描提示T2WI上可见大片高信号病灶。共83例接受CTA检查,其中超急性期、急性期、亚急性期分别为15例、29例、39例,CTA显示颅内血管病变率为53. 33%、78. 95%、100%,差异有统计学意义(P <0. 05)。共69例接受DWI检查,其中超急性期15例,DWI提示13例显著高信号,ADC呈现显著低信号,另2例DWI信号未见明显异常;急性期18例,可见DWI呈现高信号、ADC低信号;亚急性期36例,均表现为DWI等/稍高信号、ADC等/稍低信号;超急性期、急性期、亚急性期患者患侧ADC值依次逐渐提高,且与对应健侧ADC值比较差异有统计学意义(P <0. 05)。结论 CTA和DWI可有效显示不同起病时间的ACI患者脑血管病变、梗死病灶及脑实质情况,二者均可为ACI的早期诊断提供可靠依据。
Objective To analyze the application value of CT angiography( CTA) and diffusion weighted imaging( DWI) in the diagnosis of acute cerebral infarction( ACI) at different onset time.Methods One hundred patients with ACI admitted to our hospital were selected as the study objects.There were 20 cases at hyper-acute stage( <6 h),38 cases at acute stage( 6 ～ 24 h) and 42 cases in sub-acute stage( 24 ～ 72 h) according to onset time.All patients were voluntarily cooperated to complete the CTA or DWI examinations.The results of CTA and DWI at different onset time were analyzed and compared.Results Routine CT and MRI at the hyper-acute phase showed no obvious abnormalities.Routine CT scans at acute and sub-acute stages indicated the presence of early cerebral infarction in most cases.Routine MRI scans showed large hyper intense lesions on T2 WI.Of the 100 patients,83 cases underwent CTA examination including 15,29 and 39 cases in hyper-acute,acute and sub-acute stages,respectively.CTA showed that the rates of intracranial vascular lesions were 53. 33%,78. 95% and 100%,respectively,and the difference was significant( P < 0. 05). Of the 100 patients,69 cases underwent DWI examination including 15,18 and 36 cases in hyper-acute,acute and sub-acute stages,respectively.Of the 15 hyper-acute cases,13 showed significant high signal of the DWI and significant low signal of the ADC,while 2 showed no significant abnormality in the DWI signal.All 18 acute cases showed high signal of the DWI and low signal of the ADC.All 36 sub-acute cases showed slightly high signal of the DWI and slightly low signal of the ADC.The ADC values in the affected side of the patients at hyperacute,acute and sub-acute stages were gradually increased in turn.The values were significantly different when compared to those of the corresponding healthy side( P < 0. 05).Conclusion CTA and DWI can effectively display the cerebral vascular lesions,infarction lesions and brain parenchyma in ACI patients with different onset time. Both of them can provide reliable basis for the early diagnosis of ACI.
Objective To analyze the application value of CT angiography( CTA) and diffusion weighted imaging( DWI) in the diagnosis of acute cerebral infarction( ACI) at different onset time.Methods One hundred patients with ACI admitted to our hospital were selected as the study objects.There were 20 cases at hyper-acute stage( <6 h),38 cases at acute stage( 6 ～ 24 h) and 42 cases in sub-acute stage( 24 ～ 72 h) according to onset time.All patients were voluntarily cooperated to complete the CTA or DWI examinations.The results of CTA and DWI at different onset time were analyzed and compared.Results Routine CT and MRI at the hyper-acute phase showed no obvious abnormalities.Routine CT scans at acute and sub-acute stages indicated the presence of early cerebral infarction in most cases.Routine MRI scans showed large hyper intense lesions on T2 WI.Of the 100 patients,83 cases underwent CTA examination including 15,29 and 39 cases in hyper-acute,acute and sub-acute stages,respectively.CTA showed that the rates of intracranial vascular lesions were 53. 33%,78. 95% and 100%,respectively,and the difference was significant( P < 0. 05). Of the 100 patients,69 cases underwent DWI examination including 15,18 and 36 cases in hyper-acute,acute and sub-acute stages,respectively.Of the 15 hyper-acute cases,13 showed significant high signal of the DWI and significant low signal of the ADC,while 2 showed no significant abnormality in the DWI signal.All 18 acute cases showed high signal of the DWI and low signal of the ADC.All 36 sub-acute cases showed slightly high signal of the DWI and slightly low signal of the ADC.The ADC values in the affected side of the patients at hyperacute,acute and sub-acute stages were gradually increased in turn.The values were significantly different when compared to those of the corresponding healthy side( P < 0. 05).Conclusion CTA and DWI can effectively display the cerebral vascular lesions,infarction lesions and brain parenchyma in ACI patients with different onset time. Both of them can provide reliable basis for the early diagnosis of ACI.
引文
[1] Dong XL,Xu SJ,Zhang L,et al. Serum Resistin Levels May Contribute to an Increased Risk of Acute Cerebral Infarction[J].Molecular Neurobiology,2017,54(3):1919-1926.
[2]Toyoda S,Takekawa H,Asakawa Y,et al. Comparison of carotid artery ultrasonography findings between acute coronary syndrome and atherothrombotic cerebral infarction[J].Journal of Medical Ultrasonics,2018,45(1):149-154.
[3]龙斌,阳义,宋少辉,等.双源CT容积脑灌注在急性脑梗死诊断中的应用价值[J].中国现代医学杂志,2016,26(10):107-110.
[4]刘晓知,方勇超,周道田.磁共振DWI和PWI联合在不同时期脑梗死早期诊断中的应用价值[J].临床和实验医学杂志,2017,16(15):1508-1513.
[5]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]赵学媛,么恩亮,孙志华.ADC值变化对溶栓治疗前后脑缺血性半暗带的评估[J].临床放射学杂志,2016,35(2):171-174.
[7]Luo S,Yang L,Wang L. Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke[J]. Journal of Neuroradiology,2015,42(5):255-260.
[8]赵新光,赵蕊,马茜,等.脑梗死与脑出血急性期应用DWI联合SWI诊断的价值[J].中国CT和MRI杂志,2017,15(1):20-22.
[9]温学花,丁忠祥,李玉梅,等.非时变CTA在急性脑梗死患者脑侧支循环的应用研究[J].实用放射学杂志,2017,33(3):365-368.
[10]魏建海.DWI和血管成像在急性脑梗死诊断中的临床应用价值分析[J].中国医疗设备,2016,31(1):53.
[11]凌佳龙,骆少明.磁共振DWI和FLAIR序列在早期诊断急性脑梗塞中的应用价值研究[J].中国CT和MRI杂志,2018,16(1):19-21.
[12]蒋宇宏,宋少辉,刘海滨.磁共振氢质子波谱序列点分解频谱分析法和弥散加权成像在超急性期脑梗死缺血半暗带的临床应用[J].新乡医学院学报,2014,31(5):353-355.
[13]徐军红,周智鹏,邓燕贤,等.弥散加权成像及表面弥散系数在猴脑梗死模型中的应用及变化规律[J].广西医学,2013,35(11):1435-1438.
[2]Toyoda S,Takekawa H,Asakawa Y,et al. Comparison of carotid artery ultrasonography findings between acute coronary syndrome and atherothrombotic cerebral infarction[J].Journal of Medical Ultrasonics,2018,45(1):149-154.
[3]龙斌,阳义,宋少辉,等.双源CT容积脑灌注在急性脑梗死诊断中的应用价值[J].中国现代医学杂志,2016,26(10):107-110.
[4]刘晓知,方勇超,周道田.磁共振DWI和PWI联合在不同时期脑梗死早期诊断中的应用价值[J].临床和实验医学杂志,2017,16(15):1508-1513.
[5]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[6]赵学媛,么恩亮,孙志华.ADC值变化对溶栓治疗前后脑缺血性半暗带的评估[J].临床放射学杂志,2016,35(2):171-174.
[7]Luo S,Yang L,Wang L. Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke[J]. Journal of Neuroradiology,2015,42(5):255-260.
[8]赵新光,赵蕊,马茜,等.脑梗死与脑出血急性期应用DWI联合SWI诊断的价值[J].中国CT和MRI杂志,2017,15(1):20-22.
[9]温学花,丁忠祥,李玉梅,等.非时变CTA在急性脑梗死患者脑侧支循环的应用研究[J].实用放射学杂志,2017,33(3):365-368.
[10]魏建海.DWI和血管成像在急性脑梗死诊断中的临床应用价值分析[J].中国医疗设备,2016,31(1):53.
[11]凌佳龙,骆少明.磁共振DWI和FLAIR序列在早期诊断急性脑梗塞中的应用价值研究[J].中国CT和MRI杂志,2018,16(1):19-21.
[12]蒋宇宏,宋少辉,刘海滨.磁共振氢质子波谱序列点分解频谱分析法和弥散加权成像在超急性期脑梗死缺血半暗带的临床应用[J].新乡医学院学报,2014,31(5):353-355.
[13]徐军红,周智鹏,邓燕贤,等.弥散加权成像及表面弥散系数在猴脑梗死模型中的应用及变化规律[J].广西医学,2013,35(11):1435-1438.