DWI对MCA狭窄患者卒中亚型的诊断

Stroke subtype diagnosis of early DWI in patients with middle cerebral artery occlusive disease

目的:评价弥散加权MRI(Diffusion-weighted imaging,DWl)对MCA狭窄患者急性梗死的诊断价值。方法:经TCD／MRA诊断的症状性大脑中动脉粥样硬化性狭窄(以下简称MCA闭塞性病变:middle cerebral artery occlesive disease MCAOD)患者,分别于病后1周内行头颅水抑制MRI成像(Fluid-attenuated inversion recovery,FLAIR)及DWI检查,比较FLAIR、DWI所示梗死灶的类型和数量。结果:238例症状性MCAOD患者的FLAIR结果表明,单发腑梗死137例(57.6％),多发性脑梗死101例(42.4％)。其中皮层区域内梗死82例(34.5％),深部小梗死120例(50.4％),变界区梗死143例(60.1％)。而内交界区梗死、半卵园中心梗死以及伴随的皮层小梗死的发生率分别为52.9％、22.7％、13.0％,84例MCAOD患者的DWl结果表明,73.8％患者呈多发性脑梗死表现,皮层区域内梗死、交界区梗死、深部小梗死的发生率分别为46.4％、56％和44.0％,而皮层播散性小梗死(22.6％)、半卵园中心梗死(29.1％)的诊断率高于FLAIR结果。结论:DWI对于微小梗死以及多发梗死的诊断明显优于FIAIR成像,尤其对于皮层播散性小梗死灶以及半卵园中心梗死的诊断更敏感,利于卒中亚型的诊断及卒中机制的判断。

Objective: To assess the diagnostic value of early DWI in ischemic stroke patients with MCA occlusive disease . Methods: Acute ischemic stroke parents with MCAOD performed FLAIR sequenceMRI and DW1 scan. Then infaret subtypes were diagnosed respectivelydependcnt on lesion size, site and number on FLAIR and DWI. Results:238 patients with FLAIR scan showed that 42. 4% patients have multipleinfarctions. Among of them, internal border zone (IBZ) infarction was themost common infarction pattern (52. 9%); centrum ovalc and corticalsmall infarction were 22. 7%, 13. 0% respectively. The prevalence ofcortical territory infarcts, deep small infarcts and border zone infarctswere 34. 5%. 50. 4% and 60. 1% respectively. DWI results showed that thepatients with cortical territory infarcts, border zone infarcts and decpsmall infarcts were 46. 4 %,56% . 44. 0% respectively in 84 patients, andprevalence of centrum ovale and cortical small infarcts were 29. 1% .22. 6% respectively. Conclusion: DWI was more sensitive than FLAIRscan for cortical small infarct and centrum semiovale infarcts and morehelpful to understand infaret pattern and pathogencsis of ischemic slrokc with MCAOD.