急性脑梗死溶栓治疗的磁共振成像研究

Study of magnetic resonance imaging on thrombolysis in acute stroke

目的探讨MRI对急性脑梗死溶栓后血管再通和梗死灶变化的评价。方法32例大脑前循环阻塞的急性脑梗死患者,其中20例行动脉内溶栓治疗(溶栓组),12例保守治疗(保守组)。治疗前后行MR常规T1加权成像、T2加权成像检查和磁共振血管成像(MRA)以及治疗前弥散加权成像、灌注加权成像检查。比较治疗前后MRA显示的血管再通和梗死灶变化情况。结果治疗前,MRA显示78%(25/32)血管阻塞。治疗后,溶栓组MRA显示72%(13/18)血管早期再通,而保守组中29%血管再通;两组有显著性差异(P=0.0279)。血管再通的病灶增加较小,与血管未通者比较差异有显著性意义(P<0.05)。结论MRI有助于急性脑梗死治疗后血管早期再通的显示及临床治疗效果的评价。

Objective To investigate evaluation of post-thrombolytic vessel recanalization and the change of infarct lesions in acute stroke by magnetic resonance imaging （MRI）.Methods Thirty-two patients with acute ischemic stroke due to cerebral anterior circulation obstruction were included. They underwent T1WI, T2WI and MRA within 12 hours of symptom onset and 24 hours of intra-arterial thrombolysis respectively, and PWI and DWI within 12 hours of symptom onset. Of them, 20 received intra-arterial thrombolysis and others were given conservative therapy. Recanalization status and the changes of infarct lesions were analysed with MRI. Results MRA showed that 78% （25/32） of the patients had internal carotid artery or middle cerebral artery occlusion before intra-arterial thrombolysis and 72% （13/18） of the patients treated with thrombolysis had early recanalization, whereas only 29% （2/7） in those without thrombolysis. Significant difference could be seen between them（ Fisher＇ s exact test, P = 0.0279）. There was smaller increase in lesion sizes with recanalization compared with those without recanalization and the difference was significant. Conclusion MRA is helpful to showing early recanalization after thrombolysis and to judging clinical therapy.