急性缺血性卒中的MRI早期诊断价值

Diagnostic value of MRI for patients with acute ischemic stroke

目的：评价神经影像技术对早期脑梗塞的病灶显示、病变发展及其对治疗的临床应用价值。方法：35例临床初诊急性脑梗塞病人，出现症状后1．5～24h内分别行平扫CT、常规MRI、MR血管成像、弥散（DWI）和灌注（PWI）MR成像；13例行静脉内溶栓治疗并于2w内随访治疗效果。结果：35例中脑出血6例，平扫CT对急性脑梗塞征象显示率为48．3％；29例脑梗塞中，常规MRI、DWI、PWI均显示病灶；T1WI显示病灶范围最小，T2WI、FLAIR序列显示病灶范围逐渐增加；20例同时行DWI和PWI中，13例（65％）出现弥散一灌注不匹配，溶栓治疗7例症状好转（53．3％）。结论：神经影像技术中的DWI和PWI可以在脑梗塞后有效治疗时间窗内显示病灶的大小和血液动力学改变，结合CT平扫和常规MRI序列，有助于尽早溶栓治疗，减轻症状，恢复功能，提高病人生存质量。

Objective：To evaluate the clinical value of neuroimaging technique for diagnosis of acute stroke. Methods： 35 patients with acute stroke diagnosed clinically were examined with nonenhanced CT, routine MRI, MRA, diffusion imaging and perfusion imaging after 1.5 to 24 h stroke onset, respectively. 13 cases of 35 ones were treated with intravenous thrombolysis and followed - up in 2 weeks. Results： 6 patients with acute hemorrhage were diagnosed by nonenhanced CT and display rate of nonenhanced CT for acute stroke was 48. 3%. Ischemic lesions were displayed by routine MRI, diffusion imaging and perfusion imaging in 29 patients. The lesions showed by TlWI were the smallest compared with T2WI and FLAIR. Perfusion - diffusion mismatch was found in 13 cases （65） of 20 patients with acute ischemic stroke examined by both I）WI and PWI. 7 ones （53. 3%） of the 13 cases treated with intravenous thrombolysis had good therapy results. Conclusion： DWI and PWI of neruoimaging technique can display size and blood dynamics of acute ischemic lesions in the time window for thrombolysis. Combination of nonenhanced CT with routine MRI will be helpful to decision on thrombolysis treatment as early as possible.