皮层下脑梗死体积演变及其与临床预后关系的MRI研究

Application of MRI in monitoring the lesion volume evolution of subcortical infarction

目的:探讨磁共振测量皮层下脑梗死患者梗死灶体积变化,及其对于判断临床预后的价值。方法:搜集40例首次单发皮层下脑梗死患者,腔隙性脑梗死组患者19例,非腔隙性脑梗死组21例。全部研究对象均在症状出现后<7天、<15天、1月、3月、6月进行五次MRI检查。患者每次MRI检查前或检查后由两名有经验的神经内科医师,应用NIHSS量表对患者进行临床评分。比较腔隙性脑梗死组及非腔隙性皮层下脑梗死组内不同时间点脑梗死灶体积、NIH-SS评分的差异;对腔隙性脑梗死组及非腔隙性皮层下脑梗死组病灶体积与NIHSS评分进行相关性分析。结果:腔隙性脑梗死患者的病灶体积,随检查时间延长而逐渐减小;不同时间点的体积之间有显著性差异(P<0.01);患者的NIHSS评分,随检查时间延长而逐渐降低;不同时间点的评分之间有显著性差异(P<0.01)。非腔隙性皮层下脑梗死患者的病灶体积,虽然随检查时间延长而逐渐减小,但不同时间点的体积之间无显著性差异(P>0.05);患者的NIHSS评分,随检查时间延长而逐渐降低,不同时间点的评分之间有显著性差异(P<0.01)。腔隙性脑梗死患者第1次检查的病灶体积,与随访的NIHSS评分均无明显相关(P>0.05)。非腔隙性皮层下脑梗死患者第1次检查的病灶体积,与随访第4次和第5次的NIHSS评分均呈明显正相关(P<0.01)。结论:磁共振成像对监测皮层下脑梗死灶体积演变及其与临床预后的关系有重要价值。

Objective：To explore the value of magnetic resonance imaging （MRI） for monitoring the lesion volume evolution and the correlation with the scores of National Institutes of Health stroke scale （NIHSS） in patients with subcortical infarction. Methods：Forty patients with single subcortical infarction of subacute were included in the study. They were divided into lacunar （19 cases） and nonlacunar infarction （21 cases） groups. MRI examination and NIHSS evaluation were performed within 7 days,15 days,1 month,3 months and 6 months in all patients. The difference of infarction volume,NIHSS scores at different time points in lacunar and nonlacunar infarction groups were analyzed,respectively. The correlation between infarction volume and NIHSS scores was also analyzed. Results：In lacunar infarction group,the volume of infarcts decreased over time. There had significant difference among the different examinations （P0.01）. NIHSS scores decreased over time. There were significant differences among the different examinations （P0.01）. In nonlacunar infarction group,the volume of infarcts decreased over time. However,there were no significant differences among the different examinations （P0.05）. NIHSS scores decreased over time. There were significant differences among the different examinations （P0.01）. There was no significant correlation between the 1st lesion volume and the 4th and 5th NIHSS in lacunar infarction group （P0.05）. However,there was significant positive correlation between 1st lesion volume and the 4th and 5thNIHSS scores,respectively （P0.01）. Conclusion：MRI plays an important role for monitoring the lesion volume evolution and the correlation with the clinical outcome.