急性脑梗死梗死灶体积对脑半卵圆中心代谢作用的探讨

Research on the Impact of Volume of Focus on the Centrum Semiovale Metabolic Changes of Acute Cerebral Embolism

目的：应用质子磁共振波谱（1H-MRS）技术研究急性脑梗死梗死灶体积大小对患侧半卵圆中心代谢的影响。方法：应用1.5T MRI扫描仪对28例临床和MRI确诊为大脑中动脉支配区急性（6~48 h）脑梗死患者（病例组）、同期收治的半卵圆中心脑梗死患者10例（阳性对照组）和健康志愿者20名（正常对照组）均进行1H-MRS检测,测量患侧及健侧半卵圆中心感兴趣区（ROI）的N-乙酰天冬氨酸（NAA）/肌酸（Cr）比值、胆碱化合物（Cho）/肌酸（Cr）比值,所用序列为点解析波谱序列。采用Efilm workstation影像软件处理MRI,测量并计算梗死灶体积。根据脑梗死灶体积大小再将病例组分为0.5~7.9cm3、8~15.9 cm3和16~24 cm3亚组,采用SPSS 11.0统计软件行单因素方差分析。结果：①病例组（双侧）、正常对照组和阳性对照组半卵圆中心ROI：NAA/Cr、Cho/Cr比值均差异有统计学意义（P〈0.05）;②患侧ROI：0.5~7.9 cm3亚组NAA/Cr、Cho/Cr比值均较8~15.9 cm3组和16~24 cm3亚组高,组间比较差异均有统计学意义（P〈0.05）;16~24 cm3亚组NAA/Cr、Cho/Cr比值均较0.5~7.9 cm3亚组和8~15.9 cm3亚组低,组间比较均差异有统计学意义（P〈0.05）。结论：梗死灶体积为0.5~24 cm3时,病例组患侧半卵圆中心ROI损伤随梗死灶面积增大而加重;其中16~24 cm3亚组半卵圆中心ROI的损伤最为严重。

Aim：To explore the impact of volume of focus on the centrum semiovale metabolic changes of acute cerebral embolism by using the non-invasive technique of the proton magnetic resonance spectroscopy（1H-MRS）.Methods：28 patients with acute cerebral embolism in the dominated areas of middle cerebral artery,which diagnosed by clinical and MRI（case group）,10 patients with cerebral infarction of centrum semivoale（positive control group）,20 healthy volunteers（normal control group） were examined by using non-invasive technique of 1H-MRS.Centrum semiovale were examed with 1.5T MR system by selecting point resolved spectroscopy sequence and using multi-voxel approach.Measure the volume of the focus of acute cerebral embolism by Efilm workstation.The case group was divided into 3 groups according with the volume of the focus：0.5-7.9 cm3,8-15.9 cm3 and 16-24 cm3 group.The data was analyzed by one-way ANOVA with SPSS11.0.Results：①There was significant difference among the groups of case（both side）,positive control,normal control in NAA/Cr,Cho/Cr.（P0.05）.②In case group,the value of NAA/Cr,Cho/Cr in group 0.5-7.9 cm3 was the highest.It had statistically significant difference to the other 2 groups.The value of NAA/Cr,Cho/Cr in group 16-24 cm3 was the lowest.It had statistically significant difference to the other 2 groups.Conclusion：The degree of damage aggravated as the volume of the focus increased in the centrum semiovale（ROI） when volume of the focus was less than 24 cm3.However,the degree of damage on ROI around the embolism lesion was the most serious in group of 16-24 cm3.