功能磁共振对脑梗死后出血性转化的预测

Prediction of hemorrhagic transformation after cerebral infarction by functional magnetic resonance imaging

目的探讨功能磁共振在脑梗死患者出血性转化中的预测价值。方法对44例脑梗死患者进行队列研究。所有患者均进行弥散加权成像(diffusion-weighted imaging,DWI)及灌注加权成像(perfusion-weighted imaging,PWI)检查。患者根据有无溶栓分为溶栓组20例,非溶栓组24例;根据有无出血性转化(hemorrhagic transformation,HT)分为HT组13例,非HT组31例。比较各自临床及功能磁共振上的特点。结果 44例患者中,发生HT的患者共13例,占29.5%。其中溶栓组发生HT 8例,占40%。保守治疗组发生HT 5例,占20.8%。溶栓组PWI上相对局部脑血容量值(relative regional cerebral blood volume,rrCBV)较非溶栓组降低,差异有统计学意义(P=0.037)。HT组入院时血糖、DWI上病灶体积、最低ADC值异与非HT组差异有统计学意义。结论脑梗死后HT是一个常见的并发症,溶栓治疗后发生率增加,功能磁共振可以预测溶栓后HT。

Objective To investigate the predictive value of functional magnetic resonance imaging in patients with hemorrhagic transformation after cerebral infarction.Methods A cohort study was completed with 44 cases of cerebral infarction patients.All patients underwent diffusion-weighted imaging（DWI） and perfusion-weighted imaging（PWI） examination.The patients were divided into two groups（thrombolysis group of 20 patients,non-thrombolysis group of 24 patients） according to whether thrombolytic was used.According to whether occurred hemorrhagic transformation（HT）,the patients were divided into HT group of 13 cases and non-HT group of 31 cases.The features of clinical and functional magnetic resonance imaging were compared between different groups.Results In 44 patients,13 cases occurred in HT,accounting for 29.5%.8 cases in thrombolytic group occurred in HT,accounting for 40%.5 cases in conservative treatment group occurred in HT,accounting for 20.8%.The relative regional cerebral blood volume（rrCBV） of thrombolysis group on PWI were statistically lower than that of non-thrombolysis group（P = 0.037）.Compared with non-HT group,the level of blood glucose was statistically higher in HT group on admission,lesion volume on DWI was larger and low ADC value was significantly lower statistically.Conclusion Hemorrhagic transformation is a common complication in cerebral infarction,the risk increased after thrombolytic therapy.Functional magnetic resonance imaging can be helpful to predict HT in patients who received thrombolytic therapy.