^1HMRS在脑梗塞中的临床应用

The Clinical Application of 1HMRS in Cerebral Infarct

目的 应用氢质子磁共振波谱 (1HMRS)和化学位移成像 (chemicalshiftimaging ,CSI)研究人脑梗塞中代谢物随时间的变化规律 ,评价1HMRS在脑梗塞中的临床应用价值。材料与方法 2 8例脑梗塞患者根据发作时间将其分为 :超急性期 (6小时内 ) 2例 ;急性期 (6小时后至 2天内 ) 6例 ;亚急性期 (2天后至 6周内 ) 12例 ;慢性期 (6周后 ) 8例。将正常对侧相同部位 2 0例作为自身对照组。应用定点分辨选择波谱 (pointedresolvedselectivespectroscopy ,PRESS) /TE 13 5msCSI和两侧相对应部位PRESS/TE 13 5ms单体素采集。测算N 乙酰天门冬氨酸 (NAA)、肌酸 (Cr)、含胆碱类化合物 (Cho)与对照组的比值及同侧NAA/Cho、NAA/Cr、Lac/Cho(乳酸 /含胆碱类化合物 )的变化。结果 超急性期 2例出现Lac而NAA、Cho、Cr改变不明显 ;急性期 5例Lac增加 ,NAA开始减少 ,Cr稍降低 ,Cho未见明显改变 ;亚急性期Lac进一步增加 ,2例复查患者 2周后Lac开始下降 ,但仍维持较高浓度 ,NAA继续减少 ,Cr降低 ,Cho稍减少 ;慢性期NAA、Cr进一步减少 ,3例在病灶区仍检测到一定浓度Lac ,5例未见明显的Lac ,3例 6个月后病灶边缘Cho浓度比对侧高 ,5例Cho降低。另外 3例亚急性期、2例慢性期明显脂肪峰。同对照组比较 ,2 8例患者总的NAA下降最明显 ,?

Objective To study the changes of the metabolite with the lapse of time and to evaluate 1HMRS in cerebral ischemic infarction.Materials and Methods According to the time after the attack, 28 cases with cerebral infarct were divided into four groups: (1) superacute group, <6h, n=2; (2) acute group, 6h～2d, n=6; (3) subacute group, 2d～6w, n=12; and (4) chronic group, >6w, n=8. The normal side (n=20) was taken as control group. PRESS/TE 135ms CSI and PRESS/TE 135ms single voxel acquisition of bilateral corresponding VOL was made. The ratio of NAA, Cr and Cho of study group to that of control group were measured, so were the values of NAA/Cho, NAA/Cr and Lac/Cho of the same side.Results During the superacute stage (n=2), Lac, NAA, Cho and Cr showed no marked alteration. In acute stage (n=6), Lac was increased, NAA began to decrease, Cr was slightly decreased and Cho was remained unchanged. In subacute stage, Lac was further increased and began to decrease after 2 weeks in 2 cases, NAA continued to low down, Cr was lowed and Cho was slightly decreased. In the chronic stage, NAA and Cr were further decreased, Lac showed could still be detected in 3 cases or couldn't be found in 5 cases. Higher Cho in the margin of the lesion was found in 3 cases after 6 months, lowered Cho in 5 cases compared with the control group. Obvious lipid peak was seen in 3 cases in subacute stage and 2 cases in chronic stage. NAA, Cr and Cho in study group were decreased to 58±15%, 35±26%, and 7±5.8%, respectively. NAA/Cho and NAA/Cr in study group were significantly decreased (P<0.001).Conclusion Increased Lac and decreased NAA are sensitive and reliable indexes reflecting ischemic injury. 1HMRS can noninvesively monitor material and energetic metabolism, as well as the physiologic and biochemical changes in cerebral infarction, providing information useful for clinical and therapeutic estimation.