MR弥散加权成像和64排螺旋CT在急性缺血性脑卒中诊治中的应用比较

Comparison of MR-DWI and 64 slice CT in diagnosis and treatment of acute ischemic stroke

目的:探讨MR弥散加权成像(MR-DWI)与64排螺旋CT在急性缺血性脑卒中(AIS)诊治中的应用价值差异。方法:选取我院急性缺血性脑卒中患者158例,全部患者于溶栓治疗前后行颅脑MR弥散加权成像和64排螺旋CT,比较病灶与健侧成像区影像学参数,表观扩散系数(ADC)、脑血流量(CBF)、脑血容量(CBV)和达峰时间(TTP)的差异,评估两种检查方法对AIS的诊断效能ROC曲线下面积(AUC)。结果:MR-DWI显示大脑中动脉、颈内动脉血管阻塞,脑部缺血性病灶形成,64排螺旋CT显示急性颅脑基底节区缺血病灶形成,其中缺血病灶区平均ADC值、CBF和CBV明显降低;TTP明显增高,与健侧区比较差异具有统计学意义(P<0.05),经溶栓治疗后,生存组平均ADC值、CBF和CBV明显高于死亡组,TTP明显低于死亡组,两组比较差异具有统计学意义(P<0.05),MR-DWI对AIS诊断AUC值为0.812,明显高于64排螺旋CT(0.705),两者比较差异具有统计学意义(P<0.05)。结论:MR弥散加权成像和64排螺旋CT均能准确评估急性缺血性脑卒中缺血病灶形成和溶栓治疗效果,但前者的诊断效能更佳。

Objective： To compare the application of MR-DWI and 64 slice CT in diagnosis and treatment of acute ische- mic stroke. Methods： A total of 158 patients with acute ischemic stroke were selected, who all underwent brain MR-DWI and 64 slice CT pre-or-post thrombolytic therapy. Imaging parameter （ADC, CBF, CBV, TTP） were compared between lesions and the contralateral. AIS diagnostic efficiency （AUC） was evaluated. Results： MR-DWI showed middle cerebral artery and in- ternal carotid artery vascular obstruction, brain ischemic lesion, 64 slice spiral CT showed acute brain basal ganglia ischemia le- sion, average ADC ischemic lesions, CBF and CBV value significantly decreased, TTP increased obviously, compared by the contralateral region with statistical significantly difference （P〈0.05）, After thrombolysis therapy, average ADC value, CBF and CBV of survival group were significantly higher than death group, TTP was significantly lower than death group （P〈0. 05）, AUC value of MR-DWI in AIS diagnosis was 0. 812, significantly higher than 64 slice CT （0. 705） （P〈0.05）. Conclusions： MR-DWI and 64 slice spiral CT can accurately assess acute ischemic stroke lesion and thrombolytic therapy effect, butMR-DWI has higher diagnostic value.