急性大面积脑梗死血栓的磁敏感加权成像与临床相关性研究

Correlation Study between Susceptibility Weighted Imaging of the Acute Massive Ischemic Stroke Thrombosis and Clinical Scores

目的分析急性大面积脑梗死患者血栓的磁敏感加权成像(SWI)特点及其与临床的相关性。方法选择46例急性大面积脑梗死(临床症状出现<24 h)患者进行SWI检查,并在2周、3个月进行随诊。分析急性大面积脑梗死血栓的SWI图像特点,并得出相应美国国家健康研究所脑卒中分级量表(NIHSS)评分,进行相关统计学分析。结果有34例显示血栓存在,占74%。其中急性期和亚急性期(<2周)显示32例,稳定恢复期(>3个月)显示2例,不同时期内血栓的显示特点差异有统计学意义(P<0.05)。其中血栓长度≥4 cm 23例,血栓长度与临床NIHSS评分有相关性(r=0.783,P<0.01)。血栓位于梗死血管起始部26例,远侧部8例,血栓的位置与临床NIHSS评分有相关性(r=0.747,P<0.01)。结论 SWI对无创显示急性大面积脑梗死血管内血栓具有敏感性和特异性;量化分析有助于判断急性大面积脑梗死的演变情况,对临床治疗及预后评估起到一定的指导作用。

Objective To analysis the features of the acute massive ischemic stroke thrombosis in the SWI,and its correlation with clinical scores.Methods 46 patients with acute massive cerebral infarction were performed by SWI,and followed within 2 weeks and 3 months respectively.SWI images of cerebral infarction vessel clot were analyzed.Correlation between the extent of the infarction vessel thrombosis and the clinical NIHSS was analyzed.Results The clot was revealed by SWI in 34 out of 46 cerebral infarctions,the proportion is 74%.32 cases occurred in acute and subacute cerebral infarction,and only 2 cases was in steady and chronic stage.The visualization of thrombosis in different stages has statistical significance（P〈0.05）.22 cases clot length are longer than 3cm.There was a significant positive correlation between the clot length displayed in the SWI and the NIHSS scores（r = 0.783,P〈0.01）.26 thrombosis occurred in the initial part of the infarct vessels.8 thrombosis are in the distal.There was a correlation between the clot location and the NIHSS scores（r = 0.747,P〈0.01）.Conclusion SWI is sensitive and special to noninvasive display of the acute massive cerebral infarction intravascular thrombosis.Quantitative analysis is helpful to determine the evolution of the acute massive ischemic stroke,and guide the clinical treatment and prognosis evolution.