SWI检测急性脑梗死伴有微出血病变的临床价值

SWI Detection of Acute Cerebral Infarction Accompanied by Micro Acute Hemorrhage Clinical Value

目的:探讨磁敏感加权成像(SWI)在急性期脑梗死伴有微出血病变中的诊断价值,以及在急性脑梗死患者溶栓治疗复查的监测意义。方法:对64例急性脑梗死的患者,行SWI、MR常规序列、DWI(diffusion weighted imaging,DWI)、CT扫描。分析上述序列对所有急性脑梗死病例脑微出血(cerebral microbleeds,CMBs)的检出率及在SWI上的分布特点,并根据SWI序列上CMBs的检出数量,对其进行分级。对所搜集病例中行溶栓治疗的患者48h后复查。结果:在64例急性脑梗死病例中,SWI序列、常规MR序列、DWI序列、CT扫描对CMBs的检出率分别为:39.0%、0.03%、7.8%及0.0%,差异具有统计学意义。根据急性脑梗死患者CMBs数量进行分级,轻、中、重度比例分别为20%、64%、16%。CMBs中度患者最常见。行溶栓治疗的急性脑梗死患者48h后复查,SWI检测出新出血灶,并且微出血灶体积增大、数量增多,SWI比常规MRI更敏感地检测出脑出血灶。结论:SWI与常规MR、DWI序列及CT相比,在CMBs的检出中具有明显的优势,这对于急性脑梗死患者抗凝溶栓治疗筛查及评估具有重大价值。在急性脑梗死患者溶栓治疗后的复查中能敏感地检测继发性出血灶,具有重要的预后监测作用。SWI有望替代CT扫描,成为急性脑梗死伴有微出血病变患者的首选检查手段。

Objective： To investigate the diagnostic value of susceptibility-weighted imaging（SWI） in acute cerebral infarction with cerebral microbleeds and monitoring function of cerebral infarction patients after thrombolytic therapy. Methods： 64 patients in our hospital with acute cerebral infarction were performed with conventional MRI, DWI, SWI and CT. The following analyses were performed. To record the detection rate of conventional MRI, DWI, SWI and CT in acute cerebral infarction with CMBs cases, and distribution feature of CMBs in SWI image. According to the number of CMBs on SWI sequence, we classify these cases as mild, moderate, severe. Review patients with thrombolytic treatment after 48 h. Result： The detection rates of acute cerebral infarction with CMBs were 39.0%（SWI）, 0.03%（conventional MRI）, 7.8%（DWI）, and 0.0%（CT）, respectively. There was significant difference among these different scanning methods. According to the number of CMBs in patients with acute cerebral infarction on SWI sequence, the proportion was 20%（mild）, 64%（moderate）, 16%（severe）, respectively. The most common classification was moderate in our cases. Review acute cerebral infarction patients with thrombolytic treatment after 48 h, not only SWI detected new intracerebral hemorrhage, but also volume and number of some CMBs increased. SWI was more sensitive to detect hemorrhage in acute cerebral infarction patients compare with conventional MRI, DWI and CT. Therefore SWI can be a monitoring method of cerebral infarction patients after thrombolytic therapy. Conclusion： Contrast with conventional MRI, DWI and CT, SWI has obvious advantages in detecting CMBs in acute cerebral infarction patients. This has great value for patients with acute cerebral infarction in thrombolytic therapy screening and assessment. SWI was more sensitive to detect secondary intracerebral hemorrhage in acute cerebral infarction patients review after thrombolytic treatment compare with conventional MRI, DWI and CT. It has important prognostic monitoring function. SWI is expected to replace CT, to be the first choice for the patients with acute cerebral infarction accompanied by micro acute hemorrhage.