MR波谱成像在超急性脑梗死溶栓治疗中的应用研究

The application of magnetic resonance spectroscopic imaging in thrombolytic therapy of hyperacute cerebral infarction

目的探讨氢质子磁共振波谱分析(1H-MRS)在超急性脑梗死溶栓治疗中的应用价值。材料与方法根据临床治疗方案不同将超急性期脑梗死患者分为溶栓组与非溶栓组,两组均行常规磁共振(MRI)及1H-MRS扫描,分别比较病灶中心区、病灶边缘区、病灶周围正常区与对侧镜像区之间NAA、Cr、Cho、NAA/Cr、Cho/Cr、NAA/Cho等值的差异。结果 (1)溶栓组与非溶栓组病灶中心区、病灶边缘区及病灶周围正常区NAA、Cr、Cho均明显低于对侧镜像区(P<0.05),病灶中心区Lac较对侧镜像区升高(P<0.05)。(2)溶栓组病灶中心区与病灶边缘区Cr、NAA/Cho明显低于非溶栓组(P<0.05),溶栓组病灶边缘区Lac、Lac/Cr低于非溶栓组(P<0.05)。(3)溶栓组患者病灶侧NAA、NAA/Cho与临床NIHSS评分呈明显的负相关(P<0.05),病灶侧Lac与临床NIHSS评分呈明显的正相关(P<0.05)。非溶栓组患者病灶侧Lac与临床NIHSS评分呈明显的正相关(P<0.05)。结论 1H-MRS可以直接、准确地、全面地检测脑梗死溶栓治疗后脑受损神经元的恢复情况,能客观评价脑梗死预后及临床治疗效果,为其临床应用奠定基础。

Objective： To investigate the application value of proton magnetic resonance spectroscopy（1H-MRS） in thrombolytic therapy of hyperacute cerebral infarction. Materials and Methods： According to the clinical treatment, patients with acute cerebral infarction were divided into thrombolysis group and non thrombolysis group. The two groups underwent conventional magnetic resonance（MRI） and 1HMRS scans. Then we respectively compared the difference between the concentrations of Cr, Cho, NAA, the ratio of NAA/Cr, Cho/Cr, NAA/Cho in the infraction center, the border region, the normal region around the lesion and the contralateral area. Results：（1） In the thrombolysis group and non-thrombolysis group, the concentrations of Cr,Cho, NAA in the infraction center, the border region, the normal region around the lesion were significantly lower than the contralateral area（P〈0.05）, Lac increases compared with the contralateral area.（2） In the thrombolysis group, the concentrations of Cr and ratio of NAA/Cho in the infraction center and the border region were significantly lower than the non thrombolysis group（P〈0.05）, the concentrations of Lac and ratio of Lac/Cr in the border region were significantly lower than the nonthrombolysis group（P〈0.05）.（3） In the thrombolysis group, the NAA, NAA/Cho in the infraction center were significantly negatively correlated with NIHSS score, the Lac in the infraction center was significantly positively correlated with NIHSS score.In the non-thrombolysis group, the Lac in the infraction center was also significantly positively correlated with NIHSS score.Conclusions： Multivoxel 1H-MRS can directly, accurately and comprehensively detect the recovery of cerebral injured neurons after thrombolytic therapy of cerebral infarction, it can objectively evaluate prognosis of cerebral infarction and the effect of clinical treatment, providing a foundation for clinical application.