头颅磁共振DWI-FLAIR序列的不匹配性在急性缺血性脑卒中患者中的检测及临床意义研究

Study on detection in patients with acute ischemic stroke and the clinical significance of mismatch MRI DWI- FLAIR sequence

目的探讨急性缺血性脑卒中患者头颅磁共振DWI-FLAIR序列不匹配性的临床检测意义。方法筛选2015年5月至2015年12月收治的急性缺血性脑卒中患者32例,作为研究对象。所有患者均经影像学及临床症状检查确诊为急性缺血性脑卒中,根据患者卒中发病时间以及DWI-FLAIR序列信号的改变将其分为0-4.5 h组、4.5-6.0 h FLAIR阳性组与4.5-6.0 h FLAIR阴性组,观察各时相DWI-FLAIR不匹配的敏感度与特异度,并比较不同时相患者溶栓治疗效果及DWI-FLAIR序列不匹配性在溶栓指导治疗中的应用价值。结果急性缺血性脑卒中患者发病后0-3 h、0-4.5 h组患者DWI-FLAIR不匹配敏感度为67.1%、87.5%,特异度为40.6%、74.5%,阳性预测值77.9%、87.0%,阴性预测值为76.9%、43.5%;溶栓治疗效果比较中DWI-FLAIR阴性组患者溶栓后再通率明显高于DWI-FLAIR阳性组,差异具有统计学意义（P〈0.05）;DWI-FLAIR阴性组溶栓后NIHSS评分、mRs评分明显低于DWIFLAIR阳性组,差异具有统计学意义（P〈0.05）。结论急性缺血性脑卒中患者行头颅磁共振检查,DWI-FLAIR不匹配性在指导不同发病时间患者溶栓治疗中的具有重要意义,对于发病后4.5-6.0 h FLAIR阴性患者仍可进行静脉溶栓治疗,DWI-FLAIR可作为一种客观的影像学指标判断患者发病时间范围。

Objective To investigate the clinical significance of not matching in cranial MRI DWI- FLAIR sequence in patients with acute cerebral ischemic stroke. Methods 32 patients with acute ischemic stroke from May 2015 to December 2015 in our hospital were included as the research object. All patients were diagnosed by imaging methods and clinical symptoms as acute ischemic stroke. According to the time of patients with stroke incidence and the changes DWI- FLAIR sequence signal,these patients were divided into the different group,0 - 4. 5 h group,4. 5 - 6. 0 h flair positive group and 4. 5 - 6. 0 h flair and negative group. The sensitivity and specificity were observed in the different phase with the DWI- FLAIR not matching. At the same time,we compared the effect of thrombolytic therapy and evaluated the application value of DWI-FLAIR not matching in guiding the thrombolytic therapy. Results The sensitivity of acute ischemic brain after stroke onset in 0 - 3 h,0 - 4. 5 h groups DWI- FLAIR not matching was 67. 1%,87. 5% and the specificity was 40. 6%,74. 5%,the positive predictive value of 77. 9%,87.0% and the negative predictive value was 76. 9%,43. 5%. The effect of thrombolytic therapy in patients with negative thrombolysis DWI- FLAIR again pass rate was significantly higher than that of DWI- FLAIR positive group,the difference has statistical significance（ P〈0. 05）. NIHSS and Mrs scores of DWI- FLAIR negative group after thrombolysis were significantly lower than DWI- FLAIR positive group,with statistical significance（ P〈0. 05）. Conclusion Acute ischemic stroke patients outfit transcranial magnetic MRI,DWI- FLAIR mismatch of in guiding the different time of onset of thrombolytic therapy in patients with is of great significance. After the onset of 4. 5 - 6h,patients with negative flair are still of intravenous thrombolytic therapy. DWI- FLAIR can be an objective image as index to determine the onset time range.