脑梗死后磁共振灌注加权成像-弥散加权成像不匹配区血流灌注水平的动态变化和临床意义

Dynamic changes and clinical value of blood perfusion in perfusion weighted image-diffusion weighted image mismatched regions after stroke

目的探讨脑梗死后磁共振灌注加权成像-弥散加权成像（PWI-DWI）不匹配区血流灌注水平的变化，分析其变化的机制及其对预后的影响。方法纳入2009年1月至2011年6月就诊于南京大学医学院附属鼓楼医院且发病在72h内的急性前循环脑梗死患者84例，行磁共振灌注扫描，根据PWI-DWI的匹配情况将患者分为不匹配组（n=31）和匹配组（n=53）。两组患者均接受相同的包括抗血小板、抗自由基、调脂在内的综合治疗方案，在发病时、治疗的第12天和治疗3个月时行日常生活能力量表（Activity of Daily Living scale，ADL）评分，比较两组患者神经功能的恢复情况。不匹配组患者在治疗第12天时复查磁共振灌注扫描，比较治疗前后灌注参数的变化情况。结果治疗12d时两组患者的ADL评分差异无统计学意义，3个月时不匹配组的ADL评分[（75．48±3．26）分]显著优于匹配组[（66．23±3．04）分]，差异有统计学意义（t=2．079，P〈0．05）。不匹配组患者不匹配区治疗前后的相对脑血流量增加7．37％（t=-2．076，P〈0．05），相对平均通过时间缩短11．06％（t=2．972，P〈0．01）。结论梗死灶周围具有PWI-DWI不匹配区域的患者远期神经功能改善好于PWI-DWI匹配的患者，可能与不匹配区的脑组织血流灌注的改善有关。

Objective To investigate the changes and the mechanism of blood perfusion in perfusion weighted image （PWI）-diffusion weighted image （DWI） mismatched regions after infarction and to assess the effect on prognosis. Methods We assessed 84 patients with acute cerebral infarction within 72 hours of onset in the territory of anterior circulation, who admitted to Affiliated Drum Tower Hospital, Nanjing University Medical School between January 2009 and June 2011. All patients were imaged with 3.0 T MRI on day one. The patients were divided into mismatched group （31 patients） and matched group （53 patients） according to the basis of PWI-DWI. The two groups received the same treatment including anti- platelet, oxygen free radical scavenger and lowing cholesterol therapy. Barthel index was used to evaluate neurological deficit on day 0, day 12 and three months later. We also compared the perfusion parameters of day 0 with day 12 by PWI from mismatched group. Results On day 12, the value of relative cerebral blood flow increased by 7.37% （t = -2. 076, P 〈0. 05） and the value of relative mean transit time decreased by 11.06% （t = 2. 972,P 〈0. 01 ） compared with that on day 0 from mismatched group. However, there was no significant difference in Activity of Daily Living scale （ADL） score between the two groups after 12 days＇ treatment. After three months, the patients of mismatched group had higher ADL score （75.48 ± 3.26） than that of matched group （66. 23 ± 3.04 ; t = 2. 079, P 〈 0. 05 ）. Conclusion The patients of mismatched group had better neurofunction than matched group, possibly related to improvement of perfusion in mismatched area.