多模MRI在急性缺血性脑卒中患者诊治中的应用

Application of Multimodal MRI in the Diagnosis and Treatment of Patients with Acute Ischemic Stroke

目的探究多模式磁共振成像(MRI)在急性缺血性脑卒中(AIS)诊治中的应用效果。方法回顾性分析我院发病时间为4.5h-9h的210例AIS患者临床资料。经多模式MRI中弥散加权成像(DWI)及液体衰减反转恢复序列(FLAIR)不匹配筛选超急性期AIS患者,并根据其是否接受溶栓治疗分为溶栓治疗组(观察组)及非溶栓治疗组(对照组),比较两组治疗前一般资料及治疗后临床疗效[治疗7d后美国国立卫生研究院卒中量表(NIHSS)、日常生活能力评定量表(BI)]、预后情况[治疗90d后BI、改良Rankin评分(mRS)]差异。结果210例AIS患者中102例(48.57%)DWI/FLAIR不匹配,判定为超急性期AIS,其中接受溶栓治疗的有64例(62.75%,即观察组),38例(37.25%,即对照组)不愿接受溶栓治疗。两组患者一般资料比较,差异无统计学意义(P>0.05)。观察组治疗7d后NIHSS评分、治疗30d后mRS评分均低于对照组(P<0.05),而治疗7d及治疗90d后BI评分均高于对照组(P<0.05)。结论多模式MRI能辅助评估超急性期AIS患者,筛选出溶栓治疗适应病例,有助于提高AIS患者临床疗效、改善预后。

Objective To explore the effects of multimodal magnetic resonance imaging(MRI) in the diagnosis and treatment of acute ischemic stroke(AIS). Methods The clinical data of 210 patients with AIS who had a onset time from 4.5 h to 9 h in our hospital were analyzed retrospectively. Multimodal MRI diffusion-weighted imaging(DWI) and fluidattenuated inversion-recovery sequence(FLAIR) mismatching were used to screen patients with AIS in hyperacute phase, and the patients were divided into thrombolytic therapy group(observation group) and non-thrombolytic group(control group) according to whether they received thrombolytic therapy or not. The general data before treatment,clinical efficacy after treatment [National Institute of Health Stroke Scale(NIHSS), Daily Living Ability Rating Scale(BI)] and prognosis [BI after 90 d of treatment, modified Rankin score(mRS)] were compared between the two group. Results Of the 210 AIS patients, 102 cases(48.57%) were with DWI/FLAIR mismatching and were judged to be AIS in hyperacute phase. Among them, 64 cases(62.75%, observation group) received thrombolytic therapy and 38 cases(37.25%, control group) were reluctant to receive thrombolytic therapy. There were no significant differences in the general data between the two groups(P>0.05). The NIHSS score after 7 d of treatment and the mRS score after30 d of treatment in observation group were lower than those in control group(P<0.05),but the BI scores after 7 d of treatment and after 90 d of treatment were higher than those in control group(P<0.05). Conclusion Multimodal MRI can assist to evaluate patients with AIS in hyperacute phase, and screen the adaptation cases for thrombolytic therapy,and it can improve the clinical efficacy and promote the prognosis of AIS patients.