DTI对急性脑梗死患者早期诊断及临床转归的预测价值

Predictive Value of DTI in Early Diagnosis and Clinical Outcome of Patients with Acute Cerebral Infarction

目的分析磁共振弥散张量成像(DTI)对急性脑梗死(ACI)患者早期诊断及临床转归的预测价值。方法回顾性收集2017年9月-2018年6月期间我院收治的80例单侧ACI患者的诊治、随访资料,其中超急性期(发病时间<6h)16例、急性期(6-72h)38例、亚急性期(72h-14d)26例,均接受MRI检查,包括常规序列、DTI序列,至少随访3个月,依据美国国立卫生研究院卒中量表(NIHSS)评分评估临床转归情况。结果 80例ACI患者均可通过常规MRI与DTI发现梗死病灶,病灶检出率为100%。梗死灶在T2WI、DWI图像上均显示高信号,DTI上以低信号为主。不同发病时期患者病灶侧FA、DCavg值均低于健侧(P<0.05);FA、DCavg值超急性期>急性期例>亚急性期,比较有统计学差异(P<0.05)。3个月后随访发现病灶区FA、DCavg值下降率超急性期<急性期例<亚急性期,且NIHSS评分超急性期<急性期例<亚急性期,比较均有统计学差异(P<0.05)。Pearson相关分析显示,ACI患者病灶区FA、DCavg值下降率与NIHSS评分呈明显正相关(r=0.465,0.524,P<0.05)。结论 DTI参数在不同发病时期ACI患者中存在特定的改变规律,可作为临床早期诊断依据,其中FA、DCavg值与预后指标密切相关,有望用于预测临床转归。

Objective To analyze the predictive value of diffusion tensor imaging(DTI)for the early diagnosis and clinical outcome in patients with acute cerebral infarction(ACI).Methods The clinical data and follow-up data of 80 patients with unilateral ACI in the hospital from September 2017 to June 2018 were collected retrospectively.There were hyperacute phase(onset time less than 6h)of 16 cases,the acute phase(6 to 72h)of 38 cases and the subacute phase(72h to 14d)of 26 cases,all of them were given MRI examination,including regular sequence,DTI sequence with at least 3 months of followup,clinical outcomes were assessed according to the National Institutes of Health Stroke Scale(NIHSS)score.Results A total of 80 patients with ACI could find the infarct lesions by conventional MRI and DTI with 100%detection rate.Infarcts lesions showed high signal on T2WI and DWI images,and mainly showed low signal on DTI.The FA and DCavg values of the lesions were lower than those of the healthy side(P<0.05).The FA and DCavg values at the lesion side of patients in different onset periods were lower than those at the healthy side.Arranging the FA and DCavg values from large to small,the order was hyperacute phase,acute phase and subacute phase(P<0.05).After 3 months of follow-up,it was found that arranging the reduction rate of FA and DCavg values in the lesion area from small to large,the order was super acute phase<acute phase<subacute phase,and NIHSS score was hyperacute phase,acute phase and subacute phase(P<0.05).Pearson correlation analysis found that the decrease rate of FA and DCavg values in the lesion area of ACI patients was positively correlated with NIHSS score(r=0.465,0.524,P<0.05).Conclusion DTI parameters have specific changes direction in ACI patients at different onset period,which can be used as a basis for clinical diagnosis.FA and DCavg values are closely related to prognostic indicators and has the potential to be used to predict the clinical outcomes.