利用磁共振波谱成像联合弥散加权成像技术预测自发性脑出血后迟发性脑水肿

Clinical analysis of MRS and DWI in predicting delayed brain edema after spontaneous intracerebral hemorrhage

目的通过磁共振波谱成像联合弥散加权成像技术预测自发性脑出血后迟发性脑水肿的发生,并探讨该病的发生原因及防治措施。方法对湖州市第一人民医院2015年1月至2018年6月收治的头颅CT提示为自发性脑出血的患者进行分析。入院后第3天常规行MRS及DWI检查,动态CT证实14 d内脑内血肿周围水肿较7 d水肿周边直径增大1 cm以上诊断为迟发性脑水肿,设为观察组(27例),未并发迟发性脑水肿的脑出血患者设为对照组(27例),对两组患者水肿区域NAA/Cr值以及rADC值进行统计分析。结果自发性脑出血迟发性水肿患者水肿区域NAA/Cr值(1.67±0.38)较对照组NAA/Cr值(1.92±0.42)明显降低,rADC值(2.59±0.42)较对照组rADC值(2.93±0.51)明显降低,差异均有统计学意义(均P<0.05)。结论通过MRS的脑水肿区域NAA/Cr比值以及DWI检查的rADC值的统计差异变化,可以指导预判自发性脑出血后迟发性脑水肿的发生,更具客观性及科学性。

Objective Prediction of delayed brain edema after spontaneous intracerebral hemorrhage by magnetic resonance spectroscopy combined with diffusion weighted imaging, and to explore the causes and treatment of delayed brain edema after intracerebral hemorrhage. Methods The patients with spontaneous cerebral hemorrhage diagnosed by CT from January 2015 to June 2018 in our hospital were analyzed. Magnetic resonance spectroscopy and diffusion weighted imaging examinations were performed on the third day after hemorrhage. It was diagnosed as delayed brain edema that the edema range enlarged more than 1 cm in CT scan on the 14th day Compare with the 7th Day. The patients were divided into the delayed brain edema group and the control group(n=27 for each). The NAA/Cr value and rADC value of the edema area in the two groups were analyzed by T test. Results The NAA/Cr value (1.67±0.38) in the edema area of patients with delayed brain edema was significantly decreased Compare with the control group(1.92±0.42), and the rADC value (2.59±0.42) reduced significantly Compare with the control group (2.93±0.51), the differences were statistically significant (P<0.05). Conclusion MRS and DWI were susceptive in showing delayed brain edema lesions at hyper-early phase. Combination of MRS and DWI can provide a basis for clinical individual treatment programs selection and prognostic evaluation.