磁敏感加权成像在诊断急性缺血性脑卒中静脉溶栓后出血转化中的应用

Application of SWI in the hemorrhagic transformation after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke

目的探讨磁敏感加权成像(SWI)、颅脑CT在诊断急性缺血性脑卒中(AIS)静脉溶栓后出血转化(HT)中的应用效果。方法回顾性分析2016年1月~2018年6月山东省临沂市人民医院脑科医院急诊科收治的855例阿替普酶静脉溶栓患者的临床资料,所有患者均给予SWI、颅脑CT检查,比较两种影像方法识别溶栓后脑出血的情况,观察不同欧洲急性卒中协作研究的HT影像学分型患者脑出血情况。结果SWI检查发现133(15.6%)例患者发生HT,其中出血性梗死(HI)-1型79例,HI-2型33例,脑实质出血(PH)-1型12例,PH-2型9例。CT检查发现103(12.0%)例患者发生HT,其中HI-1型53例,HI-2型29例,PH-1型12例,PH-2型9例。SWI的HI-1型出血率检出率高于CT,差异有统计学意义(P<0.05),其余各型比较,差异无统计学意义(P>0.05)。结论SWI能够更加准确地发现AIS溶栓后微出血,在指导临床抗栓或抗凝治疗方面具有重要的临床意义。

Objective To investigate the application effect of hemorrhagic transformation (HT) after intravenous thrombolytic therapy with alteplase in acute ischemic stroke (AIS) patients by susceptibility weighted imaging ( SWI).Methods Clinical data of 855 AIS patients who received intravenous alteplase therapy in Emergency Department of Linyi People′s Hospital Brain Hospital of Shandong Province from January 2016 to June 2018 were retrospectively analyzed,all patients were given SWI and brain CT detection respectively,two imaging methods were compared on the identification of cerebral hemorrhage after thrombolysis,and the incidence of cerebral hemorrhage of patents with different ECASS classification was observed.Results There were 133 (15.6%) patients with HT detected by SWI after thrombolysis,including 79 cases of hemorrhagic infarction (HI)-1,33 cases of HI-2,12 cases of parenchymal hematoma (PH)-1 and 9 cases of PH-2.There were 103 (12.0%) patients with HT detected by CT after thrombolysis,including 53 cases of HI-1,29cases of HI-2,12 cases of PH-1 and 9 cases of PH-2.The bleeding rate of HI-1 detected by SWI was higher than CT,the difference was statistically significant (P < 0.05);there was no statistically significant difference between the other types (P > 0.05).Conclusion SWI has a higher value in the detection of HT after intravenous thrombolytic therapy,with important clinical significance in the guidance of the antiplatelet or anticoagulant therapy for AIS patients.