磁共振灌注成像在卒中后早期新发病灶中的预测价值

Predictive Value of PWI in Early New Lesions After Stroke Patients

目的探讨磁共振灌注成像(PWI)在预测卒中治疗后早期新发病灶中的价值。方法纳入2017年1月至2018年11月急诊入院的脑卒中患者55例为研究对象。所有患者均于血管再通治疗前及治疗后24 h内接受MRI及PWI检查。测量梗死核心区(DWI上高信号区)、高危低灌注区(随访MRI中新病灶所对应的治疗前低灌注区)及其他低灌注区(梗死及高危低灌注区以外的低灌注区)的PWI参数。采用统计学方法分析不同区域PWI参数的差异,并应用受试者工作特征曲线(ROC)分析PWI参数在预测卒中后新发病灶的价值。结果 55例中有新发病灶者40例,无新发病灶者15例。新发病灶组的患者年龄明显偏大,糖尿病病史患者较多(P=0.020;P=0.020)。新发病灶组高危低灌注区的平均通过时间(MTT)(10.26±3.05)s和达峰时间(TTP)(36.58±10.93)s长于其他灌注区(9.17±2.45)s、(32.81±8.01)s,两者差异均有统计学意义(P=0.013;P=0.026)。ROC分析显示MTT预测脑卒中后新发病灶的敏感度和特异度分别为55%和67.5%,TTP预测的敏感度和特异度分别为62.5%和65%。结论 MTT和TTP在预测卒中血管再通治疗后新发病灶的发生具有重要的价值。

Objective To investigate the value of magnetic resonance perfusion imaging(PWI) in predicting early new lesions after stroke treatment. Methods A total of 55 patients admitted to the hospital from January 2017 to November 2018 were enrolled. All patients underwent MRI and PWI before and after revascularization. Measurement of infarct core area(high-signal area on diffusion-weighted images),high-risk hypoperfusion area(pre-treatment low-perfusion area corresponding to new lesions in MRI),and other low-perfusion areas(low-perfusion areas other than infarction and high-risk low-perfusion areas) PWI parameters was done. Statistical methods were used to analyze the differences in PWI parameters in different regions,and the receiver operating curve(ROC) was used to analyze the value of PWI parameters in predicting new lesions after stroke. Results Of the 55 patients,40(72.73%) had new lesions and 15(27.27%) had no new lesions. The age of the new lesion group was significantly larger,and there were more patients with diabetes history(P=0.020;P=0.020). The mean transit time(MTT)(10.26±3.05) and peak time(TTP)(36.58±10.93) in the high-risk and low-perfusion area of the new lesion group was longer than those in other perfusion areas(9.17±2.45;32.81±8.01). There was a statistical difference(P=0.013;P=0.026). ROC analysis that showed that the sensitivity and specificity of MTT for predicting new lesions after stroke were 55% and 67.5%,respectively,and the sensitivity and specificity of TTP prediction were 62.5% and 65%,respectively. Conclusion MTT and TTP are of great value in predicting the occurrence of new lesions after recanalization of stroke.