磁共振波谱联合表观弥散系数与灌注加权成像联合DWI评价急性脑梗死后缺血半暗带的比较

Comparative study on the evaluation of ischemic penumbra after acute cerebral infarction by magnetic resonance spectroscopy combined with apparent diffusion coefficient and perfusion weighted imaging combined with DWI

目的:探讨在急性脑梗死患者病后缺血半暗带(IP)的检测上应用灌注加权成像(PWI)联合DWI或磁共振波谱(MRS)联合表观弥散系数(ADC),何种方案检验敏感性更佳,临床获益更大。方法:将我院2016-09~2019-05收治的病发3~6h内的脑梗死急性期患者252例纳入研究,于患者溶栓治疗前分别进行MRS、PWI与DWI检测,并联合DWI图像重构ADC图,再于溶栓前与病发后1月采用卒中(NIHSS)量表评估患者疾病恢复情况,对比两种检验方式对患者病后IP的检验敏感性差异,总结不同检验方法对患者临床治疗的获益程度差距。结果:MRS联合ADC的检查方案较之PWI联合DMI在IP检出率上更优,差异有意义(P<0.05);PDM(+)患者与CMA(+)患者治疗效果显著优于另外两类患者,差异有意义(P<0.05);而PDM(+)与CMA(+)患者对比、PDM(-)与CMA(-)患者对比,两组评分差异无意义(P>0.05)。结论:基于DWI的MRS-ADC技术于临床更好展开,在脑卒中急性期患者治疗前的IP检测环节具备较大潜力,可积极推动患者后续的治疗方案制定,促患者更佳的疗效收益,降低治疗风险,平衡收益比。

Objective:To investigate the sensitivity and clinical effect of perfusion weighted imaging(PWI)combined with DWI or MRS combined with apparent diffusion coefficient(ADC)in the detection of ischemic pe-numbra(IP)in patients with acute cerebral infarction.Methods:From September 2016 to May 2019,252 patients with acute cerebral infarction who were admitted to nanyang central hospital within 3 to 6 hours were included in the study.Before thrombolytic therapy,MRS,PWI and DWI were detected,and the ADC was reconstructed with DWI images.The patients were evaluated with the stroke scale(NIHSS)before thrombolysis and one month after the on-set of the disease.The sensitivity of the two groups of test methods to the examination of patients'post-disease IP was compared,and the benefit of different test methods to patients'clinical treatment was summarized.Results:The detection rate of MRS combined ADC was more sensitive than that of PWI combined DMI,and the difference was statistically significant(P<0.05).The therapeutic effect of PDM(+)and CMA(+)patients was significantly better than that of the other two groups of patients,and the difference was statistically significant(P<0.05).Compared with CMA(+)and CMA(-),PDM(+)and PDM(-),there was no significant difference in the scores between the two groups(P>0.05).Conclusion:The MRS-ADC technology based on DWI is highly sen-sitive and effective for IP detection in patients with acute stroke before treatment.