磁共振多技术联合应用对TIA脑保护作用的评价

Evaluation of MRI multi-technology combined application on TIA brain protection

目的探讨磁共振多技术扫描短暂性脑缺血发作(transient ischemic attack, TIA)对脑组织的保护作用。方法选取首次责任血管为大脑中动脉的脑梗死患者120例,按照脑梗死前有无TIA发作分为TIA组和非TIA组,两组患者均行NIHSS(美国国立卫生研究院卒中量表)评分、头颅磁共振平扫、DWI、3D-ASL(三维动脉自旋标记技术)以及体素内不相干运动成像(IVIM)的扫描,比较两组患者脑梗死面积、ADC值及NIHSS评分差异,并应用3D-ASL及IVIM分析二者差异;统计学方法采用SPSS 21.0对数据进行统计学分析,计量资料均用均数±标准差(■±S)表示。组间比较均采用独立样本t检验。检验水准均为P<0.05为差异有统计学意义。结果 TIA组患者脑梗死面积较非TIA组小,差异有统计学意义(P<0.05);TIA组患者ADC值与非TIA组患者ADC值差异无统计学意义(P>0.05);TIA组患者NIHSS评分较非TIA组患者低,差异有统计学意义(P<0.05);TIA组患者脑梗死核心区域CBF值较非TIA组高,差异有统计学意义(P<0.05);TIA组患者脑梗死区域及周边侧支循环的数量较非TIA组多,差异有统计学意义(P<0.05);TIA组患者脑梗死核心区域f值较非TIA组高,差异有统计学意义(P<0.05)。结论 TIA可以使颅脑产生缺血性预适应,即诱导产生一系列内源性保护机制来减少缺血性脑卒中对脑组织的损害,3D-ASL及IVIM对TIA脑保护作用的观察有很大帮助。

Objective To investigate the protective mechanism of transient ischemic attack(TIA) on brain tissue. Methods120 cases of cerebral infarction whose primary responsible vessel was middle cerebral artery were collected and divided into TIA group and non-TIA group according to whether there was a TIA before cerebral infarction. Both groups of patients received NIHSS(National Institutes of Health Institute Stroke Scale) score. Intracranial magnetic resonance plain scan, 3 D-ASL(three-dimensional arterial spin labeling), and IVIM(intracerebral incoherent motion imaging) scans were used to compare the difference in infarct size and NIHSS scores between the two groups. We analyzed the difference between the two by use of SD-ASL and INIM;Statistical methods SPSS 21.0 was used for statistical analysis of data. Measured data were expressed as mean±standard deviation(■±S). Each group was compared using an independent sample t-test. The test level was statistically significant at P<0.05. Results The infarct size in the TIA group was smaller than that in the non-TIA group(P<0.05). The NIHSS score in the TIA group compared with the non-TIA group patients was low,(P<0.05). In the TIA group, the CBF value was higher than that in the non-TIA group(P<0.05);the number of collateral circulation cerebral in TIA group was significantly higher than that in non-TIA group(P<0.05);In TIA group, the f value was higher than the non-TIA group(P<0.05). Conclusion TIA can produce ischemic preconditioning in the brain, which induces a series of endogenous protective mechanisms to reduce the damage to brain tissue from ischemic stroke.