不同时期脑梗死DWI、PWI成像特征及其缺血半暗带的鉴别诊断价值研究

Features of DWI and PWI of Cerebral Infarction in Different Periods and Its Differential Diagnosis Value of Ischemic Penumbra

目的探究不同时期脑梗死弥散加权成像(DWI)、灌注加权成像(PWI)特征及其缺血半暗带的鉴别诊断价值。方法回顾性分析本院2017年3月至2019年8月收治的100例脑梗死患者的临床资料,观察不同时期脑梗死患者病变区和检测对应部位表观弥散系数(ADC)值及PWI灌注参数在不同时期脑梗死中的表现,并分析DWI和PWI在不同时期脑梗死表现的关系。结果不同时期的脑梗死患者梗死区和健侧对应区的ADC值比较差异具有统计学意义(P<0.05)。超急性期和急性期rCBV、rCBF以降低为主,MTT、TTP以升高为主;亚急性期rCBV、rCBF基本正常,MTT、TTP以升高为主;慢性期rCBV、rCBF、MTT、TTP均以降低为主。超急性期和急性期分别有18例、14例患者DWI<PWI,亚急性期、慢性期未见;急性期、亚急性期、慢性期分别有4例、26例、11例患者DWI=PWI,超急性期未见;超急性期、急性期、亚急性期分别有3例、19例、5例患者DWI>PWI,慢性期没有。结论MRI检查DWI技术可显示微小的缺血病灶;PWI可显示可能存活的缺血半暗带,两者联合可有效鉴别诊断缺血半暗带。

Objective To explore the features of diffusion-weighted imaging(DWI)and perfusion-weighted imaging(PWI)of cerebral infarction in different periods and its differential diagnosis value of ischemic penumbra.Method The clinical data of 100 patients with cerebral infarction admitted from March 2017 to August 2019 in our hospital were retrospectively analyzed.The apparent diffusion coefficient(ADC)value and PWI perfusion parameters of the lesions and corresponding sites of patients with cerebral infarction in cerebral infarction in different periodswere observed.Results The difference in the ADC value of the infarction area and the healthy corresponding side between the patients with cerebral infarction in different periods was statistically significant(P<0.05).In the hyperacute and acute phases,rCBV,and rCBF mainly decreased,MTT and TTP mainly elevated;rCBV and rCBF were normal in the subacute phase,and MTT and TTP mainly elevated.In the chronic phase,rCBV,rCBF,MTT,and TTP mainly decreased.There were 18 cases and 14 cases whose DWI was lower than PWI in the hyperacute and acute phases,respectively.There were 4 cases,26 cases,and 11 cases whose DWI was equal to PWI in the acute phase,subacute phase and chronic phase,respectively,and there was no such patients in hyperacute phase.There were 3 cases,19 cases,and 5 cases whose DWI was higher than PWI in the hyperacute,acute,and subacute phases,but there was no such patients in the chronic phase.Conclusion In the MRI examination,DWI technique can show tiny ischemic lesions;PWI can show the ischemic penumbra that may survive,and the combination of them can effectively differentiate the ischemic penumbra.