DWI联合SWI在脑梗死治疗后转归中的影像价值分析

Imaging Value of DWI Combined with SWI in the Outcomes after Cerebral Infarction Treatment

目的 探讨MRI弥散加权成像(DWI)联合磁敏感加权成像(SWI)在脑梗死治疗后转归中的评估价值。方法 选取本院2019年9月至2021年1月收治的105例脑梗死接受静脉溶栓治疗的患者,所有患者均在溶栓前以及溶栓后的24h行常规MRI以及DWI与SWI序列扫描,依照其溶栓后3个月的改良Rankin评分(mRS)分将0~2分者纳入预后良好组(n=66例),3~6分者纳入预后不良组(n=39例),通过ROC曲线分析DWI联合SWI对于脑梗死治疗后转归的评估价值。结果 SWI检测术后24h缺血梗死面积高于DWI与常规序列扫描结果(P<0.05);SWI术后24h对出血转化的阳性检出率14.29%高于DWI序列5.71%与常规序列3.81%(P<0.05);预后良好组术后24h时SWI检测梗死面积小于预后不良组,出血转化发生率6.06%低于预后不良组28.21%(P<0.05);预后良好组术后24h时DWI检测rADC值高于预后不良组(P<0.05);术后24h时DWI联合SWI联合检测梗死面积、出血转化、rADC值对脑梗死溶栓治疗预后评估ROC曲线下面积为0.826高于各项指标单独检测0.743、0.611、0.721(P<0.05)。结论 DWI联合SWI可有效提高脑梗死患者溶栓治疗后转归情况预测价值。

Objective To explore the evaluation value of MRI diffusion weighted imaging(DWI) combined with susceptibility weighted imaging(SWI) in the outcomes after cerebral infarction treatment. Methods A total of 105 patients with cerebral infarction who underwent intravenous thrombolysis in the hospital from September 2019 to January 2021 were enrolled. All underwent routine MRI, DWI and SWI sequences scans before thrombolysis and with 24h after thrombolysis. According to the scores of modified Rankin scale(mRS) at 3 months after thrombolysis, 66 cases scoring 0-2 points were included into good prognosis group, while another 39 cases scoring 3-6 points were included into poor prognosis group. The evaluation value of DWI combined with SWI for outcomes after cerebral infarction treatment was analyzed by ROC curves. Results The area of ischemic infarction at 24h after surgery detected by SWI was larger than that by DWI and routine sequence scan(P<0.05). The positive detection rate of hemorrhage transformation at 24h after surgery detected by SWI was 14.29%, higher than that by DWI(5.71%) and routine sequence scan(3.81%)(P<0.05). The area of ischemic infarction at 24h after surgery detected by SWI in good prognosis group was smaller than that in poor prognosis group, and incidence rate of hemorrhage transformation was lower than that in poor prognosis group(6.06% vs 28.21%)(P<0.05). The rADC at 24h after surgery detected by DWI in good prognosis group was higher than that in poor prognosis group(P<0.05). The area under the ROC curve(AUC)of infarction area combined with hemorrhage transformation and rADC detected by DWI combined with SWI at 24h after surgery for evaluating the prognosis of cerebral infarction after thrombolysis was 0.826, greater than that of them alone(0.743, 0.611, 0.721)(P<0.05). Conclusion DWI combined with SWI can effectively improve the predictive value of outcomes in patients with cerebral infarction after thrombolysis.