多模态磁共振评估单侧急性脑梗死患者预后的应用研究

Application of multimodal magnetic resonance imaging in evaluating the prognosis of patients with unilateral acute cerebral infarction

目的研究多模态磁共振(mMRI)评估单侧急性脑梗死患者预后的应用。方法选择2015年10月—2020年5月由南通市第六人民医院诊治的单侧急性脑梗死患者135例,均行MRI检测(常规序列、SWI、DWI),观察患者常规序列、SWI、DWI信号表达及ADC值变化。根据患者预后情况分为预后良好组与预后不良组,分析多模态磁共振对单侧急性脑梗死患者的预后价值。结果135例单侧急性脑梗死患者经常规序列显示腔隙性梗死灶38例,非腔隙性梗死灶97例,大面积脑梗塞68例,小面积脑梗死29例。DWI示97例明显高信号,境界清;稍高信号38例,境界欠清;ADC值(1.01±0.16)×10-3mm2/s。SWI检查示梗死区近脑膜侧线条状低信号小血管扩张84例,腔隙性38例与非腔隙性13例均无此症;见34例患者现大脑中动脉血管内血栓,26例处于大脑中动脉中近端、远端8例;血栓主要表现呈结节样、索条样,低信号影,管径略粗;mRS(2.5±1.2)分。根据患者预后情况分为预后良好组122例,预后不良组13例。预后不良组脑静脉异常率、mRS评分均明显高于预后良好组,ADC值低于预后良好组(P<0.05);多模态MRI联合对单侧急性脑梗死患者预后的敏感性、特异性显著高于单独检测(P<0.05)。结论多模态MRI可提高单侧急性脑梗死患者的预测预后价值,重复性强,临床应用高。

Objective To investigate the value of multimodal magnetic resonance imaging(mMRI)in evaluating the prognosis of patients with unilateral acute cerebral infarction(ACI).Methods Routine MRI,susceptibility-weighted imaging(SWI),and diffusion weighted image(DWI)were performed on 135 patients with unilateral ACI The patients were followed up for 90 days.Modified Rankin Scale(mRS)was used to evaluate the prognosis and the patients were di⁃vided into good prognosis group and poor prognosis groups.The prognostic value of mMRI was analyzed using the SPSS 22.0 software.Results Routine MRI showed that there were 38 cases of lacunar infarction,97 cases of non-lacunar in⁃farction,68 cases of large-area cerebral infarction,and 29 cases of small-area cerebral infarction.DWI showed that 97 cases had high signal with clear boundary and 38 cases had slightly high signal and unclear boundary[ADC value=(1.01±0.16)×10-3 mm2/s];SWI showed 84 cases of small vessels dilated with low signal near the lateral line of meninges in the infarcted area,while 38 cases of lacunar and 13 cases of non-lacuna had no such symptoms;There were 34 cases with middle artery thrombosis,26 cases in the middle and proximal middle cerebral artery and 8 cases in the distal ar⁃tery;The main manifestations of thrombus were nodular and cable-like,with low signal shadow and slightly coarse di⁃ameter.The average mRS score was(2.5±1.2).According to prognosis,patients were divided into good prognosis group(n=122)and poor prognosis group(n=13).The rate of cerebral venous abnormalities and mRS score in the poor progno⁃sis group were significantly higher than those in good prognosis group,and the ADC value in the poor prognosis group was significantly lower than that in the good prognosis group(all P<0.05);The sensitivity and specificity of mMRI for the prediction of the prognosis of the patients with unilateral acute infarction were significantly higher than that of sin⁃gle detection(P<0.05).Conclusion mMRI has high prognostic value for patients with unilateral acute cerebral infarc⁃tion,with certain repeatability and clinical application value.