老年急性缺血性脑卒中患者影像检查优化方案的评估

Evaluation of optimal imaging protocols for elderly patients with acute ischemic stroke

目的 通过分析诊治的老年缺血性脑卒中病例,比较MRI、CT不同首诊影像方法的诊断效能与临床诊治结果的相关性,探讨基于缺血性脑卒中诊治指南的基础上形成老年性急性脑卒中患者的首诊规范流程。方法 单纯随机抽取、回顾性分析2021年1月—2022年11月在上海中医药大学附属普陀医院就诊的60岁以上老年急性脑梗塞患者450例,通过比较MRI、CT不同首诊影像方法(所有患者均进行了平扫,部分患者予以CT或MR的增强灌注扫描)的灵敏度、特异度及相关的治疗、预后等相关指标进行分类进行比较分析、评估。结果 (1)影像表现:CT影像可见患者病灶区域豆状核轮廓模糊,灰白质分界模糊,岛带低密度,脑裂/脑沟变窄。MRI影像病灶呈高信号DWI和低信号ADC值,大脑中动脉供血高信号影等。(2)获得的影像参数比较:缺血病灶区域(vs)健侧区域,前者表观扩散系数(ADC)<后者(t=687.503,P<0.05)、前者脑血流量(CBF)<后者(t=678.289,P<0.05)、前者脑血容量(CBV)<后者(t=4.102,P<0.05)、前者达峰时间(TTP)>后者(t=20.329,P<0.05),差异有统计学意义。(3)诊断效能:发病时间<6 h, MRI诊断效能(包括:约登指数、特异度、诊断符合率等)优于CT检查(P<0.05),差异有统计学意义;而发病时间≥6 h, MRI诊断效能(vs) CT诊断效能(P>0.05),差异无统计学意义。结论 MRI影像能够及时、有效地对老年缺血性脑卒中患者作出诊断,尤其是发病时间<6 h,因此,在临床尽可能优化检查程序、开辟MRI绿色通道、缩短检查等待时间,将极大改进老年缺血性脑卒中的临床诊治效率。

Objective To explore one standardized process of first diagnosis imaging method for elderly patients with acute ischemic stroke based on the comparison of the diagnosis effectiveness and treatment effect from CT and MRI as first diag⁃nosis imaging method.Methods 450 patients over 60 years old with acute cerebral infarction admitted to Putuo Hospital Affil⁃iated to Shanghai University of Traditional Chinese Medicine from January 2021 to November 2022 were randomly selected and retrospectively analyzed.The sensitivity and specificity of different first diagnosis imaging methods of MRI and CT(all patients underwent plain scans,and some ones did enhanced perfusion scans of CT or MRI)as well as related therapeutic and prognostic indexes were compared for classification analysis and evaluation.Results(1)Image performance:CT images showed blurred outline of the lentulous nucleus,blurred gray matter boundary,low density of the island zone,and narrowing of the cleft/sulci in the lesion area.MRI images showed high signal DWI and low signal ADC values,and high signal shadows of the middle cerebral artery blood supply.(2)Comparison of obtained image parameters between the MRI and CT on ischemic lesion area:The apparent diffusion coefficient(ADC)of the ischemic lesion area was lower than that of the healthy side area(t=687.503,P<0.05),cerebral blood flow(CBF)was slower than that of the healthy side area(t=678.289,P<0.05),cerebral blood volume(CBV)was smaller than that of the healthy side area(t=4.102,P<0.05),and time to peak(TTP)was longer than that of the healthy side area(t=20.329,P<0.05).(3)Diagnostic efficacy:When the onset time was<6 hours,the diag⁃nostic efficacy(including Jordan index,specificity,diagnostic coincidence rate,etc.)of MRI was superior to that of CT(P<0.05);when the onset time was≥6 hours,there was no statistically significant difference in the diagnostic efficacy between MRI and CT(P>0.05).Conclusion MRI images can make a timely and effective diagnosis of elderly patients with ischemic stroke,especially when the onset time is<6 hours.Therefore,optimizing the examination procedure as much as possible,opening up a green channel for MRI,and shortening the examination waiting time will greatly improve the clinical diagnosis and treatment efficiency of elderly ischemic stroke.