弥散加权成像与灌注成像在缺血性脑卒中诊断及预后评估中应用分析

Application of DWI and PWI in the diagnosis and prognostic evaluation of ischemic stroke

目的探讨弥散加权成像(DWI)与灌注成像(PWI)在缺血性脑卒中(CIS)诊断及预后评估中的应用价值。方法选取2017年1月至2022年12月我院收治的106例CIS患者作为观察组,另选同期健康体检者50名作为对照组。均开展磁共振成像检查,包括常规平扫、DWI、PWI,获取表观扩散系数(ADC)、局部脑血流量(rCBF)、局部脑血容量(rCBV)、平均通过时间(MTT)、达峰时间(TTP)水平,比较2组ADC、rCBF、rCBV、MTT、TTP差异,并绘制ROC曲线分析ADC、rCBF、rCBV、MTT、TTP及联合检测诊断CIS的临床价值;依据发病时间分为超急性期CIS(发病时间≤6 h)及急性期CIS(>6h),比较2组ADC、rCBF、rCBV、MTT、TTP差异;治疗3个月后使用改良Rankin量表评价患者预后,其中得分<3分为预后良好,得分≥3分为预后不良,比较2组ADC、rCBF、rCBV、MTT、TTP差异;绘制ROC曲线分析ADC、rCBF、rCBV、MTT、TTP及联合检测评估CIS预后的临床价值。结果观察组ADC、rCBF、rCBV为(0.52±0.12)、(3.5±0.4)ml·100 g^(-1)·min^(-1)、(30±3)ml,低于对照组的(0.95±0.15)、(5.1±1.0)ml·100 g^(-1)·min^(-1)、(50±5)ml,MTT、TTP为(4.9±1.1)s、(12.6±1.4)s,长于对照组的(3.2±0.4)s、(9.6±1.1)s,差异有统计学意义(P<0.05);绘制ROC曲线分析显示,ADC、rCBF、rCBV、MTT、TTP、联合检测诊断CIS的曲线下面积分别为:0.818、0.789、0.806、0.801、0.751、0.941,联合检测诊断价值最高;106例CIS患者,其中超急性期42例,急性期64例;超急性期ADC、rCBF、rCBV为(0.39±0.09)、(3.0±0.4)ml·100 g^(-1)·min^(-1)、(27.1±2.9)ml,低于急性期的(0.63±0.15)、(3.7±0.4)ml·100 g^(-1)·min^(-1)、(32.8±3.4)ml,MTT、TTP为(5.5±1.2)s、(14.4±1.4)s,长于急性期的(4.3±1.0)s、(11.2±1.3)s,差异有统计学意义(P<0.05);106例患者其中预后良好62例,预后不良44例;预后不良患者ADC、rCBF、rCBV为(0.28±0.05)、(2.6±0.3)ml·100 g^(-1)·min^(-1)、(24.2±2.8)ml,低于预后良好组的(0.75±0.14)、(4.4±0.4)ml·100 g^(-1)·min^(-1)、(35.9±3.4)ml,MTT、TTP为(5.8±1.2)s、(15.2±1.5)s,长于预后良好组的(3.9±0.6)s、(9.8±1.1)s,差异有统计学意义(P<0.05);绘制ROC曲线分析显示,ADC、rCBF、rCBV、MTT、TTP、联合检测评估CIS患者预后的曲线下面积分别为:0.781、0.747、0.746、0.799、0.770、0.925,联合检测价值最高。结论DWI联合PWI在CIS诊断及预后评估中具有较高价值,能够帮助临床早期迅速鉴别诊断,并指导治疗方案制定,以更好改善患者预后。

Objective To explore the application value of diffusion-weighted imaging(DWI)and perfusion imaging(PWI)in the diagnosis and prognosis evaluation of ischemic stroke(CIS).Methods One hundred and six CIS patients admitted to our hospital from January 2017 to December 2022 were selected as the observation group,and 50 healthy individuals in the same period were selected as the control group.All patients underwent magnetic resonance imaging examinations,including routine plain scan,DWI and PWI to obtain apparent diffusion coefficient(ADC),local cerebral blood flow(rCBF),local cerebral blood volume(rCBV),mean transit time(MTT),and time to peak(TTP)levels.The differences of ADC,rCBF,rCBV,MTT and TTP between the two groups were compared,and receiver operator characteristic(ROC)curves were drawn to analyze the clinical value of ADC,rCBF,rCBV,MTT,TTP,and combined detection in diagnosing CIS.According to the onset time,all patients were divided into hyperacute phase CIS(onset time≤6 hours)and acute phase CIS(>6 hours),and the differences in ADC,rCBF,rCBV,MTT and TTP between the two groups are compared.After 3 months of treatment,the patients′prognosis was evaluated using the modified Rankin scale,with a score<3 indicating good prognosis and a score≥3 indicating poor prognosis.The differences in ADC,rCBF,rCBV,MTT and TTP between the two groups were compared.ROC curves were drawn to analyze the clinical value of ADC,rCBF,rCBV,MTT,TTP and combined detection in evaluating the prognosis of CIS.Results The ADC,rCBF and rCBV in the observation group were(0.52±0.12),(3.5±0.4)ml·100 g^(-1)·min^(-1) and(30±3)ml,which were lower than those in the control group(0.95±0.15),(5.1±1.0)ml·100 g^(-1)·min^(-1) and(50.4±5.2)ml,while the MTT and TTP were(4.9±1.1)s and(12.6±1.4)s,which were longer than those in the control group(3.2±0.4)s and(9.6±1.1)s,and the difference was statistically significant(P<0.05).The ROC curve analysis showed that the areas under the curve(AUC)for ADC,rCBF,rCBV,MTT,TTP and combined detection for diagnosing CIS were 0.818,0.789,0.806,0.801,0.751 and 0.941,respectively,indicating the highest diagnostic value of combined detection.There were 42 hyperacute phase cases and 64 acute phase case in the 106 CIS patients.In the hyperacute phase,ADC,rCBF,and rCBV were(0.39±0.09),(3.0±0.4)ml·100 g^(-1)·min^(-1) and(27.1±2.9)ml,which were lower than those in the acute phase(0.63±0.15),(3.7±0.4)ml·100 g^(-1)·min^(-1) and(32.8±3.4)ml,while MTT and TTP were(5.5±1.2)s,(14.4±1.4)s,which were longer than those in the acute phase(4.3±1.0)s and(11.2±1.3)s,with statistically significant differences(P<0.05).There were 62 cases with a good prognosis and 44 cases with a poor prognosis in the 106 patients.The ADC,rCBF and rCBV of patients with poor prognosis were(0.28±0.05),(2.6±0.3)ml·100 g^(-1)·min^(-1) and(24.2±2.8)ml,which were lower than those of the group with good prognosis(0.75±0.14),(4.4±0.4)ml·100 g^(-1)·min^(-1) and(35.9±3.4)ml,while the MTT and TTP were(5.8±1.2)s and(15.2±1.5)s,which were longer than those of the group with good prognosis(3.9±0.6)s and(9.8±1.1)s,and the difference was statistically significant(P<0.05).The ROC curve analysis showed that the areas under the curve for evaluating the prognosis of CIS patients with ADC,rCBF,rCBV,MTT,TTP and combined detection were 0.781,0.747,0.746,0.799,0.770 and 0.925,respectively,with the highest value of combined detection.Conclusion The combination of DWI and PWI has high value in the diagnosis and prognosis evaluation of CIS,which can help clinical early and rapid differential diagnosis and guide the formulation of treatment plans to better improve patient prognosis.