急性脑梗死患者病灶体积及预后的MRI评价

MRI Findings in Cerebral Infarction and Relationship between Lesion Volume and Neurological Damage and Prognosis

目的探究脑梗死患者MRI表现与病灶体积、神经损害及预后的相关性。方法纳入辽宁省老年病医院2019年1月~2022年9月收治的脑梗死患者297例,分析其MRI表现,依据MRI检查计算病灶体积,采取Pearson相关分析病灶体积与神经损害(NIHSS评分)的相关性,绘制受试者工作特征(ROC)曲线分析病灶体积对预后的预测价值。结果45例MRI检查时处于超急性期,常规MRI扫描并未见异常表现,扩散加权成像(DWI)呈高信号,表观扩散系数(ADC)低信号,磁共振灌注成像(PWI)表现为低灌注;另252例急性期患者常规MRI扫描可见T_(1)WI低信号,T_(2)WI高信号,液体衰减反转恢复序列(FLAIR)、DWI均呈高信号表达,ADC则呈低信号。脑梗死患者病灶体积与NIHSS评分呈显著正相关(r=0.595,P<0.01),且病灶体积预测脑梗死患者预后不良的曲线下面积为0.821(95%CI:0.760~0.882),以8.467 mm3为临界值,敏感度及特异度分别为79.10%、85.30%。结论脑梗死患者MRI表现可因病程呈差异化,且MRI测得病灶体积与神经功能损伤密切相关,对预后有一定预测价值。

Objective To explore the findings of magnetic resonance imaging(MRI)in patients with cerebral infarction and analyze the relationship between lesion volume and neurological damage and prognosis.Methods A total of 297 patients with cerebral infarction admitted to the hospital from January 2019 to September 2022 according to the exclusion criteria were included in the study.All included patients were with less than 48h from onset to MRI.The MRI findings were analyzed,and MRI three-dimensional reconstruction was performed,and the lesion volume was calculated according to the Dotian formula,and Pearson correlation was used to analyze the correlation between lesion volume and neurological damage[the National Institutes of Health Stroke Scale(NIHSS)],and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of lesion volume on prognosis.Results 117 patients were in the hyperacute phase at MRI and no abnormalities were observed in conventional MRI scan,and they showed high signal in diffusion weighted imaging(DWI),low signal in apparent diffusion coefficient(ADC)and low perfusion in perfusion-weighted imaging(PWI).And another 180 cases in acute phase showed T_(1)WI low signal and T_(2)WI high signal in conventional MRI scan,high signal in fluid-attenuated inversion recovery sequence(FLAIR)and DWI and low signal in ADC.Lesion volume of patients with cerebral infarction was significantly positively correlated with NIHSS score(r=0.595,P<0.01),and the area under the curve of lesion volume was 0.821(95%CI:0.760~0.882)in predicting poor prognosis in patients with cerebral infarction,and the sensitivity and specificity were 79.10%and 85.30%when 8.467mm3 was taken as critical value.Conclusion The MRI findings of patients with cerebral infarction may be different due to the course of disease,and the lesion volume measured by MRI three-dimensional reconstruction is closely related to neurological damage and has certain predictive value on prognosis,which is worthy of clinical attention.