磁共振弥散加权成像在超急性脑梗死患者早期诊断中的临床意义及参数分析

Clinical Significance and Parameter Analysis of MRI Diffusion-Weighted Imaging in Early Diagnosis of Hyperacute Cerebral Infarction Patients

目的 探讨磁共振弥散加权成像(DWI)在超急性脑梗死(ACI)早期的诊断价值。方法 选取2021年5月—2023年5月本院收治的98例疑似超ACI患者,均行磁共振常规平扫、DWI检查,并以数字减影血管造影(DSA)为金标准,分析超ACI检出情况、诊断价值;采用kappa检验验证一致性;比较超ACI患侧与健侧表观扩散系数(ADC)值的差异。结果 98例疑似患者经金标准确诊55例超ACI,其中常规平扫确诊50例,阳性率为90.91%(50/55);DWI确诊54例,阳性率为98.18%(54/55);DWI检查诊断超ACI灵敏度、准确度及阴性预测值分别为96.36%、96.94%、95.45%,高于磁共振常规平扫的81.82%、84.69%、79.17%(P<0.05);kappa检验显示,常规磁共振平扫、DWI诊断kappa值分别为0.693、0.938,与金标准一致性分别为尚可、极好;超ACI患者患侧ADC为(0.45±0.11),健侧为(0.89±0.14);超ACI患者患侧ADC值低于健侧,差异有统计学意义(t=18.328,P=0.000)。结论 磁共振DWI在超急性脑梗死诊断中更有价值,可提高诊断准确性,便于超早期开展溶栓治疗,以提高患者疗效。

Objective To explore diagnostic value of diffusion-weighted imaging(DWI)for hyperacute cerebral infarction(ACI)at early stage.Methods The paper chose 98 suspected patients with hyperacute cerebral infarction(ACI)in our hospital from May 2021 to May 2023,treated with routine magnetic resonance imaging(MRI)plain scan and DWI examination,analyzed detection and diagnostic value of hyperacute cerebral infarction(ACI)with gold standard of digital subtraction angiography(DSA),verified consistency with kappa test.Difference in apparent diffusion coefficient(ADC)values was compared between affected and healthy sides of ACI.Results Out of 98 suspected patients,55 were diagnosed with ACI beyond gold standard,including 50 confirmed by routine plain scan,with positive rate of 90.91%(50/55).54 cases were confirmed by DWI,with positive rate of 98.18%(54/55).Sensitivity,accuracy and negative predictive value of DWI examination was 96.36%,96.94%,and 95.45%,higher than routine MRI plain scan(81.82%,84.69%,and 79.17%respectively)(P<0.05).The kappa test showed,kappa values for routine plain scan and DWI diagnosis were 0.693 and 0.938,which were consistent with gold standard,acceptable and excellent respectively.ADC of affected side of patients with hyperacute cerebral infarction was(0.45±0.11),that of healthy side was(0.89±0.14).ACI on affected side was lower than healthy side,difference was statistically significant(t=18.328,P=0.000).Conclusion Magnetic resonance DWI is valuable in diagnosis of hyperacute cerebral infarction,can improve diagnostic accuracy,facilitate early thrombolytic therapy,and improve curative effect of patients.