联合酰胺质子转移加权成像和表观扩散系数诊断Ⅱ型糖尿病患者脑梗死缺血半暗带的研究

Combined Amide Proton Transfer Imaging and Apparent Diffusion Coefficient in Diagnosing Ischemic Penumbra in Patients with Type 2 Diabetes

目的 探讨联合酰胺质子转移加权成像(APTw)和表观扩散系数(ADC)诊断Ⅱ型糖尿病(T2DM)患者脑梗死病灶是否存在缺血半暗带。方法 回顾性搜集经头颅磁共振扩散加权成像(DWI)、APTw和常规序列检查的T2DM脑梗死患者,分成DWI与APTw图像错配组和无错配组,测量病灶ADCm和APTwm值。分析两组间影像和临床参数统计学差异,应用受试者工作特征曲线(ROC)分析定量参数及联合诊断参数诊断效能,DeLong分析ROC结果之间的统计学差异。结果 两组APTwm差异有统计学意义(P=0.00),ADCm、年龄、性别、HbA1c、高血脂、高血压、吸烟史和饮酒史两组差异无统计学意义(P>0.05)。ROC分析APTwm单独和APTwm联合其他参数联合诊断均具有诊断效能,APTwm+临床参数联合诊断效能最高(AUC=0.869),DeLong分析各ROC结果之间差异无统计学意义(P>0.05)。结论 APTwm对T2DM患者脑梗死病灶是否存在缺血半暗带具有诊断效能,APTwm+临床参数联合诊断效能最高,但与APTwm单独诊断效能差异无统计学意义。

Objective To explore whether the combined amide proton transfer weighted imaging(APTw)and apparent diffusion coefficient(ADC)can diagnose the presence of the ischemic penumbra in cerebral infarction lesions in patients with type 2 diabetes mellitus(T2DM).Methods A retrospectively collected T2DM patients with cerebral infarction who underwent DWI,APT and conventional sequence head MRI examinations and divided into the DWI and APTw image mismatch group and the non-mismatch group.The APTwm and ADCm of the infarction lesions were measured.The statistical differences in imaging and clinical parameters between the two groups were analyzed.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of parameters and combined diagnostic parameters.The Delong test was used to analyze the statistical differences among the ROC results.Results There was a statistically significant difference in APTwm between the two groups(P=0.00),while there was no statistically significant difference in ADCm,age,gender,HbA1c,hyperlipidemia,hypertension,smoking history,and drinking history between the two groups(P>0.05).ROC analysis showed that APTwm alone and the combined diagnosis of APTwm combined with other parameters had diagnostic efficacy,and the combined diagnostic efficacy of APTwm+clinical parameters was the highest(AUC=0.869).The Delong test showed that there was no statistically significant difference among the ROC results(P>0.05).Conclusion APTwm has diagnostic efficacy for the presence of the ischemic penumbra in cerebral infarction lesions in T2DM patients.The combined diagnostic efficacy of APTwm with clinical parameters is the highest,but there is no statistically significant difference from the diagnostic efficacy of APTwm alone.