DSC-PWI联合MRA在脑梗死慢性期预后评估中的应用价值

Clinical Application Value of DSC-PWI Combined with MRA in Evaluating the Prognosis of Chronic Cerebral Infarction

目的探讨动态磁敏感对比增强灌注成像(DSC-PWI)联合磁共振血管成像(MRA)在脑梗死慢性期预后评估中的临床应用价值。方法回顾性对比分析34例高灌注组及47例低灌注组脑梗死区在慢性期的DSC-PWI表现;比较靶血管MRA治疗前后变化。结果高灌注组脑梗死区脑血流量(CBF)和脑血容量(CBV)明显增高,平均通过时间(MTT)和达峰时间(TTP)不同程度增高;低灌注组脑梗死区CBF、CBV明显降低,MTT、TTP不同程度增高,高、低灌注组相对PWI参数比值有显著差异(P <0. 01)。MRA复查高灌注组靶血管改善率明显好于低灌注组。19例低灌注组患者评估后介入治疗症状明显改善。结论 DSC-PWI联合MRA能提供脑梗死区慢性期的血流灌注信息,评估梗死区侧支循环代偿储备及靶血管治疗效果,为临床在脑梗死慢性期制定合理的干预措施提供重要依据。

Objective To discuss the clinical application value of DSC-PWI combined with MRA in evaluating the prognosis of chronic cerebral infarction.Methods DSC-PWI findings and MRA changes of target vessel before and after the treatment of 34 cases of patients with high perfusion and 47 cases of patients with low perfusion were retrospectively analyzed.Results CBF and CBV in the infarction area with high perfusion were noticeably increased,TTP and MTT increased with varying degrees.CBF and CBV in the infarction area with low perfusion were obviously reduced,MTT、TTP increased with varying degrees.The relative ratio of PWI parameters(r CBF、r CBV、r MTT、r TTP)in the area of the infarction had statistically significant differences between the high perfusion group and the low perfusion group(P<0.01).MRA review showed that the improvement rate of target vessels in the high perfusion group was better than that of the low perfusion group.The symptoms of 19 cases of patients with low perfusion have improved significantly after interventional surgery.Conclusion DSC-PWI joint MRA can provide perfusion information of cerebral infarction area,evaluating collateral circulation compensation reserve of the infarction area and the therapeutic effect of the target vessels,which can provide important objective basis for clinical performance of correct intervention procedures.