早期脑梗死影像学诊断与功能障碍的相关性探讨

Imaging diagnosis and dysfunctional discussion of cerebral infarction in earlier period

目的:探讨螺旋CT与MR扩散加权成像(diffusionweightedimaging,DWI)和灌注成像(perfusionimaging,PI)检查对早期脑梗死的诊断、发病部位及功能障碍的影响。方法:收集53例发病在4～24h的患者,分别行螺旋CT、MR检查,作影像对比研究及功能判定。结果:螺旋CT与DWI的敏感度分别为26%(13/50),98%(49/50)(t=11.87,P<0.01);特异度分别为67%(2/3),67%(2/3);准确度分别为28%(15/53),96%(51/53)(t=11.87,P<0.01)。53例患者中,50例确诊为早期脑梗死。其中枕叶病灶11例,9例出现一侧视力偏盲;内囊膝部病变15例,肢体力弱或偏瘫者12例;9例角回梗死患者中,有7例语言障碍;脑干病灶5例,3例意识不清;7例小脑病变中3例行走不稳,梗死部位与功能障碍符合率为72%(34/47)。3例偏瘫或失语患者未找到责任病灶,3例为短暂脑缺血发作,复查CT及DWI未见梗死灶。结论:DWI对早期脑梗死的诊断明显高与螺旋CT,梗死部位与功能障碍关系密切。

AIM:To evaluate the effect of helical CTa nd MRI ( diffusion weighted imaging,DWI and perfusion imaging,PI )in diagnosis of earl y cerebral infarction,inci-dence site and dysfunction.METHODS:HelicalCTandMR Iwereemployedin53patients whowereatOnset of illness within4-24hours respe ctively.The results were processed by imaging contrast and function judgment.R ESULTS:The sensitivity and accuracy of Heli cal CT and DWI were 26%and98% ,28%and 96%,with a significant difference(t=11.87,P<0.01) .But no significant difference was fo und in specificity between Helical C T an d DWI (66%and 66%).Among 53patients,50cases were dia gnosed as ear ly cerebral infarction.The results in dicated that unilaberal hemianopsia was f ound in 9cases of 11patients with cerebra l infarction of occipital lobe,for c e feeble or hemiplegia was in 12of 15patients with cerebral infarction of the lap o f in-ternal capsule,language disorder w as in 7of 9patients with c erebral inf arction of angular gyrus,unconsciousness w as in 3of 5patients wi th cerebral inf arction of brain stem,and ambulation lability was in 3of 7pat ients with cerebral in-farction of cerebellum.The rate of i nfarction site coi ncided with functional disturbance was 72%(34/47).And 3cases of hem ianopsia or unconsciousness had no matched sick sites,and another 3cases were diagnosed as transient ischemi attack(TIA)by review of CT and DWI.