磁敏感加权成像对大面积脑梗死预后评估的临床应用价值

Prognostic value of susceptibility-weighted imaging in massive cerebral infarction

关键词:  磁敏感加权成像  出血  血栓  侧支循环  脑梗死预后

Key words:  [Key words]　susceptibility-weighted imaging  hemorrhage  thrombosis  collateral circulation  prognosis

摘要:

[摘要]　目的　探讨磁敏感加权成像（susceptibility-weighted imaging,SWI）技术对大面积脑梗死预后评估的临床应用价值。　方法　选择43例大面积脑梗死(以Adamas标准，梗死面积直径>3 cm，并累及两个以上脑血管主干供血区)患者分别于<7天，2周，3个月进行SWI检查，得出各阶段临床NIHSS评分。分析SWI图像特点。观察脑梗死后出血、血管内血栓和梗死周围侧支血管的显示及显示程度，并与临床NIHSS评分改变进行相关统计学分析。　结果　脑梗死后出血34例，占79%。其出血程度与临床NIHSS评分改变呈负相关（P<0.01）。脑梗死血栓显示30例，占70%，血栓在责任血管的位置和长度，与临床NIHSS评分改变相关（P均<0.01）。31例存在脑梗死侧支血管，占72%。侧支血管的显示程度与临床NIHSS评分改变呈正相关(P<0.01)。　结论　SWI能够显示大面积脑梗死后出血、病变区域的血管内血栓和病变周围的侧支血管，量化分析脑梗死后出血、血栓和周围的侧支血管，对临床预后评估起到一定的指导作用。

Abstract:

[Abstract] Objective　To investigate the susceptibility-weighted imaging (SWI) characters in the massive cerebral infarction and evaluate the role of SWI in prognostic assessment of the large ischemia stroke.　Methods　43 patients with massive cerebral infarction,defined by the Adamas rules as the infarction diameters were bigger than 3 cm 2,and related to more than two main vascular territory,were performed SWI within 7 days,2 weeks and 3 months. Clinical function scores were acquired with the NIHSS. Characteristics of routine MRI and SWI images were analyzed. Presence of hemorrhage and correlated arterial thrombosis and collateral circulation after massive cerebral infarction were studied. Correlation of imaging and NIHSS score changes was analyzed.　Results　Hemorrhage was revealed by SWI in 34 out of 43 (79%) massive cerebral infarction. There was a negative correlation between the extent of hemorrhage and the change of NIHSS scores (P<0.01). Arterial thrombosis was found in 30 cases (70%). The proximal location of the thrombosis to the cerebral necrosis and the thrombus length were negatively correlated to the change of NIHSS scores (P<0.01). Collateral circulation was seen in 31 cases (72%). There was a positive correlation between the extent of collateral circulation displayed in the SWI and the change of NIHSS scores (P<0.01).　Conclusion　SWI can show the hemorrhage,correlated arterial thrombosis and the collateral circulation of massive ischemic stroke and can be used to measure the changes,thus is helpful in guiding the clinical prognosis.