SWI与3D-PCASL联合应用对急性脑梗死出血转化的预测研究

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摘要 [摘要] 目的：探讨3.0T磁共振的磁敏感加权成像（SWI）与三维的准连续式动脉自旋标记技术（3D-PCASL）评价急性脑梗死后出血转化（HT），预测评估的临床应用价值。方法：54例急性脑梗死（<72 h）均行常规MRI、3D-PCASL及SWI检查，利用SWI评估HT的类型，结合3D-PCASL获得梗死和HT区及病灶周围脑血流量（CBF）变化进行相关性分析。结果：本组54例急性脑梗死中有19例HT，其中出血性梗死（HI）型13例（HI-1型9例、HI-2型4例），脑血肿形成（PH）型6例（PH-1、2型各3例），HI和PH型的病灶区及病灶周围的局部脑血流量（rCBF）均值区分别为（32.787±10.876） mL/（100g·min）、（26.655±19.325） mL/（100g·min），（26.033±10.930） mL/（100g·min）、（28.984±11.019） mL/（100g·min），HI和PH型的病灶区的rCBF差异有统计学意义（t=0.766，P=0.000，<0.01，t=0.834，P=0.041，<0.05）。在54例急性脑梗死中，病灶内及周围高灌注出血分别占42.8%、50%，正常灌注区及周围出血分别占50%、37.5%，低灌注区及周围分别占31.7%、28.1%，急性脑梗死与HT病灶区及周围低、正常、高灌注的进行t检验分析具有统计学意义（t=0.658，P=0.002，<0.01）。结论：SWI与3D-PCASL联合应用对急性脑梗死和HT病灶内及周围量化分析rCBF变化情况，对急性脑梗死HT预测，为临床制定正确的治疗方案和预后判断具有重要临床意义。

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关键词 ：脑梗塞, 磁共振成像

Abstract：Abstract: Objective: To evaluate the clinical value of combined using 3.0T magnetic resonance magnetic susceptibility weighted imaging(SWI) and three dimensional pseudo continuous arterial spin labeling(3D-PCASL) in prediction of hemorrhagic transformation(HT) after acute cerebral infarction. Methods: Fifty-four cases of acute cerebral infarction(<72 h) were performed conventional MRI, 3D-PCASL and SWI. The SWI were used to assess the type of HT. Combined with SWI and 3D-PCASL, the infarction area, HT area and cerebral blood flow(CBF) of each patient were calculated and the correlation relationship among them were analyzed. Results: In 54 cases of acute cerebral infarction, 19 cases were HT, 13/19 cases were HI type, 6/19 cases were PH type. The average rCBF zone in HI or PH lesions and area around two types of the lesions were (32.787±10.876), (26.655±19.325), (26.033±10.930), (28.984±11.019) mL/(100g·min), the differences of rCBF in HI and PH lesions area difference was statistically significant(t=0.766, P=0.000, <0.01, t=0.834, P=0.041, <0.05). Within and around the 54 cases of acute cerebral infarction lesions, the high perfusion hemorrhage presented in 42.8% and 50% lesions, respectively. Normal perfusion and surrounding hemorrhage presented in 50% and 37.5% of lesions, respectively. Hypo-perfusion and the surrounding hemorrhage presented in 31.7% and 28.1% lesions, respectively. Acute cerebral infarction and HT lesion area and the surrounding low, normal, high perfusion of the t test analysis statistically significant(t=0.658, P=0.002, <0.01). Conclusion: Combined the SWI and 3D-PCASL is useful in prediction of HT after acute cerebral infarction.

Key words： Brain infarction Magnetic resonance imaging

收稿日期: 2016-08-26

PACS:	Ｒ743.33
	Ｒ445.2

基金资助:连云港市科技局科研项目（编号SH617）。

通讯作者: 许开喜，江苏省连云港市中医院南京中医药大学附属连云港医院，222000。E-mail：2008lygxkx@163.com

作者简介: 许开喜，江苏省连云港市中医院南京中医药大学附属连云港医院，222000。E-mail：2008lygxkx@163.com

引用本文:

许开喜，丰广魁，马先军，陈新建，左涛生，卞光荣，王金，胡方云，吴常征. SWI与3D-PCASL联合应用对急性脑梗死出血转化的预测研究[J]. 中国临床医学影像杂志, 2017, 28(5): 309-314.
XU Kai-xi, FENG Guang-kui, MA Xian-jun, CHEN Xin-jian, ZUO Tao-sheng, BIAN Guang-rong,. Combined with SWI and 3D-PCASL in prediction of bleeding after acute cerebral infarction. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(5): 309-314.

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http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I5/309

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