磁敏感加权成像对大面积脑梗死后出血转化早期诊断临床价值的预探索研究

摘要/Abstract

摘要：

目的探讨磁共振成像（magnetic resonance imaging，MRI）磁敏感加权成像（susceptibility-weightedimaging， SWI）技术在早期诊断大面积脑梗死后出血转化（hemorrhagic transformation，HT）中的价值。方法纳入39例经磁共振确诊的大面积脑梗死患者为研究对象，在发病72 h内行头颅计算机断层扫描（computed tomography，CT）和SWI检查，比较两种检查方法对脑梗死后HT的检出率及敏感性。参考欧洲协作性急性卒中研究（European Cooperative Acute Stroke Study，ECASS）分型标准对脑梗死后HT 患者的HT进行分级，比较HT分级在两种检查方法中的差异，分析脑梗死后HT分级与美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分的相关性。结果 SWI、CT两种方法诊断脑梗死HT的阳性率分别为61.54％和12.82％（P <0.001）；SWI检出发生脑梗死后HT者24例，其中1级占12.82%；2级占25.64%；3级占15.48%；4级占7.69%；经Spearman相关性分析，SWI序列的HT分级与临床NIHSS评分的增长呈正相关（R =0.94，P <0.01）。结论 SWI技术可以早期、敏感评价大面积脑梗死后HT。

文章导读： 大面积脑梗死后出血转化是新兴的磁共振磁敏感加权成像技术（MRI SWI）较少涉及的领域，本
研究显示，在此领域，磁敏感加权成像的敏感性明显优于计算机断层扫描（CT），且其显示的出血
转化分级与临床神经功能评分正相关。

关键词: 磁敏感加权成像; 大面积脑梗死; 出血转化; 体层摄影术; X线计算机

Abstract:

Objective To investigate the early diagnostic value of susceptibility weighted imaging (SWI) on hemorrhagic transformation (HT) after massive cerebral infarction. Methods Thirty nine cases with massive cerebral infarction diagnosed by magnetic resonance were enrolled and head computed tomography (CT) and magnetic resonance imaging (MRI) including SWI were performed within 72 hours after onset. The detection rate and the sensitivity of two methods for diagnosing HT were compared. The HT after cerebral infarction was graded based on European Cooperative Acute Stroke Study (ECASS), the difference in HT grade by two examination methods was compared, HT grading and the National Institutes of Health Stroke Scale (NIHSS) score correlation were analyzed. Results The positive rates of SWI or CT in the diagnosis of HT were 61.54% and 12.82% (P <0.001) respectively. Twenty four cases (61.54%) with HT after massive cerebral infarction were detected by SWI, grade 1 accounted for 12.82%, and grade 2, 3, 4 for 25.64%, 15.48% and 7.69%, respectively. SWI was significantly superior to conventional CT in early detection of hemorrhagic transformation after massive cerebral infarction. HT grading by SWI was positively correlated with NIHSS scores (R =0.94, P <0.01). Conclusion The HT after massive cerebral infarction can be early, sensitively, objectively evaluated by SWI, which provides the basis for the adjusting treatment programs.

Key words: Susceptibility weighted imaging; Massive cerebral infarction; Hemorrhagic transformation; Tomography; X-ray computer

刘远洪1，牛智领1，梁金花1，马娜1，张盼盼1，刘乐喜1，聂志余2. 磁敏感加权成像对大面积脑梗死后出血转化早期诊断临床价值的预探索研究[J]. 中国卒中杂志.

LIU Yuan-Hong, NIU Zhi-Ling, LIANG Jin-Hua, MA Na, ZHANG Pan-Pan, LIU Le-Xi, NIE Zhi-Yu.. Clinical Value of Susceptibility Weighted Imaging on Hemorrhagic Transformation after
Massive Cerebral Infarction[J]. Chinese Journal of Stroke.

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