作者：王朝刚，张晓曼，李兆妍，徐远杰，范建江

单位：

河南省郑州市第一人民医院神经内科

Units：

Department of Neurological, Zhengzhou First People’s Hospital;

关键词：

脑梗死; 灌注加权成像; 弥散加权成像; 诊断; 预后;

Keywords：

Cerebral infarction;Perfusion weighted imaging;Diffusion weighted imaging;Diagnosis;Prognosis;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.318

Funds：

河南省医学科技攻关计划（联合共建）项目（LHGJ20190985）；

摘要：

目的 分析弥散加权成像（DWI）和灌注加权成像（PWI）在超急性期脑梗死诊断及预后评估中的应用价值。方法 选取2020年4月至2021年3月郑州市第一人民医院收治的78例行溶栓治疗的超急性期脑梗死（脑梗死发病时间<6 h）患者作为超急性期组，45例未行溶栓治疗的急性期脑梗死（脑梗死发病时间为6 h～3 d）患者作为急性期组，33例未行溶栓治疗的亚急性期脑梗死（脑梗死发病时间为4 d～3周）患者作为亚急性期组。比较三组患者梗死区DWI、PWI检查指标[表观弥散系数（ADC）、局部脑血容量（rC BV）、局部脑血流量（rC BF）、平均通过时间（MTT）、达峰时间（TTP）]；比较超急性期组溶栓治疗前后、不同预后患者梗死区DWI、PWI检查指标；比较超急性期组DWI-PWI匹配与DWI-PWI不匹配患者溶栓治疗后15 d美国国立卫生研究院卒中量表（NIHSS）评分、溶栓治疗后3个月预后。绘制ROC曲线以评价梗死区DWI、PWI检查指标对超急性期脑梗死的诊断价值及对超急性期脑梗死患者预后的预测价值。结果 急性期组和亚急性期组患者梗死区ADC、rC BV、rC BF大于超急性期组，梗死区MTT、TTP短于超急性期组；亚急性期组患者梗死区ADC、rC BV、rC BF大于急性期组，梗死区MTT、TTP短于急性期组（P<0.05）。溶栓治疗后，超急性期组患者梗死区ADC、rC BV、rC BF大于溶栓治疗前，梗死区MTT、TTP短于溶栓治疗前（P<0.05）。溶栓治疗后3个月，超急性期组预后良好患者38例，预后不良患者40例。超急性期组预后良好患者梗死区ADC、rC BV、rC BF大于预后不良患者，MTT、TTP短于预后不良患者（P<0.05）。超急性期组DWI-PWI匹配患者30例，DWI-PWI不匹配患者48例。超急性期组DWI-PWI不匹配患者溶栓治疗后15 d NIHSS评分低于DWI-PWI匹配患者，预后优于DWI-PWI匹配患者（P<0.05）。梗死区ADC、rC BV、rC BF、MTT、TTP诊断超急性期脑梗死的AUC分别为0.841[95%CI(0.780,0.903)]、0.859[95%CI(0.803,0.916)]、0.873[95%CI(0.821,0.926)]、0.725[95%CI(0.646,0.804)]、0.783[95%CI(0.711,0.855)]。梗死区ADC、rCBV、rCBF、MTT、TTP预测超急性期脑梗死患者预后的AUC分别为0.860[95%CI(0.777,0.943)]、0.815[95%CI(0.721,0.909)]、0.826[95%CI(0.732,0.920)]、0.673[95%CI(0.552,0.795)]、0.677[95%CI(0.556,0.798)]。结论 梗死区ADC、rC BV、rC BF对超急性期脑梗死具有一定诊断价值，对超急性期脑梗死患者预后具有一定预测价值；且DWI-PWI不匹配患者溶栓治疗效果、预后更好。

Abstract：

Objective To analyze the application value of perfusion weighted imaging（PWI） and diffusion weighted imaging（DWI） in the diagnosis and prognosis evaluation of hyperacute cerebral infarction. Methods From April 2020 to March 2021, 78 patients with hyperacute cerebral infarction（onset time of cerebral infarction < 6 h） who underwent thrombolytic therapy in Zhengzhou First People’s Hospital were selected as the hyperacute phase group, 45 patients with acute cerebral infarction（onset time of cerebral infarction was 6 h-3 d） who did not receive thrombolytic therapy were selected as the acute phase group, and 33 patients with subacute cerebral infarction（onset time of cerebral infarction was 4 d-3 weeks） who did not receive thrombolytic therapy were selected as the subacute phase group. The examination indexes of DWI and PWI of infarct size [apparent dispersion coefficient（ADC）, regional cerebral blood volume（rCBV）, regional cerebral blood flow（rCBF）, mean transit time（MTT）, time to peak（TTP） ] were compared among the three groups. In the hyperacute group, DWI and PWI examination indexes of infarct size before and after thrombolytic therapy, DWI and PWI examination indexes in patients with different prognosis were compared. The National Institutes of Health Stroke Scale（NIHSS） score at 15 days after thrombolytic therapy and the prognosis 3 months after thrombolytic therapy were compared between DWI-PWI matched patients and DWI-PWI mismatched patients in the hyperacute phase group. ROC curve was drawn to evaluate the diagnostic value of DWI and PWI examination indexes of infarct size for hyperacute cerebral infarction and the predictive value of DWI and PWI examination indexes of infarct size for prognosis in patients with hyperacute cerebral infarction. Results ADC, rCBV and rCBF of infarct zise in the acute phase group and the subacute phase group were larger than those in the hyperacute phase group, the MTT and TTP of infarct size were shorter than those in the hyperacute phase group. ADC, rCBV and rCBF of infarct zise in the subacute group were higher than those in the phase acute group, MTT and TTP of infarction size were shorter than those in acute phase group（P < 0.05）. In the hyperacute group, ADC, rCBV and rCBF of infarct zise after thrombolytic therapy were larger than those before thrombolytic therapy, and the MTT and TTP of infarct size were shorter than those before thrombolytic therapy（P < 0.05）. Three months after thrombolytic therapy, there were 38 patients with good prognosis and 40 patients with poor prognosis in the hyperacute group. In hyperacute phase group, ADC, rCBV and rCBF of infarct zise in patients with good prognosis were higher than those in patients with poor prognosis, MTT and TTP were shorter than those in patients with poor prognosis（P < 0.05）. There were 30 DWI-PWI matched patients and 48 DWI-PWI mismatched patients in hyperacute phase group. In hyperacute phase group, the NIHSS score at 15 days after thrombolytic therapy of DWI-PWI mismatched patients was lower than that DWI-PWI matched patients, and the prognosis was better than that of DWI-PWI matched patients（P < 0.05）. The AUC of ADC, rCBV, rCBF, MTT and TTP of infarct zise for diagnosing hyperacute cerebral infarction was 0.841 [95%CI（0.780, 0.903） ], 0.859 [95%CI（0.803,0.916） ], 0.873 [95%CI（0.821, 0.926） ], 0.725 [95%CI（0.646, 0.804） ], 0.783 [95%CI（0.711, 0.855） ], respectively. The AUC of ADC, rCBV, rCBF, MTT and TTP of infarct zise in predicting the prognosis of patients with hyperacute cerebral infarction was 0.860 [95%CI（0.777, 0.943） ], 0.815 [95%CI（0.721, 0.909） ], 0.826 [95%CI（0.732, 0.920） ], 0.673 [95%CI（0.552, 0.795） ], 0.677 [95%CI（0.556, 0.798） ], respectively. Conclusion ADC, rCBV and rCBF of infarct zise have certain diagnostic value for hyperacute cerebral infarction, and have certain predictive value for the prognosis of patients with hyperacute cerebral infarction. The effect of thrombolytic therapy and prognosis are better in DWI-PWI mismatched patients.

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