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目的研究单发急性脑梗死整体病灶区治疗前与后氢质子磁共振波谱(1H-MRS)特征,并探讨其临床应用价值。资料与方法 26例患者分别在急性期和治疗平稳期行常规MRI及1H-MRS检查。1H-MRS检测采用单体素或多体素对病灶区行整体取样。对比分析治疗前与后整体梗死病灶区氮-乙酰天门冬氨酸(NAA)、胆碱类复合物(Cho)和肌酸(Cr)积分值,记录乳酸(Lac)峰次数;同时检测对侧正常脑组织区相应代谢物。运用Barthel指数量表记录患者的神经功能评分。扩散加权成像(DWI)上测量病灶容积并分析治疗前与后容积变化。比较治疗前与后病灶区NAA积分值与梗死病灶容积(V)的比值并分析其与神经功能评分的相关性。结果 26例患者在12～72 h和治疗(20±7.17)天接受了两次MR检查,获得52次1H-MRS结果。治疗前、后病灶区NAA分别与对侧半球相应正常区相比均有下降(P<0.05),梗死病灶区治疗前与后NAA未见明显改变(P>0.05);治疗后梗死病灶容积较治疗前变小(P<0.05);治疗后NAA/V比值及神经功能评分较治疗前值均有升高(P<0.05);NAA/V比值与患者神经功能评分呈正相关(r=0.315,P<0.05)。病灶区治疗前与后Cho及Cr值相比及其分别与对侧相应区相比,无显著性差异(P>0.05),但部分Cho(9/26)及Cr(7/26)治疗前后的值起伏较大。Lac峰出现率为23%(12/52)。结论1H-MRS对单发急性脑梗死治疗前与后病灶整体取样动态监测其单一的NAA水平改变,对于评价临床神经功能康复有局限性;动态监测梗死病灶区NAA水平与梗死病灶容积比值,可能是一项反映临床神经功能恢复的客观指标;Cho与Cr值总体相对平稳;Lac峰的出现有一定的诊断价值。
Objective To study the characteristics of proton magnetic resonance spectroscopy (1H-MRS) before and after treatment in the whole lesion area of single acute cerebral infarction and explore its clinical value. Materials and Methods 26 patients underwent routine MRI and 1H-MRS in acute phase and stable treatment respectively. 1H-MRS detection using single voxel or multi-voxel on the lesion line overall sampling. The values of NAA, Cho and Cr in whole infarction area before and after treatment were compared and recorded, and the number of lactic acid (Lac) peak was recorded. At the same time, the contralateral Normal brain tissue area corresponding metabolites. Patients’ neurological scores were recorded using the Barthel Index Scale. Volume of lesions was measured on diffusion-weighted imaging (DWI) and changes in volume before and after treatment were analyzed. The ratio of NAA score to infarct volume (V) before and after the treatment was compared and the correlation between NAA score and neurological function score was analyzed. Results Twenty-six patients underwent two MR examinations at 12-72 h and at treatment (20 ± 7.17) days, obtaining 52 1H-MRS results. NAA in the lesion area before and after treatment both decreased compared with the corresponding normal area in the contralateral hemisphere (P <0.05), but NAA in the infarct area did not change significantly (P> 0.05) The NAA / V ratio and nerve function score were significantly higher than those before treatment (P <0.05). The NAA / V ratio was positively correlated with the neurological score (r = 0.315, P <0.05). There was no significant difference in Cho and Cr values before and after treatment between the lesion area and the corresponding contralateral contralateral area (P> 0.05), but some Cho (9/26) and Cr (7/26) before and after treatment The value of the ups and downs. The appearance of Lac peak was 23% (12/52). CONCLUSIONS: 1H-MRS can detect single NAA level changes in patients with acute cerebral infarction before and after treatment. There is a limitation in assessing clinical neurological rehabilitation. The ratio of NAA level to infarct volume may be dynamically monitored Is an objective indicator of clinical nerve function recovery; Cho and Cr values are generally relatively stable; Lac peak appears a certain diagnostic value.