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目的探讨磁敏感加权成像(SWI)中的低信号血管影在急性缺血性脑卒中(acute ischemic stroke,AIS)诊断中的临床应用价值。资料与方法选择符合纳入标准的AIS患者11例,发病时间3～48h,其中男性8例,女性3例,年龄28～85岁,行MRI。序列:T1WI,T2WI,T2液体衰减反转恢复序列(T2FLAIR),扩散加权成像(DWI),三维时间飞跃法磁共振血管成像(3D TOF MRA),SWI,灌注加权成像(PWI)及T1WI增强扫描。由3名有经验的神经放射学医师采用盲法分析MRI结果。结果11例患者均可见大脑中动脉(MCA)供血区缺血病灶。SWI显示MCA内低信号与MRA显示的颈内动脉(ICA)、MCA血管阻塞有较好的相关性(Spearman等级相关系数ρs=0.7698,P=0.0056),其预测ICA、MCA血管阻塞的灵敏性为100%,特异性为66.7%。SWI示11例中4例缺血区内可见异常的静脉血管影,PWI显示病灶体积与缺血区内出现走行僵直的静脉血管影这一征象有较好的相关性(Spearman等级相关系数ρs=0.8367,P=0.0013);相对平均通过时间(rMTT)与缺血区内出现走行僵直的静脉血管影这一征象也有较好的相关性(Spearman等级相关系数ρs=0.7188,P=0.0127)。T1WI增强扫描示1例可见MCA管壁强化。结论AIS患者SWI中的低信号血管影与血栓形成及血流速度减慢有关,即其病理机制与去氧血红蛋白浓度增加有关。
Objective To investigate the clinical value of low signal angiography in magnetic resonance weighted imaging (SWI) in the diagnosis of acute ischemic stroke (AIS). Materials and Methods Eleven patients with AIS who met the inclusion criteria were selected. The onset time ranged from 3 to 48 hours. There were 8 males and 3 females, aged 28-85 years. MRI was performed. Sequences: T1WI, T2WI, T2 T2FLAIR, DWI, 3D TOF MRA, SWI, perfusion weighted imaging (PWI) and T1WI enhanced scan . Blind analysis of MRI results was performed by three experienced neuroradiologists. Results All the 11 patients showed ischemic lesions in the middle cerebral artery (MCA) donor area. SWI showed that there was a good correlation between low signal in MCA and internal carotid artery (ICA) and MCA occlusion (Spearman rank correlation coefficient ρs = 0.7698, P = 0.0056) showed by MRA, which predicts the sensitivity of ICA and MCA occlusion Is 100%, specificity is 66.7%. SWI showed abnormal venous blood vessels in 4 ischemic areas in 11 cases. PWI showed that there was a good correlation between the lesion volume and venous blood vessels in the ischemic area (Spearman rank correlation coefficient ρs = 0.8367, P = 0.0013). Relative mean transit time (rMTT) also showed a good correlation with venous angiography in the ischemic region. Spearman rank correlation coefficient ρs = 0.7188, P = 0.0127. T1WI enhanced scan showed 1 case showed MCA wall enhancement. Conclusion The low signal angiogenesis in SWI of AIS patients is related to thrombosis and slowing of blood flow velocity, which means the pathological mechanism is related to the increase of deoxyhemoglobin concentration.