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目的分析急性大面积脑梗死患者血栓的磁敏感加权成像(SWI)特点及其与临床的相关性。方法选择46例急性大面积脑梗死(临床症状出现<24 h)患者进行SWI检查,并在2周、3个月进行随诊。分析急性大面积脑梗死血栓的SWI图像特点,并得出相应美国国家健康研究所脑卒中分级量表(NIHSS)评分,进行相关统计学分析。结果有34例显示血栓存在,占74%。其中急性期和亚急性期(<2周)显示32例,稳定恢复期(>3个月)显示2例,不同时期内血栓的显示特点差异有统计学意义(P<0.05)。其中血栓长度≥4 cm 23例,血栓长度与临床NIHSS评分有相关性(r=0.783,P<0.01)。血栓位于梗死血管起始部26例,远侧部8例,血栓的位置与临床NIHSS评分有相关性(r=0.747,P<0.01)。结论 SWI对无创显示急性大面积脑梗死血管内血栓具有敏感性和特异性;量化分析有助于判断急性大面积脑梗死的演变情况,对临床治疗及预后评估起到一定的指导作用。
Objective To analyze the characteristics of magnetic resonance weighted imaging (SWI) of thrombus in patients with acute large area cerebral infarction and its clinical relevance. Methods 46 cases of acute large area cerebral infarction (clinical symptoms <24 h) were selected for SWI examination and were followed up for 2 weeks and 3 months. The characteristics of SWI images of acute massive cerebral infarction were analyzed, and the corresponding National Institutes of Health Stroke Scale (NIHSS) scores were obtained for statistical analysis. Thirty-four cases showed thrombus, accounting for 74%. There were 32 cases in acute and subacute phase (<2 weeks), 2 cases in stable recovery phase (> 3 months), and the difference of thrombus in different periods was statistically significant (P <0.05). Thrombus length ≥ 4 cm in 23 cases, thrombus length and clinical NIHSS score (r = 0.783, P <0.01). Thrombus was found in 26 cases at the beginning of infarction and in 8 cases at distal part. The location of thrombus was correlated with clinical NIHSS score (r = 0.747, P <0.01). Conclusion SWI is sensitive and specific to non-invasive visualization of intravascular thrombosis in acute large area cerebral infarction. Quantitative analysis is helpful to judge the evolution of acute large area cerebral infarction and play a guiding role in clinical treatment and prognosis evaluation.