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背景:磁共振、经颅多普勒均可对急性脑梗死进行超早期评估,急性脑梗死发生形态结构的变化时,M RI是可靠的诊断方法,但对于尚未发生明显形态变化时,经颅多普勒检查则尤其重要,两者联合应用的评估价值不明确。目的:应用M RI联合经颅多普勒检查临床高度怀疑的脑梗死患者,探讨其对急性脑梗死的超早期评估价值。设计:病例分析,盲法评估。单位:大庆油田总医院磁共振室及四川大学华西医学校区临床流行病学教研室和公共卫生学院卫生经济教研室。对象:选择2000-05/2001-07在大庆油田总医院发病时间在12h 以内有卒中样起病临床高度怀疑脑梗死患者225例,所有检查均征得患者同意。男121例,女104例;年龄为33～86岁,平均(62±12)岁。方法:所有纳入的患者先行经颅多普勒检查再进行M RI检查,两者检查时间间隔不超过1h,全部病例于15d 后再次进行随访M RI检查(作为诊断脑梗死的金标准)。M RI检查观察病变的部位、形态、大小及信号的情况。经颅多普勒检查探测双侧大脑前、中、后动脉以及颈内动脉、椎基底动脉的血流速度、收缩期、舒张期峰值、血流频谱、血流声频。主要观察指标:M RI、经颅多普勒、M RI联合经颅多普勒诊断急性脑梗死的敏感性、特异性及准确性。结果:参加试验225例患者,其中5例不符合纳入标准,220例进入结果分析。①220例M RI诊断急性脑梗死的敏感性为79.3%,特异性为98.4%,准确性为90.5%。经颅多普勒诊断急性脑梗死的敏感性为80.4%,特异性为81.3%,准确性为80.9%。M RI平行联合经颅多普勒诊断急性脑梗死的敏感性为96.7%,特异性为80.5%,准确性为87.3%。结论:M RI联合经颅多普勒诊断急性脑梗死的敏感性和特异性均很高,两者平行联合应用能够快速准确地对急性脑梗死进行评估。
BACKGROUND: Magnetic resonance imaging and transcranial Doppler can be used for early assessment of acute cerebral infarction. M RI is a reliable diagnostic method for morphological changes of acute cerebral infarction. However, when there is no obvious morphological change, transcranial Doppler examination is particularly important, the combined evaluation of the value of the two is not clear. OBJECTIVE: To evaluate the ultra early evaluation of acute cerebral infarction by using M RI combined with transcranial Doppler in patients with highly suspected clinical cerebral infarction. Design: Case Analysis, Blind Evaluation. Unit: Department of Magnetic Resonance, Daqing Oilfield General Hospital and Department of Clinical Epidemiology and School of Public Health, Department of Health Economics, West China Medical University, Sichuan University. PARTICIPANTS: A total of 225 patients with clinically suspected high degree of cerebral infarction who had been diagnosed as having a stroke within 12 hours after their onset in Daqing Oilfield General Hospital were selected from May 2000 to July 2001. All patients were given consent. There were 121 males and 104 females, ranging in age from 33 to 86 years with an average of (62 ± 12) years. Methods: All included patients underwent transcranial Doppler examinations before M RI examination, the time between the two examinations did not exceed 1h, all cases were again followed up 15 days M RI examination (as the gold standard for the diagnosis of cerebral infarction). M RI examination to observe the location of the lesion, morphology, size and signal situation. Transcranial Doppler ultrasound examination of bilateral frontal, middle and posterior arteries and internal carotid artery, vertebrobasilar blood flow velocity, systolic, diastolic peak, blood flow spectrum, blood flow audio frequency. MAIN OUTCOME MEASURES: The sensitivity, specificity and accuracy of M RI, transcranial Doppler, M RI combined with transcranial Doppler in the diagnosis of acute cerebral infarction. RESULTS: A total of 225 patients participated in the trial, 5 of which did not meet the inclusion criteria and 220 were included in the result analysis. 120 cases of M RI diagnosis of acute cerebral infarction was 79.3% sensitivity, specificity was 98.4%, accuracy was 90.5%. Transcranial Doppler diagnosis of acute cerebral infarction was 80.4%, specificity was 81.3%, accuracy was 80.9%. M RI parallel combined transcranial Doppler diagnosis of acute cerebral infarction was 96.7% sensitivity, specificity 80.5%, accuracy 87.3%. Conclusions: The sensitivity and specificity of M RI combined with transcranial Doppler in the diagnosis of acute cerebral infarction are very high. The combined application of M RI and acute transcranial Doppler can evaluate acute cerebral infarction quickly and accurately.