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目的:探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)量化指标对急性脑缺血溶栓治疗预后评估的价值。方法:112例急性脑缺血患者在溶栓前进行磁共振(MR)检查,包括常规序列及DWI序列。对其中46例符合溶栓条件的患者进行溶栓治疗,作为治疗组;48例不符合溶栓条件的患者进行常规治疗,作为对照组;其余3例带有金属假牙及填充物患者MR图像质量不满意;15例诊断为TIA发作,进行保守治疗。测量所得DWI图像显示的梗死体积、梗死部位、梗死边缘及进展区弥散系数(ADC)值,将梗死体积与ADC值指标量化后与溶栓预后指标进行相关性分析,探讨其可能的评估价值。结果:对照组与溶栓组中的DWI各区域的ADC值无统计学差异(P=0.07、0.46、0.71、0.34)。溶栓组DWI所测量的梗死体积与临床NIHSS评分、住院天数、预后以及颅内出血(ICH)密切相关(P=0.009、0.034、0.048、0.015)。梗死体积越大,NIHSS评分越高、并发出血的可能性也越大。结论:DWI测量脑梗死范围大小可能有助于评价急性脑缺血溶栓治疗预后,ADC值可能评估价值不大。
Objective: To investigate the value of quantitative weighted magnetic resonance imaging (DWI) in assessing the prognosis of acute cerebral ischemic thrombolysis. Methods: One hundred and twelve patients with acute cerebral ischemia were examined by magnetic resonance (MR) before thrombolysis, including routine sequence and DWI sequence. Forty-six patients undergoing thrombolytic therapy were treated with thrombolytic therapy as a treatment group. Forty-eight patients who did not meet thrombolysis were routinely treated as a control group. The remaining three patients with metallic dentures and filler MR images Not satisfied; 15 cases diagnosed as TIA attack, conservative treatment. The infarct volume, infarct area, infarct margin and ADC value were measured by DWI. Correlation analysis of infarct volume and ADC value and prognosis of thrombolysis was carried out, and its possible evaluation value was discussed. Results: There was no significant difference in ADC values between DWI and control groups in control group and thrombolytic group (P = 0.07,0.46,0.71,0.34). Infarct volume measured by DWI in thrombolysis group was closely related to clinical NIHSS score, length of hospital stay, prognosis and intracranial hemorrhage (ICH) (P = 0.009,0.034,0.048,0.015). The larger the infarct volume, the higher the NIHSS score and the greater the likelihood of bleeding. Conclusion: The range of infarct size measured by DWI may be helpful to evaluate the prognosis of acute cerebral ischemic thrombolytic therapy. The value of ADC may not be evaluated.