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随着我国步入老龄化社会,脑梗死发病率也在不断攀升,较高的死亡率和致残率给家庭和社会带来了沉重的负担。血栓形成的病因病理过程,对于脑梗死治疗方案和治疗药物选择均具有重要的临床意义。而现有的循证医学研究[1-2]表明,急性脑梗死发生时,给予病人及时足量的重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)可改善病人临床预后,减轻临床症状,降低致残率和死亡率。但由于对血栓评估手段主要依靠于病理,使得这种方法无法在临床上广泛推广。随着多模态影像技术兴起,尤其是磁共振影像功能的开发,使得这一设想在临床上提供了技术可能。磁敏感加权成像(susceptiblity weighted imaging,SWI)通过对不同磁性物质在磁共振影像中的差异梯度和依赖于血管中血氧饱和度变化引起的血红细胞磁敏感变化效应,进而形成相应的影像[3]。本课题研究SWI上磁敏感血栓征(susceptiblity vessel sign,SVS)这一影像学现象,对于急性脑梗死病人的责任血管内血栓进行识别和定位,根据SVS提供的信息,对于指导临床治疗方案的选择以及病人预后评估可能具有重要的临床意义。现作报道。
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本次符合入组标准的急性脑梗死病人共计25例,男13例(52%),女12例(48%);年龄(69.04±16.96)岁;患有高血压者15例(60%),糖尿病者5例(20%),心房颤动者5例(20%),高脂血症者9例(36%),有长期吸烟不良嗜好者8例(32%),长期饮酒者1例(4%),全部入组病人刚入院时NIHSS评分(7.52±5.27)分。
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25例病人中,发现17例(68%)在SWI上有沿着病变血管走形的SVS,全部17例SVS阳性病人(100%)在对应的MRA上发现有相应血管的狭窄或者闭塞;8例SVS阴性病人在对应的MRA上发现有血管狭窄或闭塞(见图 1、2)。SVS阳性病人血管闭塞率高于阴性病人(P < 0.05)(见表 1)。
SVS MRA 合计 血管狭窄 血管闭塞 阳性 4(16.0) 13(52.0) 17(68.0) 阴性 3(12.0) 5(20.0) 8(32.0) 合计 7(28.0) 18(72.0) 25(100.0) 表 1 SWI发现责任动脉内血栓[n;百分率(%)]
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对25位脑梗死病人发病90 d后的随访,发现17例SVS阳性的病人中有10例(58.8%)病人临床预后不良,而在8例SVS阴性病人中仅有1例(12.5%)病人临床预后不良;SWI上的SVS阳性病人较阴性病人临床预后不良率高(χ2=4.74,P < 0.05)。
磁敏感血栓征在急性缺血性脑卒中病人诊治中的意义
Clinical application value of susceptibility vessel sign in patients with acute ischemic stroke
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摘要:
目的探讨磁敏感加权成像上磁敏感血栓征(SVS)在急性脑梗死临床诊断和治疗中的意义。 方法对25例急性脑梗死病人入院5 d内完善常规MRI、DWI、SWI和MRA等相关检查。对SWI对颅内责任血管血栓定位进行统计分析,并对全部脑梗死病人入院时进行神经缺损程度评分,发病90 d后进行残障评分,判断磁敏感血栓征对病人临床预后是否具有指示意义。 结果25例病人中,发现17例病人(68%)在SWI上有沿着病变血管走形的SVS,且SVS阳性病人血管闭塞率高于阴性病人(P < 0.05);对25位脑梗死病人发病90 d后随访发现,17例SVS阳性的病人有10例病人临床预后不良,而8例SVS阴性病人,仅有1例病人临床预后不良,SWI上的SVS阳性病人较阴性病人临床预后不良率高(P < 0.05)。 结论脑梗死急性期,SWI的SVS征可以提示颅内责任动脉内血栓,并能提示病人临床预后不良。 Abstract:ObjectiveTo investigate the significance of magnetic sensitive weighted imaging(SVS)in the diagnosis and treatment of acute cerebral infarction. MethodsThe routine detection of MRI, DWI, SWI and MRA in 25 patients with acute cerebral infarction were implemented.The location of intracranial responsible blood vessel thrombosis was analyzed using SWI, the nerve defect degree score on admission and disability score after 90 days of onset were performed in all cases, and the significance of magnetically sensitive thrombus sign in judging the prognosis of patients was analyzed. ResultsAmong 25 patients with acute cerebral infarction, the SVS along lesion vessel in 17 cases(68%)were found in SWI, and the vascular occlusion rate in SVS-positive patients was higher than that in SVS-negative patients(P < 0.05).During the following-up for 90 days of 25 patients with cerebral infarction, the clinical prognosis in 10 cases with positive SVS, 8 cases with negative SVS and 1 case were poor, and the poor clinical prognosis rate of positive SVS patients in SWI was higher compared with negative SVS patients(P < 0.05). ConclusionsDuring the acute phase of cerebral infarction, the SVS sign in SWI can indicate the intracranial responsible intra-arterial thrombosis, and poor clinical prognosis. -
表 1 SWI发现责任动脉内血栓[n;百分率(%)]
SVS MRA 合计 血管狭窄 血管闭塞 阳性 4(16.0) 13(52.0) 17(68.0) 阴性 3(12.0) 5(20.0) 8(32.0) 合计 7(28.0) 18(72.0) 25(100.0) -
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