1、一 10 48 一论著MM I不同发病期脑梗死患者MRI-DWI影像学差异比较现代医用影像学2 0 2 3年6 月第32 卷第6 期胡蝶，洪建平，程建芳中国人民解放军庐山康复疗养中心（九江市17 1医院）放射科（江西九江332 0 0 0）【摘要】目的：比较不同发病期脑梗死患者核磁共振弥散加权成像（MRI-DWI)的影像学差异。方法：回顾性分析2 0 16 年1月至2 0 2 1年6 月我院收治的532 例脑梗死患者临床资料，所有患者均使用MRI-DWI、T 1加权成像（TIWI)、液体衰减反转恢复序列（FLAIR)检查，根据患者发病至检查时间分为超急性期组（n=104，发病至检查时间6 h）
2、、急性组（n=183，发病至检查时间7-7 2 h）、亚急性组（n=146，发病至检查时间7 3h10d）、慢性组（n=99，发病至检查时间11d），分析4组患者组间病变区MRI-DWI、T 1W I、FLA IR 信号强度，比较4组患者组内病变区和健侧对应区MRI-DWI影像学指标差异表观弥散系数（ADC)，比较4组患者组间病变区ADC差异，采用Pearson分析模型分析病变区ADC与脑梗死患者发病至检查时间的相关性。结果：超急性期组患者病变区MRI-DWI呈高信号，TIWI呈低信号，FLAIR呈中信号；急性期组患者病变区MRI-DWI、T IW I、FLA IR均呈高信；亚急性期组患者MR
3、I-DWI呈高信号，TIWI呈低信号，FLAIR呈高信号；慢性期组患者MRID W I呈低信号，TIWI呈低信号，FLAIR呈中信号。4组患者组内病变区ADC显著低于健侧对应区（P0.05）。4组患者组间病变区 ADC 比较均有明显差异，且超急性期组 急性组 亚急性组 慢性组(P0.05)。病变区ADC 与脑梗死患者发病期呈正相关(P0.05）。结论：不同发病期脑梗死患者病变区MRI-DWI、T 1I W I、FLA I R 信号强度不同，且MRI-DWI参数存在明显差异，临床可根据其影像学指标判断患者发病期从而对应制订治疗方案。关键词：发病期；脑梗死；核磁共振；弥散加权成像；影像学指标；相关
4、性Comparison of MRI-DWI Imaging Differences in Patientswith Cerebral Infarction at Different Onset StagesHu Die,Hong Jianping,Cheng JianfangDepartment of Radiology,Lushan Rehabilitation Center of the Chinese Peoples Liberation Army(Jiujiang 171 Hospital)（Ji u j i a n g,Ji a n g x i 332 0 0 0)Abstract
5、 Objective:To compare the imaging differences of magnetic resonance imaging diffusion-weightedimaging(MRI-DWI)in patients with cerebral infarction at different onset stages.Methods:The clinical data of 532patients with cerebral infarction admitted to the hospital between January 2016 and June 2021 w
6、ere retrospectively analyzed.All patients were examined by MRI-DWI,TI weighted imaging(TIWI)and fluid attenuated inversion recovery sequence(FLAIR).According to the time from onset to examination,the patients were divided into hyperacute group(n=104,timefrom onset to examination 6h),acute group(n=18
7、3,time from onset to examination of 7h 72h),subacute group(n=146,time from onset to examination of 73h 10d)and chronic group(n=99,time from onset to examination 11 d).Thesignal intensities of MRI-DWI,TI WI and FLAIR in diseased area of the four groups were analyzed.The differences in MRI-DWI imaging
8、 indicator apparent diffusion coefficient(ADC)in diseased area and contralateral area were comparedamong the four groups.The difference in ADC in diseased area was compared,and Pearson analysis model was used toanalyze the correlation between ADC in diseased area and time from onset to examination i
9、n patients with cerebral infarction.Results:Patients in hyperacute group showed high signal on MRI-DWI,low signal on TIWI and middle signal on FLAIRin diseased area.Patients in acute group displayed all high signals on MRI-DWI,TIWI and FLAIR.Patients in subacute作者简介：胡蝶，女，江西九江人，大学本科，主治医师，研究方向：缺血性脑疾病。
10、M M I MONTHLY Vol 32 No.6 Jun.2023group were shown as high signal on MRI-DWI,low signal on TIWI and high signal on FLAIR.Patients in chronic groupshowed low signal on MRI-DWI,low signal on TIWI and middle signal on FLAIR.The ADC in diseased area in the fourgroups was significantly lower than that in
11、 contralateral area(P0.05).There was a statistical difference in ADC indiseased area among the four groups,and the ADC was shown as hyperacute groupacute group subacute group chronicgroup(P 0.05).The ADC in diseased area was positively correlated with the onset stage of patients with cerebralinfarct
12、ion(P0.05).Conclusion:The signal intensities of MRI-DWI,T1WI and FLAIR are different in diseased areaof patients with cerebral infarction at different onset stages,and there are significant differences in the MRI-DWIparameters.Clinically,the onset stage of patients can be judged based on the imaging
13、 indicators so as to formulate thetreatment regimen accordingly.Key words:onset stage;cerebral infarction;MRI;dffusion weighted imaging;imaging indicators;correlation脑梗死也称缺血性脑卒中，为动脉硬化等多种原因导致大脑血液灌注发生障碍导致脑部组织缺血缺氧产生不可逆性损伤的疾病，发病后患者神经功能会受到不同程度损伤，严重可致残甚至致死1-2 ，且根据流行病学数据统计，脑梗死占我管脑血管死亡率50%左右，存活者致残率也高达50%，且脑
14、梗死患者治疗方案与发病“时间窗”相关，以发病至检查时间可分为不同发病期，不同发病期需给予针对性治疗方案，来提高临床疗效，降低致残率和致死率3。部分脑梗死患者由于发病时身边无监护人等原因导致其发病至检查时间不确定，因此通过快速有效检查方式判断脑梗死患者发病期至关重要4。临床常用头部核磁共振(MRI)进行检查，MRI有许多检查序列，如弥散加权成像（D W I）、T 1加权成像（T1WI）、液体衰减反转恢复序列（FLAIR）等，为研究不同发病期脑梗死患者MRI检查差异，本次研究我院532 例脑梗死患者临床资料，分析不同发病期脑梗死患者影像学差异，现将结果报告如下。1资料与方法1.1一般资料回顾性分析
15、2 0 16 年1月至2 0 2 1年6 月我院收治的532 例脑梗死患者临床资料，纳入标准：均经MRI 检查确诊为脑梗死5；无既往脑出血、脑梗死病史；临床资料完成。排除标准：合并免疫、血液系统疾病；合并精神系统疾病；由脑外伤、肿瘤等疾病导致的脑梗死；合并脑部非血管疾病。根据患者发病至检查时间分为超急性期组（n=104，发病至检查时间6 h）、急性组（n=183，发病至检查时间7-7 2 h）、亚急性组（n=146，发病至检查时间一10 49 一73h-10d）、慢性组（n=99，发病至检查时间11d），超急性组中男性54例，女性50 例；年龄41-78岁，平均（59.8 9 9.7 6）岁；
16、脑梗死部位：额顶叶8 例，脑干11例，枕叶5例，基底节区6 5例，大脑半球10 例，多发性5例。急性组中男性9 1例，女性9 2 例；年龄40 7 6 岁，平均（58.7 7 9.53）岁；脑梗死部位：额顶叶16 例，脑干2 2 例，枕叶11例，基底节区9 5例，大脑半球2 6 例，多发性13例。亚急性组中男性7 3例，女性7 3例；年龄42 7 5岁，平均（59.339.7 1)岁；脑梗死部位：额顶叶14例，脑干19 例，枕叶10 例，基底节区7 9 例，大脑半球17 例，多发性7 例。慢性组中男性55例，女性54例；年龄437 6 岁，平均（6 0.2 49.8 3）岁；脑梗死部位：额顶叶6 例，脑干10 例，枕叶4例，基底节区6 1例，大脑半球14例，多发性4例。本次研究符合赫尔辛基宣言原则。1.2方法所有患者均使用西门子essenza公司生产的核磁共振扫描仪器分别进行MRIDWI、T 1W I、FLA I R序列扫描，患者处于仰卧位，将头部放置于仪器线圈内，调整合适位置后从听毗线处开始扫面，扫描范围包括患者全脑，MRI-DWI、T 1W I、FLA I R 检测参数：TR340
