中国卒中杂志
中國卒中雜誌
중국졸중잡지
CHINESE JOURNAL OF STROKE
2015年
8期
656-661
,共6页
杜万良%张心邈%李姝雅%王伊龙%王拥军
杜萬良%張心邈%李姝雅%王伊龍%王擁軍
두만량%장심막%리주아%왕이룡%왕옹군
弥散加权成像%缺血性卒中%大动脉粥样硬化%小动脉闭塞
瀰散加權成像%缺血性卒中%大動脈粥樣硬化%小動脈閉塞
미산가권성상%결혈성졸중%대동맥죽양경화%소동맥폐새
Diffusion weighted imaging%Ischemic stroke%Large artery atherosclerosis%Small artery occlusion
目的探讨弥散加权成像（diffusion weighted imaging，DWI）阴性的急性缺血性卒中患者的临床特点、影像学表现、病因。<br> 方法回顾性分析自2012年1月～2014年7月首都医科大学附属北京天坛医院神经内科急诊溶栓绿色通道就诊的DWI阴性的疑似急性缺血性卒中患者，收集其人口学特征、临床表现、影像数据，进行病因学分类。<br> 结果连续收集134例溶栓医生初步判断为DWI阴性的疑似急性缺血性卒中患者，其中男性90例，女性44例，中位数年龄57岁（四分位数间距50～70），从发病到完成DWI检查的中位数时间266.5 min（四分位数间距205.3～362.5）。中位数美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分2（四分位数间距1～3）。33例患者住院进一步诊治。有27例（81.8%）被诊断为缺血性卒中，另有6例（18.2%）诊断为其他疾病。27例诊断为缺血性卒中的住院患者中，9例（33.3%）经重新读片后发现缺血灶，5例（18.5%）症状加重后复查出现缺血灶，1例（3.7%）未加重但复查出现缺血灶，1例（3.7%）症状加重后复查DWI仍无缺血灶但有可以解释症状的磁共振血管成像（magnetic resonance angiography，MRA）大血管闭塞/狭窄或灌注加权成像（perfusion weighted imaging）低灌注区，6例（22.2%）虽DWI阴性但MRA有可以解释症状的大血管闭塞/狭窄或PWI有低灌注区，5例（18.5%） D W I阴性且未见大血管异常。诊断为缺血性卒中的27例患者，根据急性卒中治疗低分子肝素试验病因分型法（Trial of Org 10172 in Acute Stroke Treatment，TOAST）的分型标准，15例（55.6%）为大动脉粥样硬化，11例（40.7%）为小动脉闭塞，1例（3.7%）病因不明。住院患者中，除1例（3.0%）患者出院时明显残疾外，其余32例（97.0%）患者出院时结局良好。101例患者在急诊治疗后出院。其中80例（79.2%）DWI阴性且未见其他异常，5例（5.0%）经重新读片后发现缺血灶，14例（13.9%）虽DWI阴性但MRA有可以解释症状的大血管闭塞/狭窄或PWI低灌注区修正诊断为缺血性卒中，2例（2.0%）诊断为其他疾病。<br> 结论 DWI阴性的急性缺血性卒中，多数为小卒中。大动脉粥样硬化性闭塞/狭窄和小动脉闭塞是主要病因。在急诊溶栓绿色通道中，溶栓医生初步判断为DWI阴性的疑似急性缺血性卒中患者，存在读片遗漏、显影延迟的可能和病情加重的风险。
目的探討瀰散加權成像（diffusion weighted imaging，DWI）陰性的急性缺血性卒中患者的臨床特點、影像學錶現、病因。<br> 方法迴顧性分析自2012年1月～2014年7月首都醫科大學附屬北京天罈醫院神經內科急診溶栓綠色通道就診的DWI陰性的疑似急性缺血性卒中患者，收集其人口學特徵、臨床錶現、影像數據，進行病因學分類。<br> 結果連續收集134例溶栓醫生初步判斷為DWI陰性的疑似急性缺血性卒中患者，其中男性90例，女性44例，中位數年齡57歲（四分位數間距50～70），從髮病到完成DWI檢查的中位數時間266.5 min（四分位數間距205.3～362.5）。中位數美國國立衛生研究院卒中量錶（National Institutes of Health Stroke Scale，NIHSS）評分2（四分位數間距1～3）。33例患者住院進一步診治。有27例（81.8%）被診斷為缺血性卒中，另有6例（18.2%）診斷為其他疾病。27例診斷為缺血性卒中的住院患者中，9例（33.3%）經重新讀片後髮現缺血竈，5例（18.5%）癥狀加重後複查齣現缺血竈，1例（3.7%）未加重但複查齣現缺血竈，1例（3.7%）癥狀加重後複查DWI仍無缺血竈但有可以解釋癥狀的磁共振血管成像（magnetic resonance angiography，MRA）大血管閉塞/狹窄或灌註加權成像（perfusion weighted imaging）低灌註區，6例（22.2%）雖DWI陰性但MRA有可以解釋癥狀的大血管閉塞/狹窄或PWI有低灌註區，5例（18.5%） D W I陰性且未見大血管異常。診斷為缺血性卒中的27例患者，根據急性卒中治療低分子肝素試驗病因分型法（Trial of Org 10172 in Acute Stroke Treatment，TOAST）的分型標準，15例（55.6%）為大動脈粥樣硬化，11例（40.7%）為小動脈閉塞，1例（3.7%）病因不明。住院患者中，除1例（3.0%）患者齣院時明顯殘疾外，其餘32例（97.0%）患者齣院時結跼良好。101例患者在急診治療後齣院。其中80例（79.2%）DWI陰性且未見其他異常，5例（5.0%）經重新讀片後髮現缺血竈，14例（13.9%）雖DWI陰性但MRA有可以解釋癥狀的大血管閉塞/狹窄或PWI低灌註區脩正診斷為缺血性卒中，2例（2.0%）診斷為其他疾病。<br> 結論 DWI陰性的急性缺血性卒中，多數為小卒中。大動脈粥樣硬化性閉塞/狹窄和小動脈閉塞是主要病因。在急診溶栓綠色通道中，溶栓醫生初步判斷為DWI陰性的疑似急性缺血性卒中患者，存在讀片遺漏、顯影延遲的可能和病情加重的風險。
목적탐토미산가권성상（diffusion weighted imaging，DWI）음성적급성결혈성졸중환자적림상특점、영상학표현、병인。<br> 방법회고성분석자2012년1월～2014년7월수도의과대학부속북경천단의원신경내과급진용전록색통도취진적DWI음성적의사급성결혈성졸중환자，수집기인구학특정、림상표현、영상수거，진행병인학분류。<br> 결과련속수집134례용전의생초보판단위DWI음성적의사급성결혈성졸중환자，기중남성90례，녀성44례，중위수년령57세（사분위수간거50～70），종발병도완성DWI검사적중위수시간266.5 min（사분위수간거205.3～362.5）。중위수미국국립위생연구원졸중량표（National Institutes of Health Stroke Scale，NIHSS）평분2（사분위수간거1～3）。33례환자주원진일보진치。유27례（81.8%）피진단위결혈성졸중，령유6례（18.2%）진단위기타질병。27례진단위결혈성졸중적주원환자중，9례（33.3%）경중신독편후발현결혈조，5례（18.5%）증상가중후복사출현결혈조，1례（3.7%）미가중단복사출현결혈조，1례（3.7%）증상가중후복사DWI잉무결혈조단유가이해석증상적자공진혈관성상（magnetic resonance angiography，MRA）대혈관폐새/협착혹관주가권성상（perfusion weighted imaging）저관주구，6례（22.2%）수DWI음성단MRA유가이해석증상적대혈관폐새/협착혹PWI유저관주구，5례（18.5%） D W I음성차미견대혈관이상。진단위결혈성졸중적27례환자，근거급성졸중치료저분자간소시험병인분형법（Trial of Org 10172 in Acute Stroke Treatment，TOAST）적분형표준，15례（55.6%）위대동맥죽양경화，11례（40.7%）위소동맥폐새，1례（3.7%）병인불명。주원환자중，제1례（3.0%）환자출원시명현잔질외，기여32례（97.0%）환자출원시결국량호。101례환자재급진치료후출원。기중80례（79.2%）DWI음성차미견기타이상，5례（5.0%）경중신독편후발현결혈조，14례（13.9%）수DWI음성단MRA유가이해석증상적대혈관폐새/협착혹PWI저관주구수정진단위결혈성졸중，2례（2.0%）진단위기타질병。<br> 결론 DWI음성적급성결혈성졸중，다수위소졸중。대동맥죽양경화성폐새/협착화소동맥폐새시주요병인。재급진용전록색통도중，용전의생초보판단위DWI음성적의사급성결혈성졸중환자，존재독편유루、현영연지적가능화병정가중적풍험。
Objective Diffusion weighted imaging (DWI)-negative acute ischemic stroke is not uncommon, but likely to cause dififculty to diagnose. The purpose of this study was to describe the clinical and imaging features of DWI-negative patients with acute ischemic stroke and discuss the potential causes. <br> Methods We retrospectively selected DWI-negative patients with suspected acute ischemic stroke presented to the Code Stroke System of Beijing Tiantan Hospital, from January 2012 to July 2014. Data of demographic characteristics, clinical presentations and imaging were collected, and causes were classiifed. <br> Results 134 patients (90 men and 44 women) were included. Median age was 57 years (interquartile range 50~70). Median interval from the onset to DWI were 266.5 minutes (interquartile range 205.3~362.5). Median National Institutes of Health Stroke Scale (NIHSS) score 2 (interquartile range 1~3). 33 patients were hospitalized for further treatment. There are 27 cases (81.8%) diagnosed as ischemic stroke, 6 cases (18.2%) diagnosed as other diseases. Among the 27 patients with ischemic stroke, infarction leisions were found in 9 cases (33.3%) after the films were re-read, in 5 cases (18.5%) when DWI repeated after symptoms getting worse, in 1 case (3.7%) when DWI repeated without aggravating. Large vessel occlusion/stenosis on magnetic resonance angiography (MRA) or hypoperfusion on perfusion weighted imaging (PWI) responsible for symptoms were found in 1 case (3.7%) with aggravating, in 6 cases (22.2%) without aggravating. No infarction leision or large vascular abnormalities on MRA was found in 5 cases (18.5%). In 27 patients with ischemic stroke, based on Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification criteria, 15 cases (55.6%) were attributed to large artery atherosclerosis, 11 cases (40.7%) were attributed to small artery occlusion, 1 case (3.7%) was attributed to unknown etiology. In 33 hospitalized patients, besides 1 case with disability, all the other 32 cases (97.0%) were discharged with good outcome. 101 patients were discharged after emergency treatment. Among them, infarction leisions were found in 5 cases (5.0%) after the iflms were re-read. Large vessel occlusion/stenosis on MRA or hypoperfusion on PWI responsible for symptoms were found in 14 cases (13.9%) and the diagnosis was modiifed as ischemic stroke. Another 2 patients (2.0%) were diagnosed as diseases other than cerebral infarction. No abnormality on imaging was found in the other 80 cases (79.2%). <br> Conclusion DWI-negative acute ischemic strokes are mostly minor stroke. Large artery atherosclerotic occlusion/stenosis and small artery occlusion are the main cause. In the the Code Stroke System, DWI-negative patients with suspected acute ischemic stroke primarily interpreted by stroke doctors have a possibility of lesions omitted and imaging delayed, also the risk of aggravation.
