中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
31期
2526-2531
,共6页
戴真煜%陈飞%姚立正%董从松%刘洋%侍海存%张志平%杨乃忠%张明生
戴真煜%陳飛%姚立正%董從鬆%劉洋%侍海存%張誌平%楊迺忠%張明生
대진욱%진비%요립정%동종송%류양%시해존%장지평%양내충%장명생
磁共振成像%弥散张量成像%脑梗死
磁共振成像%瀰散張量成像%腦梗死
자공진성상%미산장량성상%뇌경사
Magnetic resonance imaging%Diffusion tensor imaging%Cerebral infarction
目的 评价磁共振扩散张量成像(DTI)及扩散张量纤维束成像(DTT)在急性缺血性脑梗死时相判断中的临床应用价值.方法 回顾分析东南大学医学院附属盐城医院2013年1月至2015年1月期间52例经临床及磁共振诊断为不同时相(超急性期、急性期及亚急性期)的单侧急性缺血性脑梗死患者的DTI图像.在DTI序列各项异性指数(FA)、容积比各项异性(VRA)、平均扩散系数(DCavg)及衰减指数(Exat)参数图上选取病灶、近病灶边缘脑组织及相应对侧为感兴趣区(ROI),记录各ROI参数值并计算病灶-对侧各参数的相对值.同时以病灶及对侧ROI为种子点重建DTT图.比较病灶、近病灶边缘脑组织与相应对侧间各参数值的差异,分析病灶-对侧各参数相对值在不同时相脑梗死间的差异.结果 各时相急性缺血性脑梗死DTT图均可观察到纤维束损伤表现.脑梗死病灶区DCavg值各时相均低于对侧,Exat值各时相均高于对侧(P ＜0.05);FA和VRA值仅在急性期和亚急性期低于对侧(P＜0.05).脑梗死近病灶边缘脑组织FA、VRA和Exat值在超急性期高于对侧(P＜0.05),DCavg值在超急性期低于对侧(P ＜0.05);FA、VRA、DCavg和Exat值在急性期与亚急性期脑梗死与对侧差异无统计学意义.从超急性期到亚急性期脑梗死病灶-对侧FA和VRA相对值逐渐减低(P＜0.05),其中VRA相对值在急性期与亚急性期中差异无统计学意义.超急性期脑梗死病灶-对侧DCavg相对值明显高于急性期和亚急性期脑梗死(P＜0.05),然而在急性期与亚急性期中差异无统计学意义.ROC曲线分析示病灶-对侧FA、VRA和DCavg相对值在超急性和急性脑梗死间最佳诊断界值分别为0.852、0.886和0.541;病灶-对侧FA相对值在急性和亚急性脑梗死间最佳诊断界值为0.595.结论 FA、VRA、DCavg及Exat值在不同时相急性缺血性脑梗死中存在特定的改变规律,临床可综合运用于发病时间不明确的急性缺血性脑梗死的时相判断,从而有助于选择合理的治疗方案.
目的 評價磁共振擴散張量成像(DTI)及擴散張量纖維束成像(DTT)在急性缺血性腦梗死時相判斷中的臨床應用價值.方法 迴顧分析東南大學醫學院附屬鹽城醫院2013年1月至2015年1月期間52例經臨床及磁共振診斷為不同時相(超急性期、急性期及亞急性期)的單側急性缺血性腦梗死患者的DTI圖像.在DTI序列各項異性指數(FA)、容積比各項異性(VRA)、平均擴散繫數(DCavg)及衰減指數(Exat)參數圖上選取病竈、近病竈邊緣腦組織及相應對側為感興趣區(ROI),記錄各ROI參數值併計算病竈-對側各參數的相對值.同時以病竈及對側ROI為種子點重建DTT圖.比較病竈、近病竈邊緣腦組織與相應對側間各參數值的差異,分析病竈-對側各參數相對值在不同時相腦梗死間的差異.結果 各時相急性缺血性腦梗死DTT圖均可觀察到纖維束損傷錶現.腦梗死病竈區DCavg值各時相均低于對側,Exat值各時相均高于對側(P ＜0.05);FA和VRA值僅在急性期和亞急性期低于對側(P＜0.05).腦梗死近病竈邊緣腦組織FA、VRA和Exat值在超急性期高于對側(P＜0.05),DCavg值在超急性期低于對側(P ＜0.05);FA、VRA、DCavg和Exat值在急性期與亞急性期腦梗死與對側差異無統計學意義.從超急性期到亞急性期腦梗死病竈-對側FA和VRA相對值逐漸減低(P＜0.05),其中VRA相對值在急性期與亞急性期中差異無統計學意義.超急性期腦梗死病竈-對側DCavg相對值明顯高于急性期和亞急性期腦梗死(P＜0.05),然而在急性期與亞急性期中差異無統計學意義.ROC麯線分析示病竈-對側FA、VRA和DCavg相對值在超急性和急性腦梗死間最佳診斷界值分彆為0.852、0.886和0.541;病竈-對側FA相對值在急性和亞急性腦梗死間最佳診斷界值為0.595.結論 FA、VRA、DCavg及Exat值在不同時相急性缺血性腦梗死中存在特定的改變規律,臨床可綜閤運用于髮病時間不明確的急性缺血性腦梗死的時相判斷,從而有助于選擇閤理的治療方案.
목적 평개자공진확산장량성상(DTI)급확산장량섬유속성상(DTT)재급성결혈성뇌경사시상판단중적림상응용개치.방법 회고분석동남대학의학원부속염성의원2013년1월지2015년1월기간52례경림상급자공진진단위불동시상(초급성기、급성기급아급성기)적단측급성결혈성뇌경사환자적DTI도상.재DTI서렬각항이성지수(FA)、용적비각항이성(VRA)、평균확산계수(DCavg)급쇠감지수(Exat)삼수도상선취병조、근병조변연뇌조직급상응대측위감흥취구(ROI),기록각ROI삼수치병계산병조-대측각삼수적상대치.동시이병조급대측ROI위충자점중건DTT도.비교병조、근병조변연뇌조직여상응대측간각삼수치적차이,분석병조-대측각삼수상대치재불동시상뇌경사간적차이.결과 각시상급성결혈성뇌경사DTT도균가관찰도섬유속손상표현.뇌경사병조구DCavg치각시상균저우대측,Exat치각시상균고우대측(P ＜0.05);FA화VRA치부재급성기화아급성기저우대측(P＜0.05).뇌경사근병조변연뇌조직FA、VRA화Exat치재초급성기고우대측(P＜0.05),DCavg치재초급성기저우대측(P ＜0.05);FA、VRA、DCavg화Exat치재급성기여아급성기뇌경사여대측차이무통계학의의.종초급성기도아급성기뇌경사병조-대측FA화VRA상대치축점감저(P＜0.05),기중VRA상대치재급성기여아급성기중차이무통계학의의.초급성기뇌경사병조-대측DCavg상대치명현고우급성기화아급성기뇌경사(P＜0.05),연이재급성기여아급성기중차이무통계학의의.ROC곡선분석시병조-대측FA、VRA화DCavg상대치재초급성화급성뇌경사간최가진단계치분별위0.852、0.886화0.541;병조-대측FA상대치재급성화아급성뇌경사간최가진단계치위0.595.결론 FA、VRA、DCavg급Exat치재불동시상급성결혈성뇌경사중존재특정적개변규률,림상가종합운용우발병시간불명학적급성결혈성뇌경사적시상판단,종이유조우선택합리적치료방안.
Objective To evaluate the clinical application value of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTF) in judging infarction time phase of acute ischemic cerebral infarction.Methods To retrospective analysis DTI images of 52 patients with unilateral acute ischemic cerebral infarction (hyper-acute,acute and sub-acute) from the Affiliated Yancheng Hospital of Southeast University Medical College,which diagnosed by clinic and magnetic resonance imaging.Set the regions of interest (ROIs) of infarction lesions,brain tissue close to infarction lesions and corresponding contra (contralateral normal brain tissue) on DTI parameters mapping of fractional anisotropy (FA),volume ratio anisotropy (VRA),average diffusion coefficient (DCavg) and exponential attenuation (Exat),record the parameters values of ROIs and calculate the relative parameters value of infarction lesion to contra.Meanwhile,reconstruct the DTI images based on the seed points (infarction lesion and contra).The study compared each parameter value of infarction lesions,brain tissue close to infarction lesions and corresponding contra,also analysed the differences of relative parameters values in different infarction time phases.Results The DTT images of acute ischemic cerebral infarction in each time phase could show the manifestation of fasciculi damaged.The DCavg value of cerebral infarction lesions was lower and the Exat value was higher than contra in each infarction time phase (P ＜ 0.05).The FA and VRA value of cerebral infarction lesions were reduced than contra only in acute and sub-acute infarction (P ＜ 0.05).The FA,VRA and Exat value of brain tissue close to infarction lesions were increased and DCavg value was decreased than contra in hyper-acute infarction (P ＜ 0.05).There were no statistic differences of FA,VRA,DCavg and Exat value of brain tissue close to infarction lesions in acute and sub-acute infarction.The relative FA and VRA value of infarction lesion to contra gradually decreased from hyper-acute to sub-acute cerebral infarction (P ＜ 0.05),but there were no difference of the relative VRA value between acute and sub-acute cerebral infarction.The relative DCavg value of infarction lesion to contra in hyper-acute infarction than that in acute and sub-acute infarction (P ＜ 0.05),however there was also no difference between acute and sub-acute infarction.ROC curve showed the best diagnosis cut off value of relative FA,VRA and DCavg of infarction lesions to contra were 0.852,0.886 and 0.541 between hyper-acute and acute cerebral infarction,the best diagnosis cut off value of relative FA was 0.595 between acute and sub-acute cerebral infarction,respectively.Conclusion The FA,VRA,DCavg and Exat value have specific change mode in acute ischemic cerebral infarction of different infarction time phases,which can be combine used in judging infarction time phase of acute ischemic cerebral infarction without clear onset time,thus to help selecting the reasonable treatment protocols.
