CAJ | 학술논문

目的：探讨缺血性脑梗死后急性期和亚急性期微血管渗透性改变及脑梗死后出血性转化(hemorrhagic transformation，HT)的预测。材料与方法收集缺血性脑梗死病人43例，急性期10例，亚急性期33例，进行常规MRI及 DCE-MRI扫描。利用药代动力学模型计算容积转运常数Ktrans，比较每一个病人梗死区和对侧正常脑组织的Ktrans值以及出血组和非出血组的Ktrans值有无差异，比较不同时期梗死区强化对预测HT的意义。结果所有病人梗死区Ktrans值较对侧正常脑组织明显增高(P＜0.05)。10例在急性期有脑实质强化的病人都有继发出血，在亚急性期和慢性期15例病人有继发出血，18例没有继发出血，Fisher's精确检验有统计学意义(P＜0.05)。与亚急性期HT或没有HT的病人相比，急性期有HT组病人的Ktrans值明显增高(P＜0.05)，但是亚急性期HT和非HT的病人Ktrans值比较没有统计学差异(P＞0.05)。结论急性期脑实质强化对HT的预测有更高的特异性，且渗透性比亚急性期更高。早期脑实质强化及HT与毛细血管内皮的紧密连接和基底膜损伤有关。后期脑实质强化及HT与侧枝循环的建立有关，DCE-MRI可以定量评估血脑屏障的渗透性，对进一步研究HT的分型提供更科学的依据。
목적：탐토결혈성뇌경사후급성기화아급성기미혈관삼투성개변급뇌경사후출혈성전화(hemorrhagic transformation，HT)적예측。재료여방법수집결혈성뇌경사병인43례，급성기10례，아급성기33례，진행상규MRI급 DCE-MRI소묘。이용약대동역학모형계산용적전운상수Ktrans，비교매일개병인경사구화대측정상뇌조직적Ktrans치이급출혈조화비출혈조적Ktrans치유무차이，비교불동시기경사구강화대예측HT적의의。결과소유병인경사구Ktrans치교대측정상뇌조직명현증고(P＜0.05)。10례재급성기유뇌실질강화적병인도유계발출혈，재아급성기화만성기15례병인유계발출혈，18례몰유계발출혈，Fisher's정학검험유통계학의의(P＜0.05)。여아급성기HT혹몰유HT적병인상비，급성기유HT조병인적Ktrans치명현증고(P＜0.05)，단시아급성기HT화비HT적병인Ktrans치비교몰유통계학차이(P＞0.05)。결론급성기뇌실질강화대HT적예측유경고적특이성，차삼투성비아급성기경고。조기뇌실질강화급HT여모세혈관내피적긴밀련접화기저막손상유관。후기뇌실질강화급HT여측지순배적건립유관，DCE-MRI가이정량평고혈뇌병장적삼투성，대진일보연구HT적분형제공경과학적의거。
AbstractObjective:To evaluate the permeability changes in ischemic infarction in patients of acute stage and subacute stage and to predict the post-infarction hemorrhagic transformation.Materials and Methods:The data of 43 patients (10 acute stage and 33 subacute stage) who had routine MRI and DCE-MRI performed were retrospectively analyzed. Volume transitional co-efifciency (Ktrans) was measured with pharmacokinetic model. Statistical analysis of Ktrans was performed in the following different groups: infarcted tissue and contralateral normal tissue; hemorrhagic group and non- hemorrhagic group. The correlation of enhancement of different stages was analyzed byFisher's test.Results:The Ktrans values of infarcted areas dramatically increased compared to those in the conterlateral’s in all cases (P<0.05). Subsequent hemorrhage was found in all 10 cases of acute stage and 15 cases of subacute stage while not found in the rest 18 cases, which was statistically different withFisher's test (P<0.05). Ktrans values of cases with HT of acute stage were significantly higher than those with or without HT in subacute stage respectively (P<0.05). However, there was no statistical difference in Ktrans values between HT group and non-HT group in subacute stage. Conclusion:The speciifcity was better in early parenchymal enhancement in predicting HT and the permeability was higher compared to later periods. Early parenchymal enhancement and subsequent HT is likely associated with injury of early capillary endothelial cells of tight dense connections and basement membranes. Parenchymal enhancement in later period and HT is likely associated with establishment of collateral circulation. DCE-MRI could quantitatively evaluate osmotic quantity. It is of great help for further research on HT category.