CAJ | 학술논문

目的：比较觉醒后缺血性脑卒中和确认发病时间缺血性脑卒中M RI影像特点，明确弥散加权成像（diffu‐sion‐weighted imaging ，DWI）和液体反转恢复序列（fluid attenuated inversion recovery ，FLAIR）失匹配在确定觉醒后缺血性脑卒中患者发病时间的作用。方法选择急性缺血性脑卒中首次发现异常6 h内完成头颅 M RI检查200例，包括DWI和FLAIR ，根据发病时间是否明确分为觉醒后缺血性脑卒中组（觉醒组）87例和确认发病时间缺血性脑卒中组（确认发病组）113例，收集患者一般情况及影像特征，比较2组DWI‐FLAIR失匹配在不同时间段特点。结果觉醒组与确认发病组首次出现异常到 MRI 检查2 h 内 DWI‐FLAIR 失匹配比较，无显著差异（50．0％ vs 70．0％，P＝0．181）。随着时间的增加，觉醒组DWI‐FLAIR失匹配大幅度减少，确认发病组在出现异常到MRI检查时间4．0 h内仍有较高的DWI‐FLAIR失匹配存在。觉醒组DWI‐FLAIR失匹配在首次出现异常到MRI检查2．1～3．0h、3．1～4．0h、4．1～5．0h明显低于确认发病组（13．6％ vs60．7％，9．5％ vs47．8％，5．9％ vs 45．0％），差异有统计学意义（ P＜0．05，P＜0．01）。入院神经功能缺损评分和首次出现异常到M RI检查时间为2.1～3．0 h、3．1～4．0 h、4．1～5．0 h、5．1～6．0 h与MRI检查DWI‐FLAIR 失匹配密切相关，是DWI‐FLAIR失匹配预测因素。结论首次出现异常到M RI检查2 h的觉醒后缺血性脑卒中患者可能适合静脉溶栓治疗。
목적：비교각성후결혈성뇌졸중화학인발병시간결혈성뇌졸중M RI영상특점，명학미산가권성상（diffu‐sion‐weighted imaging ，DWI）화액체반전회복서렬（fluid attenuated inversion recovery ，FLAIR）실필배재학정각성후결혈성뇌졸중환자발병시간적작용。방법선택급성결혈성뇌졸중수차발현이상6 h내완성두로 M RI검사200례，포괄DWI화FLAIR ，근거발병시간시부명학분위각성후결혈성뇌졸중조（각성조）87례화학인발병시간결혈성뇌졸중조（학인발병조）113례，수집환자일반정황급영상특정，비교2조DWI‐FLAIR실필배재불동시간단특점。결과각성조여학인발병조수차출현이상도 MRI 검사2 h 내 DWI‐FLAIR 실필배비교，무현저차이（50．0％ vs 70．0％，P＝0．181）。수착시간적증가，각성조DWI‐FLAIR실필배대폭도감소，학인발병조재출현이상도MRI검사시간4．0 h내잉유교고적DWI‐FLAIR실필배존재。각성조DWI‐FLAIR실필배재수차출현이상도MRI검사2．1～3．0h、3．1～4．0h、4．1～5．0h명현저우학인발병조（13．6％ vs60．7％，9．5％ vs47．8％，5．9％ vs 45．0％），차이유통계학의의（ P＜0．05，P＜0．01）。입원신경공능결손평분화수차출현이상도M RI검사시간위2.1～3．0 h、3．1～4．0 h、4．1～5．0 h、5．1～6．0 h여MRI검사DWI‐FLAIR 실필배밀절상관，시DWI‐FLAIR실필배예측인소。결론수차출현이상도M RI검사2 h적각성후결혈성뇌졸중환자가능괄합정맥용전치료。
Objective Mismatch in lesion visibility between diffusion‐weighted image (DWI) and fluid‐attenuated inversion recovery (FLAIR) has been proposed as a biomarker for the estimation of ischemic lesion age .To compare the MRI features of wake‐up ischemic stroke and clear‐onset time stroke ,and to identify the role of DWI‐FLAIR mismatch in determing the onset time of wake‐up stroke .Methods Two hundred patients with acute ischemic stroke were divided into wake‐up stroke group (n=87) and clear‐onset time stroke group (n=113)according to the onset time of their disease .Their general condition and image characteristics were recorded .The DWI‐FLAIR mismatch at different time points was compared between the two groups .Results No sig‐nificant difference was found in the DWI‐FLAIR mismatch between the two groups (50 .0% vs 70 .0% ,P=0 .181) .The DWI‐FLAIR mismatch decreased sharply in wake‐up stroke group with the increasing time .The proportion of patients with DWI‐FLAIR mismatch in clear‐onset time stroke group was still high within 4 .0 hours from the abnormal to MRI times .The DWI‐FLAIR mismatch was significantly lower in wake‐up stroke group than in clear‐onset time stroke group at 2.1-3.0,3.1-4.0,4.1-5.0h(13.6% vs60.7% ,9.5% vs47.8% ,5.9% vs45.0% ,P<0.05, P<0 .01) .The neurological dysfunction score was a predictor of DWI‐FLAIR mismatch .Conclu‐sion wake‐up stroke patients can be treated with thrombolytic therapy .