多模磁共振弥散加权成像-灌注加权成像不匹配在急性缺血性脑卒中溶栓时间窗内的评估作用

摘要

Objective To assess the relationship between diffusion-weighted imaging-perfusionweighted imaging (DWI-PWI) mismatch and the prognosis of patients with acute anterior circulation ischemic stroke receiving intravenous thrombolysis.Methods Patients with acute anterior circulation ischemic stroke who finished multimode MRI (T1 WI,T2 WI,DWI,PWI) within 4.5 hours after disease onset were recruited in this study.They were divided into DWI-PWI mismatched and matched groups.All patients received intravenous thrombolysis using recombinant tissue type plasminogen activator (rt-PA).Head CT was performed 24 hours later to exclude cerebral hemorrhage,and the patients were followed up for 3 months.The improvement of neurological function,the rate of death and symptomatic intracranial hemorrhage (sICH) were recorded.Results A total of 63 patients were recruited in this study,of which 41 patients presented DWI-PWI mismatch while 22 patients presented DWI-PWI match.Three months later,the rate of the improvement of neurological function in the DWI-PWI mismatched group was significantly higher than that in the DWI-PWI matched group (70.7％ vs 40.9％,x2 =5.32,P =0.021).Of note,no significant difference in the rate of death and sICH was found between DWI-PWI mismatched and matched groups (9.8％ vs 13.6％,x2 =0.22,P =0.640).Conclusions Compared with DWI-PWI matched group,the DWI-PWI mismatched group has better prognosis after receiving intravenous tbrombolysis.The results provide more direct evidence supporting the application of intravenous thrombolysis under the guidance of multimode MRI in acute anterior circulation ischemic stroke.%目的 评价多模磁共振弥散加权成像(DWI)-灌注加权成像(PWI)不匹配对发病在4.5h内急性缺血性脑卒中患者静脉溶栓预后的影响.方法 入选从发病到完成多模MRI检查(T1 WI,T2WI,DWI,PWI)在4.5h以内的前循环脑梗死患者,根据检查结果分为DWI-PWI不匹配组与DWI-PWI匹配组,对所有患者在4.5h内采用重组组织型纤溶酶原激活剂行静脉溶栓治疗.溶栓后24 h复查头颅CT排除有无出血并随访3个月.采用改良Rankin量表(mRS)评分评估两组患者神经功能恢复情况,并观察比较总的死亡与症状性颅内出血(sICH)发生率.结果 共入选63例患者,其中DWI-PWI不匹配组41例,DWI-PWI匹配组22例.两组患者3个月后mRS评分0～1分者分别为29例(70.7％)和9例(40.9％),差异有统计学意义(x2=5.32,P=0.021);而两组患者3个月内死亡及sICH的总发生率分别为9.8％和13.6％,差异无统计学意义(x2=0.22,P=0.640).结论 在溶栓时间窗内多模磁共振DWI-PWI不匹配者静脉溶栓治疗效果优于DWI-PWI匹配者,基于多模MRI指导的静脉溶栓个性化治疗值得临床推荐.