目的 探讨临床-弥散加权成像不匹配(CDM)能否有效预测进展性脑梗死的发生,以指导临床诊断和治疗.方法 收集发病24h内入院的脑梗死病人120例,根据NIHSS评分进行分组,分为进展组与非进展组,利用磁共振脑动脉成像(MRA)、磁共振弥散加权成像(DWI)及颈动脉彩超检查评价颈内动脉、大脑中动脉狭窄或闭塞及梗死部位,并根据NIHSS评分及Alberta卒中早期评分(ASPECTS)将每组患者分为CDM(+)及CDM(-)两亚组,分析临床-弥散加权成像不匹配(CDM)与进展性脑梗死的相关性.结果 进展组中CDM(+)及MRA显示的大脑中动脉狭窄或闭塞发生率明显高于非进展组,差异有统计学意义(P＜0.05);Logistic回归分析显示,CDM、大脑中动脉狭窄或闭塞是进展性脑梗死的独立危险预测指标;侧脑室体旁梗死或分水岭梗死是进展性脑梗死的常见类型.结论 通过临床-弥散加权成像不匹配、MRA显示的大脑中动脉狭窄或闭塞及梗死部位能有效地预测进展性脑梗死的发生.%Objective To explore whether clinical - DWI mismatch( CDM )could effectively predict the occurrence of PCI and to guide early clinical diagnosis and treatment. Methods 120 patients with acute cerebral infarction in hospital no more than 24 hours were selected. According to whether cerebral infarction were progressed after admission, the patients were divided into PCI group and non - progression group. MR angiogra-phy ( MRA ), Diffusion Weighted Imaging( DWI) and Carotid color dopplar ultrasound were used to evaluate stenosis or occlusion of MCA, ICA and cerebral infarction position. According to the NIHSS and Alberta Stroke Program Early CT Score ( ASPECTS ), the patients were divided into two subgroups of CDM( + )and CDM( - )group to analyze the relationship between CDM and occurrence of PCI. Results The incidence of CDM( + )and stenosis or occlusion of MCA diagnosed by MRA in PCI group were significantly higher than that in non - progression group( P < 0. 05 ). Logistic regression analysis showed that CDM, stenosis or occlusion of middle cerebral artery were independent risk predictors of PCI. Infarction site in body of lateral ventricle side or Watershed infarction has the higher incidence of PCI. Conclusion CDM, stenosis or occlusion of MCA diagnosed by MRA and cerebral infarction location could effectively predict the occurrence of PCI.
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