磁共振灌注成像及表观扩散系数图预测超急性期脑梗死患者亚急性期梗死体积的对比研究

摘要

目的：对比分析基于超急性期表观扩散系数（ADC）图及磁共振灌注成像（PWI）预测亚急性期（发病后5～7 d）脑梗死体积的临床可行性。方法：回顾性分析发病6 h内完成多模式磁共振成像（MRI）检查并于发病后5～7 d复查常规MR检查的超急性期脑梗死患者20例。应用美国GE Healthcare 3.0 T超导MR扫描仪后处理工作站自带的专用后处理软件进行图像上异常区域体积的测量。经相关和回归分析及ROC曲线分析，比较基于PWI和ADC图这2种方法预测亚急性期梗死体积及梗死体积增长之间的差异。结果：ADC图、脑血流量（CBF）图、脑血容量（CBV）图、平均通过时间（MTT）图、达峰时间（TTP）图预测梗死体积值与复查液体衰减反转恢复（FLAIR）异常区域体积值之间均呈显著线性相关（P均＜0.05）。其中ADC图预测梗死体积与V2之间的相关性（r=0.954）比PWI各参数图预测梗死体积与V2间的相关性高（P均＜0.05）。ADC不匹配与梗死体积增长间呈明显线性相关（r=0.744，P=0.001）；而CBF不匹配、CBV不匹配、MTT不匹配、TTP不匹配与梗死体积增长间均无明显直线相关关系。结论：采用设备自带后处理软件，基于超急性期ADC图预测亚急性期梗死体积及梗死体积增长的方法比基于PWI各参数图的方法可行性更强，可作为临床早期预测梗死体积变化的简便方法。%Objective: To compare perfusion-weighted imaging (PWI) and apparent diffusion coefifcient (ADC) maps in prediction of infarct lesion volumes and growth in patient with hyperacute cerebral artery in-farct.Methods: Twenty hyperacute cerebral artery stroke patients who underwent multimodal magnetic reso-nance imaging (MRI) in hyperacute (<6 h) phase and the follow-up MRI in the subacute (days 5-7) phase were retrospectively reviewed. Diffusion- and perfusion-weighted imaging lesion volumes were semi-automatically measured by a post-processing software of GE Healthcare 3.0 T MR scanner (Signa Twin Speed, GE Medical System, Milwaukee, Wisconsin, USA). Finally, to compare the two methods in infarct growth prediction, correla-tion and regression analysis and receiver operating characteristic curves were used.Results: The lesion volume of follow-up FLAIR was highly correlated with volumes predicted with ADC-, CBF-, CBV-, MTT-, and TTP-maps (allP<0.05). The correlation was higher for ADC-predicted volume (r=0.954, 95%CI: 0.804-1.000) than that for PWI- predicted volume (P<0.05). Besides, The infarct growth was correlated with ADC-DWI mismatch (r=0.744,P=0.001), but we didn’t ifnd any correlation among infarct growth and CBF-DWI, CBV-DWI, MTT-DWI, TTP-DWI mismatches (allP>0.05).Conclusion: Data showed that by using the post-processing software provided by MR equipment, the ADC-based method is more feasible than PWI-based method for evaluating in-farct growth and volume in the subacute phase, which makes early estimation of prognosis possible.