摘要
目的：探讨MRI急诊快速评价在超急性期缺血性脑卒中静脉溶栓治疗中的应用.方法：对313例发病＜12h的急性脑梗死患者先行CT平扫,排除有明显低密度梗死灶后行MR快速成像序列检查[包括弥散加权成像（DWI）,时飞法三维血管成像（3D TOF-MRA）及T2加权成像（T2WI）],约5min完成;筛选超急性期脑梗死（DWI略高信号,而T2 WI未见明显高信号）158例（52.1％）,并对其行重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗及预后评估.结果：发病＜4.5 h组、4.5～≤9h组及＞9～12h组的患者中分别75.4％（43/57例）、54.1％ （73/135）及34.7％ （31/121例）患者符合超急性期脑梗死;其中136例患者行静脉溶栓治疗;溶栓后发生非症状性颅内出血12例（8.8％）,症状性颅内出血4例（2.9％）,1例（0.74％）死亡;90 d评估预后良好125例（91.9％）.结论：急诊MRI快速评价界定超急性期脑梗死指导的静脉溶栓治疗是一种安全有效方法,能排除发病＜4.5 h但梗死灶已非超急性期脑梗死患者及界定发病＞4.5h或不明确时间窗的超急性期脑梗死患者.
Purpose：To investigate the value of fast multimode magnetic resonance imaging （MRI） based emergency assessment in hyperacute stroke thrombolysis.Methods：Three hundreds and thirteen patients with 12-hour time window acute ischemic stroke were examined by plain CT,105 cases （33.5％） of them were precluded by CT and 208 were examined by fast multimode MRI which included diffusion-weighted imaging （DWI）,three dimensional time of flight magnetic resonance angiography （3D TOF-MRA） and T2 weighted imaging （T2WI）.One hundred and fifty-eight （52.1％） patients with hyperacute cerebral infarction were confirmed by fast multimode MRI and among them 136 （43.5％） patients were treated by recombinant tissue plasminogen activator （rt-PA） and were followed up periodically by MRI.Results：Of the patients with the time window of ＜4.5h,4.5-9h and 9-12h,75.4％（43/57）,54.1％（73/135） and 34.7％（31/121） were confirmed with hyperacute stroke by fast multimode MRI respectively,136 patients selected by fast multimode MRI received thrombolysis.The incidence of non-symptomatic intracranial hemorrhage was 12/136（8.8％）,symptomatic intracranial hemorrhage was 4/136（2.9％） and the mortality was 1/136（0.7％）.The median life quality Barthal index （BI） of these 136 patients selected by fast multimode MRI to receive thrombolysis was 95,the 90 days modified Rankin scale scores （mRs） of 125 cases （91.9％） were less than 2,10 cases （7.4％） mRs were 3-5 and 1 case （0.74％） was 6.Conclusions：Routine fast multimode emergency assessment MRI of hyperacute stroke has significant clinical value for excluding patients whose time windows were ＜4.5h but not belong to superacute stroke and confirming superacute stage whose time windows were undefined or beyond 4.5 hours after symptom onset.Fast multimode MRI emergency assessment of hyperacute ischemic stroke thrombolysis is safe and effective.
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2014年第4期309-312,共4页
Chinese Computed Medical Imaging
基金
上海市卫计委基金(20134179)
浦东新区卫生系统重点学科建设基金(PWZX2014-15)
浦东新区卫生系统领先人才培养基金(PWR12010-02)
上海市浦东新区人民医院重点学科群基金(PRXIQ2013-03)~~
关键词
急性脑梗死
磁共振成像
静脉溶栓
Cerebrovascular accident
Magnetic resonance imaging
Thrombolysis
作者简介
通信作者：白青科，赵振国（电子邮箱：zhaozhenguo1@sina．com）
