摘要
目的探讨3.0T磁共振多模态功能成像在急性缺血性脑梗死溶栓时间窗内的评估与指导作用。方法回顾性分析2022年2月-2023年2月本院急诊科收治的急性缺血性脑梗死患者100例临床资料,所有患者均接受静脉溶栓治疗,根据患者发病时间以及FLAIR信号改变情况将其分为A组(0~4.5h)、B组(4.5~6h FLAIR阳性)以及C组(4.5~6h FLAIR阴性),根据患者NIHSS评分以及mRS评分对静脉溶栓治疗后患者预后结局进行评估,对比三组患者治疗后7d临床转归。结果三组患者年龄、性别、NIHSS评分、DWI-ASPECTS评分比较无显著差异(P>0.05),但A组自发病至MRI检查所用时间明显低于B、C组(P<0.05),且A、B组梗死灶体积、rLMC评分与C组比较存在显著差异(P<0.05)。A、B组患者血管再通率明显高于C组(P<0.05),且A、B组患者溶栓后24h、溶栓后7d时以及溶栓后90d时mRS评分均低于C组(P<0.05),但C组溶栓后7d出血转化率与B组比较无显著差异(P>0.05)。结论磁共振多模态功能成像在急性缺血性脑梗死溶栓时间窗内具有重要的指导价值,发病4.5~6h FLAIR阴性患者可能仍处于溶栓时间窗内,通过静脉溶栓治疗可获得良好疗效,故可将DWI-FLAIR不匹配作为主要标志指导发病时间不确定的急性缺血性脑梗死静脉溶栓治疗决策的判定。
Objective To explore evaluation and guiding effect of 3.0T magnetic resonance multimodal functional imaging in thrombolysis time window of acute ischemic stroke.Methods The paper reviewed and analyzed clinical data of 100 patients with acute ischemic stroke in emergency department from February 2022 to February 2023,treated with intravenous thrombolysis,and divided them into group A(0~4.5 hours),group B(4.5~6h FLAIR positive)and group C(4.5~6h FLAIR negative)based on onset time and changes in FLAIR signal.Prognosis of patients after intravenous thrombolysis treatment based on NIHSS scores and mRS scores was evaluated,clinical outcomes of three groups 7 days after treatment was compared.Results There was no significant difference in age,gender,NIHSS scores and DWI-ASPECTS scores among three groups(P>0.05).However,onset to MRI examination time in group A was significantly lower than group B and C(P<0.05),there was significant difference in infarct volume and rLMC scores between group A and B from group C(P<0.05).Recanalization rate of blood vessels in group A,B was significantly higher than group C(P<0.05),mRS scores of group A and B were lower than group C at 24 hours,7 days and 90 days after thrombolysis(P<0.05).However,there was no significant difference in bleeding conversion rate between group C and B at 7 days after thrombolysis(P>0.05).Conclusion Magnetic resonance multimodal functional imaging has important guiding value in thrombolysis time window of acute ischemic stroke.Patients with negative FLAIR from 4.5 to 6 hours after onset may still be within thrombolysis time window,intravenous thrombolysis can achieve good curative effect.Therefore,DWI-FLAIR mismatch can be an important marker to guide decision-making of intravenous thrombolysis treatment for acute ischemic stroke with uncertain onset time.
作者
彭学锋
韩国武
向恕梅
PENG Xuefeng;HAN Guowu;XIANG Shumei(Xingshan County People's Hospital/Radiology and Imaging Department,Xingshan Hospital,Central South Hospital,Wuhan University,Yichang,Hubei 443700)
出处
《智慧健康》
2023年第16期1-4,13,共5页
Smart Healthcare
关键词
3.0T磁共振多模态功能成像
急性缺血性脑梗死
溶栓时间窗
临床意义
3.0T magnetic resonance multimodal functional imaging
Acute ischemic stroke
Thrombolytic time window
Clinical significance
作者简介
彭学锋(1973-),男,汉族,湖北兴山,大专,主管技师,研究方向:MRI多模态功能成像技术临床应用;通信作者:韩国武(1975-),男,汉族,湖北兴山,本科,主任医师,研究方向:MRI多模态功能成像技术临床应用。
