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目的:探讨3.0T磁共振的磁敏感加权成像(SWI)与三维的准连续式动脉自旋标记技术(3D-PCASL)评价急性脑梗死后出血转化(HT),预测评估的临床应用价值。方法:54例急性脑梗死(<72 h)均行常规MRI、3D-PCASL及SWI检查,利用SWI评估HT的类型,结合3D-PCASL获得梗死和HT区及病灶周围脑血流量(CBF)变化进行相关性分析。结果:本组54例急性脑梗死中有19例HT,其中出血性梗死(HI)型13例(HI-1型9例、HI-2型4例),脑血肿形成(PH)型6例(PH-1、2型各3例),HI和PH型的病灶区及病灶周围的局部脑血流量(rCBF)均值区分别为(32.787±10.876)mL/(100g·min)、(26.655±19.325)mL/(100g·min),(26.033±10.930)mL/(100g·min)、(28.984±11.019)mL/(100g·min),HI和PH型的病灶区的rCBF差异有统计学意义(t=0.766,P=0.000,<0.01,t=0.834,P=0.041,<0.05)。在54例急性脑梗死中,病灶内及周围高灌注出血分别占42.8%、50%,正常灌注区及周围出血分别占50%、37.5%,低灌注区及周围分别占31.7%、28.1%,急性脑梗死与HT病灶区及周围低、正常、高灌注的进行t检验分析具有统计学意义(t=0.658,P=0.002,<0.01)。结论:SWI与3D-PCASL联合应用对急性脑梗死和HT病灶内及周围量化分析rCBF变化情况,对急性脑梗死HT预测,为临床制定正确的治疗方案和预后判断具有重要临床意义。
Objective: To evaluate the clinical value of 3.0T magnetic resonance weighted imaging (SWI) and three-dimensional quasi-continuous arterial spin labeling (3D-PCASL) in the evaluation of hemorrhagic transformation (HT) after acute cerebral infarction. Methods: The routine MRI, 3D-PCASL and SWI were performed in 54 cases of acute cerebral infarction (<72 h). The types of HT were evaluated by SWI. The changes of infarction, HT and CBF Conduct correlation analysis. Results: Of the 54 acute cerebral infarction patients, there were 19 cases of HT, including 13 cases of HI, 9 cases of HI-1 and 4 cases of HI-2 and 6 cases of cerebral hematoma (PH) (3 cases in PH-1 and 2 cases). The average regional cerebral blood flow (rCBF) in HI and PH-type lesion and surrounding lesion were (32.787 ± 10.876) mL / (100g · min) 19.325 mL / 100 g · min -1, 26.033 ± 10.930 mL / 100 g · min -1 and 28.984 ± 11.019 mL / 100 g · min -1, respectively. There were significant differences in rCBF between HI and PH lesions (t = 0.766, P = 0.000, <0.01, t = 0.834, P = 0.041, <0.05). In 54 cases of acute cerebral infarction, hemorrhage in and around the lesion accounted for 42.8% and 50% respectively, with normal perfusion area and peripheral hemorrhage accounting for 50% and 37.5%, respectively. The area of low perfusion and surrounding area accounted for 31.7% and 28.1% respectively, T-test analysis of acute cerebral infarction and HT lesion area and surrounding low, normal, high perfusion had statistical significance (t = 0.658, P = 0.002, <0.01). Conclusion: The combination of SWI and 3D-PCASL in the quantitative analysis of rCBF in acute cerebral infarction and HT lesions and the prediction of acute cerebral infarction HT have important clinical significance in the development of correct treatment and prognosis.