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目的评价扩散加权成像(DW I)对急性脑梗死的诊断价值和限度。方法回顾性分析58例急性脑梗死患者的MR I检查资料,其中超急性期19例(<6 h),急性期24例(6~24 h),亚急性期15例(24~72 h)。均行FLAIR T1W I,FSE T2W I,FLAIRT2W I和SE-EPI DW I序列扫描。测定病灶ADC值和对侧镜像区ADC值作对照分析。6例行MRA检查。结果(1)58例DW I均显示相应神经体征分布区的梗死灶,明显优于FLAIR T1W I,FSE T2W I,FLAIR T2W I序列;(2)超急性期、急性期和亚急性期病灶ADC值均下降,各期病灶ADC值与对侧镜像区ADC值比较均有显著性差异(P<0.05),各期病灶侧ADC值两两相互比较均无显著性差异(P>0.05);(3)6例MRA中2例大脑中动脉(MCA)完全闭塞,4例MCA信号减低。结论DW I较常规序列发现急性脑梗死早,但根据ADC值或DW I的信号变化难以鉴别超急性期、急性期和亚急性期病灶。
Objective To evaluate the diagnostic value and limits of diffusion-weighted imaging (DWI) for acute cerebral infarction. Methods A retrospective analysis of 58 cases of acute cerebral infarction in patients with MRI examination data, including 19 cases of hyperacute (<6 h), 24 cases of acute (24 24 h), 15 cases of subacute (24 to 72 h) . All performed FLAIR T1W I, FSE T2W I, FLAIRT2W I and SE-EPI DW I sequence scans. The ADC value of lesion was compared with ADC value of contralateral mirror area. 6 routine MRA examination. Results (1) 58 cases of DWI showed infarction in the corresponding distribution of neurological signs, significantly better than FLAIR T1W I, FSE T2W I, FLAIR T2W I sequence; (2) hyperacute, acute and subacute lesions ADC (P <0.05). There was no significant difference (P> 0.05) in the ADC values between the lesion side and the lesion side (P> 0.05); ( 3) Two cases of middle cerebral artery (MCA) were completely occluded in 6 cases of MRA and four cases of MCA decreased. Conclusions DWI is earlier than acute cerebral infarction in conventional sequence. However, it is difficult to identify hyperacute, acute and subacute lesions according to the change of ADC or DWI signal.