急性缺血性脑卒中出血转化的磁敏感成像研究.docVIP

急性缺血性脑卒中出血转化的磁敏感成像研究 作者：朱丽丽，李绍东，杨春，徐凯 【摘要】 目的 探讨磁敏感成像(SWI)在急性缺血性脑卒中(AIS)出血转化(HT)中的应用价值。方法 对18例症状出现6 h内的AIS患者行常规MRI及SWI检查，静脉溶栓后1～2周复查 CT或MRI。根据复查时有无出血将其分为出血组(HT组)和无出血组(无HT组)，分析溶栓前两组的SWI影像特征。结果 8例超急性期缺血性脑卒中患者无HT组15例，HT组3例。HT在SWI上呈显著低信号。溶栓前HT组中2例SWI上可见大脑中动脉行径粗大低信号影，2例见缺血区内微出血灶，1例见缺血区异常静脉影;无HT组均未见大脑中动脉粗大低信号影和缺血区异常静脉影，2例有缺血区外微出血灶。结论 急性缺血性脑卒中SWI上大脑中动脉行径粗大低信号影、缺血区异常静脉血管影和微出血灶等征象可能与HT有关。SWI可为AIS 治疗 方案的选择提供重要信息。 【关键词】 急性缺血性脑卒中;出血性转化;磁共振成像;磁敏感成像 　　Abstract： Objective To investigate the application value of susceptibility-wEighted imaging (SWI) in hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS). Methods Conventional MRI and SWI were performed in 18 patients with AIS within 6 days of symptom onset. Follow-up CT or MRI was performed within 1-2 weeks after thrombolytic therapy to evaluate hemorrhage. The patients were divided into HT group and Non-HT group and thEIr features of SWI were analyzed. Results Of the 18 patients with hyperacute ischemic stroke, 15 were in Non-HT group and 3 in HT group. Significant hypointensity was revealed on SWI in patients with HT. In HT group, 2 patients presented hypointensity along the course of the middle cerebral artery (MCA), 2 patients had microbleeds in ischemic lesions and 1 patient showed abnormal veins on SWI. In Non-HT group, no hypointensity along the course of MCA or abnormal veins were detected on SWI, except 2 patients with microbleeds outside loci of lesions. Conclusion Hypointensity along the course of MCA, abnormal veins and microbleeds on SWI might be associated with HT in hyperacute ischemic stroke. SWI can provide important information for clinical AIS regimen. 　　Key words： acute ischemic stroke; hemorrhagic transformation; magnetic resonance imaging; susceptibility-weighted imaging 　　溶栓治疗是急性缺血性脑卒中(AIS)的有效治疗手段，而出血转化(HT)是AIS溶栓后最常见、最严重的并发症之一，HT极大程度地限制了溶栓治疗的临床应用。利用影像手段在脑缺血早期预测溶栓治疗后发生HT的风险具有重要的临床应用价值。磁敏感成像(SWI)是一种新近 发展 起来的磁共振成像技术，它利用不同组织间的磁敏感性差异成像，对血液的代谢产物、静脉等非常敏感。本研究对18例接受静脉溶栓治疗的超急性期缺血性脑卒中患者溶栓