耿文;姜亮;陈慧铀;许权;殷信道;周俊山;张颖冬;

• 1:南京医科大学附属南京医院(南京市第一医院)医学影像科
• 2:南京医科大学附属南京医院(南京市第一医院)神经内科

摘要(Abstract)：

目的探讨急性脑梗死磁共振扩散加权成像(diffusion weighted imaging,DWI)与急性卒中治疗Org 10172试验(trial of org 10172 in acute stroke treatment,TOAST)分型、传统危险因素的关系。材料与方法选择在本院神经内科住院的急性脑梗死患者942例,行头颅DWI检查后,记录其DWI影像学分型;年龄、高血压等临床资料;糖尿病、血脂等实验室常规检查,并根据结果行TOAST分型,对DWI表现与TOAST、传统危险因素进行统计学分析。结果 942例急性脑梗死患者中,大动脉粥样硬化型(large artery atherosclerosis,LAA)占比最高(49.04%),其次为小动脉闭塞型(small artery occlusion,SAO)(39.49%)、心源性栓塞型(cardioembolism,CE)(6.16%)、不明原因型(undetermined etiology,UND)(5.20%)、其他原因型(other determined etiology,OC)(0.11%)。DWI影像学特点与TOAST分型存在显著的相关性(χ~2=397.785,P=0.000)。皮质-皮质下梗死、单侧前循环梗死、大的穿通支梗死、前-后循环梗死多与LAA型有关,差异有明显统计学意义(P<0.05);小的穿通支梗死多与SAO型有关;差异有统计学意义(P<0.05)。皮质梗死、双侧前循环梗死及后循环梗死与TOAST分型无明显相关性(P>0.05)。在942例急性脑梗死DWI分型中,年龄、NIHSS评分、冠心病、房颤的组间差异显著(P<0.05),434例单发病灶的平均直径为(20.75±19.81)mm,组间比较差异有统计学意义(P=0.000),508例多发病灶的平均最大直径为(33.39±26.92)mm,组间比较差异有统计学意义(P=0.000),平均最小直径为(5.20±3.27)mm,组间比较差异无统计学意义(P=0.513)。结论 DWI影像学特点与急性脑梗死患者的TOAST分型有关,年龄、NIHSS评分、冠心病、房颤等传统危险因素对DWI影像学特点具有一定的影响,因此,急性脑梗死患者早期行DWI影像学检查,结合临床传统危险因素,可以指导临床选择较优治疗方案,降低致残率和致死率。

关键词(KeyWords)： 卒中;TOAST分型;扩散加权成像;磁共振成像

Abstract:

Keywords:

基金项目(Foundation): 江苏省科技发展计划项目(编号:BE2017614)~~

作者(Author): 耿文;姜亮;陈慧铀;许权;殷信道;周俊山;张颖冬;

Email:

DOI:

参考文献(References)：

• [1]World Health Organization.The world health report 1999.Health Millions,1999,25(4):3-5.
• [2]Kim JS,Bonovich D.Research on intracranial atherosclerosis from the east and west:Why are the results different?.J Stroke,2014,16(3):105-113.
• [3]Furie KL,Kasner SE,Adams RJ,et al.Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke,2011,42(1):227-276.
• [4]Kumar MA,Vangala H,Tong Dc,et a1.MRI guides dlagnostic approach for ischaemic stroke.J Neurol Neurosurq Psychiatry,2011,82(11):1201-1205.
• [5]Wang X,Huang JX,Fan YH,et al.The relationship between etiology of acute ischemic stroke and early diffuse weighted imaging.Chin J Neurol,2005,38(5):301-304.王新,黄家星,范玉华,等.急性缺血性卒中病因与早期弥散加权成像表现的关系.中华神经科杂志,2005,38(5):301-304.
• [6]Kang DW,Chalela JA,Ezzeddine MA,et al.Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes.Arch Neurol,2003,60(12):1730-1734.
• [7]Wessels T,Wessels C,Ellsiepen A,et al.Contribution of diffusionweighted imaging in determination of stroke etiology.AJNR Am J Neuroradiol,2006,27(1):35-39.
• [8]Shao SJ,Liu WH.Study on the type and mechanism of infarction and stroke in the internal and middle cerebral arteries.J Apopl and Nerv Dis,2007,24(2):212-214.邵素君,刘文宏.颈内和大脑中动脉狭窄与闭塞的梗死类型及卒中机制的研究.中风与神经疾病杂志,2007,24(2):212-214.
• [9]Andre JB,Zaharchuk G,Fischbein NJ,et al.Clinical assessment of standard and generalized autocalibrating partially parallel acquisition diffusion imaging:effects of reduction factor and spatial resolution.AJNR Am J Neuroradiol,2012,33(7):1337-1342.
• [10]Ge TT,Xu WA,Cao SG,et al.The relationship between DWI and etiology of acute ischemic stroke.Neural Injury and Functional Reconstruction,2014,9(2):135-139.葛婷婷,徐文安,曹树刚,等.急性缺血性卒中的DWI病灶分型与病因分型的关系.神经损伤与功能重建,2014,9(2):135-139.
• [11]Hjort N,Christensen S,Solling C,et a1.Ischemie injury detected by diffusion imaging 11 minutes after stroke.Ann Neurol,2005,58(3):462-465.
• [12]Adams HP Jr,Bendixen BH,Kappelle LJ,et al.Classification of subtype of acute ischemic stroke.Stroke,1993,24(1):35-41.
• [13]Engelter ST,Wetzel SG,Radue EW,et al.The clinical significance of diffusion-weighted MR imaging in infratentorial strokes.Neurology,2004,62(4):574-580.
• [14]Lee LJ,Kidwell CS,Alger J,et al.Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography.Stroke,2000,31(5):1081-1089.
• [15]Wang BJ,Liu GR,Li YC,et al.The relationship between the expression of magnetic resonance diffuse weighted imaging in ischemic stroke and its etiology.Chin J Geriatr Heart Brain Ves Dis,2013,15(4):397-400.王宝军,刘国荣,李月春,等.缺血性脑卒中磁共振弥散加权成像表现与其病因的关系.中华老年心脑血管病杂志,2013,15(4):397-400.
• [16]Liu YR,Li KZ,Zheng JM,et al.Relationship between subtype of Chinese ischemic cerebral apoplexy and early proliferation of weighted imaging.Chin J Gerontol,2014,19(34):5361-5363.刘又榕,李康增,郑建明,等.中国缺血性脑卒中亚型与早期弥漫加权成像表现的关系.中国老年学杂志,2014,19(34):5361-5363.
• [17]Ay H,Koroshetz WJ,Vangel M,et al.Conversion of ischemic brain tissue into infarction increases with age.Stroke,2005,36(12):2632-2636.
• [18]Wu LP,Huang YX,Chen LK.Relationship between homocysteine and hypersensitive c-reactive protein and acute cerebral infarction.Guangxi Med,2016,38(9):1285-1300.吴霖浦,黄永新,陈林坤.同型半胱氨酸及超敏C-反应蛋白与急性脑梗死严重程度及分型的关系.广西医学,2016,38(9):1285-1300.
• [19]Liu YB,Chen YR.Clinical value of homocysteine in acute cerebral infarction.J Practical Med Techniques,2016,23(6):635-637.刘勇波,陈燕如.同型半胱氨酸在急性脑梗死中的临床价值.实用医技杂志,2016,23(6):635-637.
• [20]Jiang H,Lun Y,Wu X,et al.Association between the hypomethylation of osteopontin and integrinβ3 promoters and vascular smooth muscle cell phenotype switching in great saphenous varicose veins.Int J Mol Sci,2014,15(10):18747-18761.
• [21]Alqahtani SA,Luby M,Nadareishvili Z,et al.Perfusion deficits and association with clinical outcome in patients with anterior choroidal artery stroke.J Stroke Cerebrovasc Dis,2017,26(8):1755-1759.