首页|头颅3.0T MRI评估急性脑梗死神经功能损伤的价值及预测出血转化的临床研究

头颅3.0T MRI评估急性脑梗死神经功能损伤的价值及预测出血转化的临床研究

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目的:探究头颅3。0T磁共振成像(MRI)评估急性脑梗死(ACI)神经功能损伤的价值,并分析对出血转化(HT)的预测价值,为临床改善预后提供参考。方法:选取 2022 年 1 月至 2023 年 3 月我院收治的104 例ACI患者,入组后均接受头颅3。0T MRI检查,根据NIHSS评分评估神经功能损伤程度分为轻度组(<7 分,34 例)、中度组(7~14 分,44 例)、重度组(>14 分,26 例)3 个亚组,又依据发病 7~10d后头颅3。0T MRI检查评估结果分为HT组(31 例)、未HT组(73 例)2 个亚组。比较不同各亚组ACI患者头颅3。0T MRI参数,并分析与神经功能损伤、HT情况的关系,进一步评估神经功能损伤程度、预测HT风险。结果:VRA、FA比较,轻度组(0。15±0。03、0。30±0。08)>中度组(0。13±0。03、0。24±0。06)>重度组(0。06±0。02、0。12±0。03)(F=82。774、63。120,P<0。05);Vp、Kep、Ve、ktrans比较,轻度组(0。19±0。06、0。57±0。17、0。29±0。08、0。43±0。13)<(0。32±0。09、0。78±0。22、0。47±0。14、0。69±0。18)中度组<重度组(0。45±0。11、0。93±0。24、0。75±0。17、0。83±0。20)(F=65。855、22。384、88。892、43。605,P<0。05);HT组VRA、FA(0。08±0。02、0。19±0。06)低于未HT组(0。13±0。03、0。31±0。09)(t=9。972、7。978,P<0。05);HT组Vp、Kep、Ve、ktrans(0。38±0。11、0。85±0。25、0。56±0。14、0。72±0。21)高于未 HT 组(0。16±0。05、0。52±0。16、0。28±0。08、0。44±0。21)(t=14。065、8。063、12。881、6。220,P<0。05);头颅 3。0T MRI参数VRA、FA与ACI患者神经功能损伤、HT情况均呈负相关(r1=-0。641、-0。627,r2=-0。625、-0。611,P<0。05),Vp、Kep、Ve、ktrans与ACI患者神经功能损伤、HT情况均呈正相关(r1=0。701、0。579、0。754、0。688,r2=0。673、0。589、0。670、0。583,P<0。05);VRA、FA、Vp、Kep、Ve、ktrans联合预测神经功能重度损伤的AUC 最大,为 0。913(95%CI:0。841~0。959),敏感度为 84。62%,特异度为 87。18%(P<0。05),上述头颅 3。0T MRI 参数联合预测 ACI 患者 HT 发生的 AUC 最大,为 0。925(95%CI:0。857~0。968),敏感度为90。32%,特异度为79。45%(P<0。05)。结论:头颅3。0T MRI检查参数与ACI患者神经功能损伤、HT密切相关,VRA、FA、Vp、Kep、Ve、ktrans联合对于神经功能重度损伤、HT发生均有较高预测价值,具有临床指导意义。
Clinical Study on the Value of 3.0T MRI in Assessing Neurological Impairment and Hemorrhagic Transformation in Acute Cerebral Infarction
Objective:To explore the value of 3.0T magnetic resonance imaging(MRI)in assessing neurological injury in acute cerebral infarction(ACI)and to analyze its predictive value for hemorrhagic trans-formation(HT),providing a reference for clinical improvement of prognosis.Methods:A total of 104 ACI patients admitted to our hospital from January 2022 to March 2023 were selected.All subjects underwent 3.0T MRI examination of the head.According to the NIHSS score,the degree of neurological impairment was divid-ed into three subgroups:mild group(<7 points,34 cases),moderate group(7-14 points,44 cases),and severe group(>14 points,26 cases).Additionally,based on the results of the 3.0T MRI examination 7-10 days after onset,the patients were divided into two subgroups:HT group(31 cases)and non-HT group(73 cases).The 3.0T MRI parameters of ACI patients in different subgroups were compared,and their relation-ship with neurological impairment and HT was analyzed to further assess the degree of neurological impairment and predict the risk of HT.Results:The VRA and FA in the mild group(0.15±0.03,0.30±0.08)were greater than in the moderate group(0.13±0.03,0.24±0.06),which in turn were greater than in the severe group(0.06±0.02,0.12±0.03)(F=82.774,63.120,P<0.05);the Vp,Kep,Ve,and ktrans in the mild group(0.19±0.06,0.57±0.17,0.29±0.08,0.43±0.13)were less than in the moderate group(0.32±0.09,0.78±0.22,0.47±0.14,0.69±0.18),which in turn were less than in the severe group(0.45±0.11,0.93±0.24,0.75±0.17,0.83±0.20)(F=65.855,22.384,88.892,43.605,P<0.05);the VRA and FA in the HT group(0.08±0.02,0.19±0.06)were lower than in the non-HT group(0.13±0.03,0.31±0.09)(t=9.972,7.978,P<0.05);the Vp,Kep,Ve,and ktrans in the HT group(0.38±0.11,0.85±0.25,0.56±0.14,0.72±0.21)were higher than in the non-HT group(0.16±0.05,0.52±0.16,0.28±0.08,0.44±0.21)(t=14.065,8.063,12.881,6.220,P<0.05);the 3.0T MRI parameters VRA and FA were negatively correlated with neurological impairment and HT in ACI patients(r1=-0.641,-0.627,r2=-0.625,-0.611,P<0.05),while Vp,Kep,Ve,and ktrans were positively correlated with neurological impairment and HT in ACI patients(r1=0.701,0.579,0.754,0.688,r2=0.673,0.589,0.670,0.583,P<0.05);the combined prediction of VRA,FA,Vp,Kep,Ve,and ktrans for severe neurological impair-ment had the largest AUC of 0.913(95%CI:0.841-0.959),with a sensitivity of 84.62%and specificity of 87.18%(P<0.05),and the combined prediction of these 3.0T MRI parameters for the occurrence of HT in ACI patients had the largest AUC of 0.925(95%CI:0.857-0.968),with a sensitivity of 90.32%and speci-ficity of 79.45%(P<0.05).Conclusion:The 3.0T MRI examination parameters are closely related to neu-rological impairment and HT in ACI patients,and the combination of VRA,FA,Vp,Kep,Ve,and ktrans has a high predictive value for severe neurological impairment and HT occurrence,which is of clinical guid-ance significance.

Acute cerebral infarction3.0T MRINerve function injuryBleeding transforma-tion

张楠、史智超、王菁、王进才、王伟翰

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河北省石家庄市人民医院,河北 石家庄 050000

急性脑梗死 3.0T MRI 神经功能损伤 出血转化

2024

河北医学
河北省医学会

河北医学

CSTPCD
影响因子:1.915
ISSN:1006-6233
年,卷(期):2024.30(12)