[1]黄正旺,张水诚,庞杰荣.磁敏感加权成像与动脉自旋标记成像在脑卒中溶栓后脑出血转化的评估价值[J].中国医学物理学杂志,2024,41(12):1532-1536.[doi:DOI:10.3969/j.issn.1005-202X.2024.12.010]
　HUANG Zhengwang,ZHANG Shuicheng,PANG Jierong.Predictive value of susceptibility weighted imaging and arterial spin labeling imaging for cerebral hemorrhage transformation after thrombolysis in stroke[J].Chinese Journal of Medical Physics,2024,41(12):1532-1536.[doi:DOI:10.3969/j.issn.1005-202X.2024.12.010]
点击复制

磁敏感加权成像与动脉自旋标记成像在脑卒中溶栓后脑出血转化的评估价值()
分享到：

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第12期
页码:
1532-1536
栏目:
医学影像物理
出版日期:
2024-12-17

文章信息/Info

Title:
Predictive value of susceptibility weighted imaging and arterial spin labeling imaging for cerebral hemorrhage transformation after thrombolysis in stroke
文章编号:
1005-202X（2024）12-1532-05
作者:
黄正旺; 张水诚; 庞杰荣
广东同江医院放射科， 广东 佛山 528300
Author(s):
HUANG Zhengwang;  ZHANG Shuicheng;  PANG Jierong
Department of Radiology, Guangdong Tongjiang Hospital, Foshan 528300, China
关键词:
磁敏感加权成像; 动脉自旋标记成像; 缺血性脑卒中; 溶栓; 脑出血转化
Keywords:
susceptibility weighted imaging arterial spin labeling imaging ischemic stroke thrombolysis cerebral hemorrhage transformation
分类号:
R445.2；R743.33
DOI:
DOI:10.3969/j.issn.1005-202X.2024.12.010
文献标志码:
A
摘要:
目的：分析磁敏感加权成像（SWI）与动脉自旋标记成像（ASL）对急性缺血性脑卒中溶栓后脑出血转化评估的临床价值。方法：选取2021年12月至2023年11月广东同江医院收治的发病溶栓前及溶栓后24 h内的80例急性缺血性脑卒中患者，均行计算机断层扫描（CT）、常规磁共振成像（MRI）、SWI与ASL序列扫描。分析患者毛刷征和不对称性皮质静脉征情况，比较SWI与ASL诊断溶栓后脑出血转化的价值。将11例急性缺血性脑卒中溶栓后脑出血转化的患者纳入出血性转化组，69例未发生出血性转化的患者纳入非出血性转化组，Logistic回归分析溶栓后出血性转化的影响因素。结果：80例急性缺血性脑卒中患者溶栓前通过SWI扫描显示，毛刷征阳性率、不对称性皮质静脉征阳性率为71.25%（57/80）、68.75%（55/80）。溶栓后毛刷征阳性率、不对称性皮质静脉征阳性率为16.25%（13/80）、15.00%（12/80），溶栓前后SWI检查出的毛刷征和不对称性皮质静脉征比较，差异有统计学意义（P<0.05）。SWI诊断急性缺血性脑卒中溶栓后脑出血转化的敏感度为90.91%（10/11），特异度为95.65%（66/69），准确率为95.00%（76/80）；ASL诊断敏感度为72.73%（8/11），特异度为88.41%（61/69），准确率为86.25%（69/80）；SWI诊断的敏感度、特异度略高于ASL。脑出血转化单因素分析中，两组患者年龄、心房颤动、NIHSS 评分、CMBs分级比较，差异有统计学意义（P<0.05）；多因素分析显示，心房颤动、NISHH评分、CMBs分级是溶栓后出血转化的独立影响因素。结论：SWI检测毛刷征和不对称性皮质静脉征的敏感性较高，对于评估急性溶栓后脑出血转化有重要价值，可作为急性缺血性脑卒中的常规检查序列。
Abstract:
Abstract: Objective To analyze the clinical value of susceptibility weighted imaging (SWI) and arterial spin labeling imaging (ASL) in the prediction of hemorrhage transformation after thrombolysis in acute ischemic stroke. Methods A total of 80 patients with acute ischemic stroke admitted to Guangdong Tongjiang Hospital from December 2021 to November 2023, before and within 24 h after thrombolytic therapy, were enrolled, and all of them underwent computed tomography (CT), magnetic resonance imaging (MRI), SWI and ASL sequential scanning. The brush sign and asymmetrical cortical venous sign of patients were analyzed, and the diagnostic value of SWI and ASL for cerebral hemorrhage transformation after thrombolysis was compared. Eleven patients with cerebral hemorrhage transformation after thrombolysis were included in hemorrhagic transformation group, while the other 69 patients without hemorrhagic transformation were included in non-hemorrhagic transformation group. Logistic regression analysis was conducted to explore the influencing factors of hemorrhagic transformation after thrombolysis. Results The positive rates of brush sign and asymmetric cortical vein sign were 71.25% (57/80) and 68.75% (55/80) by SWI scanning before thrombolysis in 80 patients with acute ischemic stroke, while those were 16.25% (13/80) and 15.00% (12/80) after thrombolysis. The differences between brush sign and asymmetric cortical venous sign detected by SWI before and after thrombolysis were statistically significant (P<0.05). SWI versus ASL had sensitivity of 90.91% (10/11) versus 72.73% (8/11), specificity of 95.65% (66/69) versus 88.41% (61/69), and accuracy of 95.00% (76/80) versus 86.25% (69/80) in the diagnosis of cerebral hemorrhage transformation after thrombolysis, revealing that SWI had higher sensitivity and specificity than ASL. The univariate analysis of cerebral hemorrhage transformation showed that the age, atrial fibrillation, NIHSS score and CMBs grade in two groups differed significantly (P<0.05) and the multivariate analysis identified atrial fibrillation, NISHH score and CMBs grade as independent risk factors of cerebral hemorrhagic transformation after thrombolysis. Conclusion SWI has high sensitivity in detecting brush sign and asymmetric cortical venous sign, which is of great value for predicting cerebral hemorrhage transformation after acute thrombolysis, and can be used as a routine examination sequence for acute ischemic stroke.

相似文献/References:

[1]江宇,崔惠勤.一站式多模态平扫MR动态成像在急性脑卒中的应用及对缺血半暗带的早期干预效果[J].中国医学物理学杂志,2020,37(3):307.[doi:DOI:10.3969/j.issn.1005-202X.2020.03.010]
　JIANG Yu,CUI Huiqin.Application of one-stop multimodal dynamic magnetic resonance imaging in acute stroke and effects of early intervention on ischemic penumbra[J].Chinese Journal of Medical Physics,2020,37(12):307.[doi:DOI:10.3969/j.issn.1005-202X.2020.03.010]
[2]张海燕,谭秀革,陈奕菲,等.磁共振联合磁敏感加权成像评估急性脑梗死的临床价值[J].中国医学物理学杂志,2021,38(3):340.[doi:DOI:10.3969/j.issn.1005-202X.2021.03.014]
　ZHANG Haiyan,TAN Xiuge,CHEN Yifei,et al.Clinical value of MRI combined with SWI in evaluating acute cerebral infarction[J].Chinese Journal of Medical Physics,2021,38(12):340.[doi:DOI:10.3969/j.issn.1005-202X.2021.03.014]
[3]黎嘉敏,区杰浩,李晓丹,等.对比增强磁敏感加权成像序列与肺癌脑转移瘤检出的相关性[J].中国医学物理学杂志,2022,39(5):556.[doi:DOI:10.3969/j.issn.1005-202X.2022.05.006]
　LI Jiamin,OU Jiehao,et al.Correlation between contrast-enhanced SWI sequence and detection of brain metastases from lung cancer[J].Chinese Journal of Medical Physics,2022,39(12):556.[doi:DOI:10.3969/j.issn.1005-202X.2022.05.006]
[4]丁昭军,刘文罡,黄俊昊,等.SWI结合ASL对急性期缺血性脑卒中血流动力学评估及诊断价值[J].中国医学物理学杂志,2024,41(1):50.[doi:DOI:10.3969/j.issn.1005-202X.2024.01.007]
　DING Zhaojun,LIU Wengang,HUANG Junhao,et al.Hemodynamic evaluation and diagnostic value of SWI combined with ASL in acute ischemic stroke[J].Chinese Journal of Medical Physics,2024,41(12):50.[doi:DOI:10.3969/j.issn.1005-202X.2024.01.007]

备注/Memo

备注/Memo:
【收稿日期】2024-09-28 【基金项目】佛山市科技计划项目（2220001004620） 【作者简介】黄正旺，副主任医师，研究方向：神经系统疾病及肝胆疾病放射影像，E-mail: wangwang83@126.com
更新日期/Last Update: 2024-12-20