摘要
目的探讨MR扩散张量成像（DTI）及白质纤维束成像（DTT）技术与NIHSS评分系统在急性缺血性脑梗死患者预后判断评价中的优势，为临床提供参考。方法对34例患者[男性19例，女性15例，年龄35—73岁，平均（58±2．4）岁]在急性期（发病时间〈72h）行1．5T常规头颅MR常规检查，同期行DTI及DTT成像，根据白质纤维束（CST）与梗死灶的关系分为相邻、部分穿过及完全穿过3组，将其功能结局分别预测为痊愈、部分恢复及瘫痪并作为预测理论值（100％）；患者就诊或入院时或在发病24h内采用NIHSS评价脑梗死的严重程度，根据严重程度（〈6分；6～16分及〉16分）将34例患者分为3组，将其功能结局分别预测为痊愈、部分恢复及瘫痪并作为预测理论值（100％）。最后通过随访并对所有的患者进行肌力测试（MMT），将结果作为预后评价的实际值与上述理论值作一对比并进行评价，判断二者符合率。结果34例患者的NIHSS评分范围为2～30分，其中6例痊愈者平均评分为（4．13±1．356）分；13例部分恢复者平均评分为（11．47±3．067）分，15例瘫痪者平均评分为（23．09±4．482）分，两者比较差异有统计学意义（P〈0．01）。比较两个分组方法所得的实际值的符合率，结果显示采用梗死灶与CST关系进行分组所得实际值的符合率较NIHSS评分分组所得实际值的符合率高，具有统计学意义（P〈0．05）。结论采用梗死灶与CST关系进行分组所得实际值的符合率较NIHSS评分分组所得实际值的符合率高，其差异具有统计学意义（P〈0．05），同时随着NIHSS评分分值的升高，脑梗死患者的肢体瘫痪危险度增加。
Objective To compared the evaluation of MR diffusion tensor imaging （DTI） and NIHSS scoring system in acute ischemic cerebral infarction patients and provide clinical references for the disease prognosis. Methods All patients in the acute phase （onset 〈 72 h） performed 1.5T conventional MRI and DTI, DTT examination. The FA and ADC values of infarct and corresponding part of the contralateral normal brain tissue were measured. Three patterns of corticospinal tract （CST） involvement were identified according to the relation of CST and infarct： close, partly involved and completely in- volved. The outcomes of fully recovery, partial recovery and paralysis were prognosed by 3 patterns of CST involvement re- spectively. These outcomes were regarded as theoretical predicted value. The 34 patients were divided into 3 groups accord- ing to the NIHSS evaluation, NIHSS score 〉 16 points, patients are completely paralyzed group, between 6 to 16, patients will be defined as part of the recovery group, less than 6 points were defined as fully recovery group. After therapy, the pa- tients were evaluaed by MMT test, the resuhs were compared with above theoretical values. Results The NIHSS score of 34 patients from 2 to 30. The average score were 4.13 ± 1. 356 in the 6 cases of fully recovery, 11.47 ± 3. 067 in the 13 cases of partial recovery,23.09±4.482 in the 16 cases of paralysis, which had significant difference （P 〈0.01 ）. Compared the coincidence of actual value in two system, the DTI with DTT was more better than NIHSS, the difference had statistical significance （ P 〈 0.05 ）. Conclusion DTI combined with DTr had more accurate than NIHSS score system inprognosis of acute ischemic cerebral infarction outcome.
出处
《临床放射学杂志》
CSCD
北大核心
2014年第6期812-817,共6页
Journal of Clinical Radiology
