弥散加权成像鉴别诊断超急性脑梗死与超急性脑出血的价值

doi:10.3760/cma.j.cn441417-20240913-02022

摘要/Abstract

摘要：

目的　探讨弥散加权成像（DWI）在超急性脑梗死与超急性脑出血鉴别诊断中的价值。方法　采用前瞻性研究。选取2022年1月至2023年12月驻马店市中心医院收治的超急性脑梗死和脑出血患者，各35例。超急性脑梗死患者中，男19例、女16例，年龄（58.69±5.16）岁，发病时间（2.45±1.02）h。超急性脑出血患者中，男21例、女14例，年龄（58.42±5.05）岁，发病时间（2.39±1.03）h。所有患者进行DWI和常规磁共振成像（MRI）检查，比较DWI和常规MRI对超急性脑梗死和超急性脑出血的检出率和病变部位信号特征，分析DWI检查超急性脑梗死和超急性脑出血的病变位置特征。采用统计学软件SPSS 26.0对数据进行分析，组间比较采用t检验、χ²检验。结果　DWI对超急性脑梗死的检出率为97.14%（34/35）、超急性脑出血检出率为94.29%（33/35），均高于常规MRI检出率［62.86%（22/35）、65.71%（23/35）］（均P<0.05）；DWI和常规MRI检查超急性脑梗死病变部位的信号特征主要为高信号，超急性脑出血病变部位的信号特征主要为混杂信号和低信号，且DWI对超急性脑梗死和超急性脑出血的病变部位信号特征的灵敏度均高于常规MRI检查（均P<0.05）。DWI检查结果显示，超急性脑梗死病变位置在小脑、大脑皮质的检出率分别为54.29%（19/35）、25.71%（9/35），高于超急性脑出血［5.71%（2/35）、2.86%（1/35）］；在脑干、基底节区的检出率分别为2.86%（1/35）、14.29%（5/35），低于超急性脑出血检查［22.86%（8/35）、65.71%（23/35）］（均P<0.05）。结论　DWI能提升超急性脑梗死和超急性脑出血的检出率，准确判断病变部位，评估病灶信号特征，为临床鉴别脑梗死与脑出血提供可靠的参考依据。

关键词:

脑梗死, 脑出血, 超急性, 弥散加权成像

Abstract:

Objective　To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) in the differential diagnosis of hyperacute cerebral infarction and hemorrhage. Methods　This was a prospective study. Thirty-five patients with hyperacute cerebral infarction and 35 patients with hyperacute cerebral hemorrhage treated at Zhumadian Central Hospital from January 2022 to December 2023 were selected. Among the patients with hyperacute cerebral infarction, there were 19 males and 16 females; they were (58.69±5.16) years old; the onset time was (2.45±1.02) h. Among the patients with hyperacute cerebral hemorrhage, there were 21 males and 14 females; they were (58.42±5.05) years; the onset time was (2.39±1.03) h. All the patients were examined by DWI and conventional magnetic resonance imaging (MRI). The detection rates of hyperacute cerebral infarction and hemorrhage and the signal characteristics of the lesion sites were compared between DWI and conventional MRI. The lesion location characteristics of hyperacute cerebral infarction and hemorrhage were analyzed. The statistical software SPSS 26.0 was used to statistically analyze the data. t and χ² tests were used to compare the data between the groups. Results　The detection rate of DWI for hyperacute cerebral infarction was 97.14% (34/35), and that for hyperacute cerebral hemorrhage was 94.29% (33/35); both were higher than those of conventional MRI [62.86% (22/35) and 65.71% (23/35)] (both P<0.05). The signal characteristics of the lesion sites of hyperacute cerebral infarction were mainly high signal in DWI and conventional MRI; the signal characteristics of the lesion sites of hyperacute cerebral hemorrhage were mainly mixed signal and low signal; the sensitivity of DWI to the lesion site signal characteristics of acute cerebral infarction and hemorrhage was higher than that of conventional MRI (both P<0.05). The DWI examination results showed that the detection rates of cerebellar and cerebral cortex lesions in hyperacute cerebral infarction were 54.29% (19/35) and 25.71% (9/35), respectively, which higher than those of hyperacute cerebral hemorrhage [5.71% (2/35) and 2.86% (1/35)]. The detection rates in brain stem and basal ganglia were 2.86% (1/35) and 14.29% (5/35), respectively, which were lower than those in hyperacute intracerebral hemorrhage [22.86% (8/35) and 65.71% (23/35)] (all P<0.05). Conclusion　DWI can improve the detection rates of hyperacute cerebral infarction and hemorrhage, accurately determine the lesion sites, evaluate the lesion signal characteristics, and provide reliable references for clinical differentiation of cerebral infarction and hemorrhage.

Key words:

Cerebral infarction, Cerebral hemorrhage, Hyperacute, Diffusion weighted imaging

远波杨晓庆李俊丽闫松.

弥散加权成像鉴别诊断超急性脑梗死与超急性脑出血的价值 [J]. 国际医药卫生导报, 2025, 31(2): 289-293.

Yuan Bo, Yang Xiaoqing, Li Junli, Yan Song.

Value of diffusion weighted imaging in differential diagnosis of hyperacute cerebral infarction and hemorrhage [J]. International Medicine and Health Guidance News, 2025, 31(2): 289-293.

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