Abstract:

Objective　To evaluate the value of diffusion-weighted magnetic resonance imaging (DWI) combined with serum C-reactive protein (CRP) in identifying the time window of acute ischemic cerebral infarction. Methods　A retrospective analysis was conducted on the clinical data of 195 patients with acute cerebral infarction admitted to Baoji Central Hospital from June 2021 to June 2023. There were 111 males and 84 females; they were 57-75 years old. The patients were divided into an ultra-acute stage group (course of disease ≤ 6 h; 67 cases), an acute stage group (course of disease of 6-72 h; 79 cases), and a subacute stage group (course of disease of ≥72~168 h; 49 cases) according to the time from onset to magnetic resonance imaging examination. The DWI examination results [apparent diffusion coefficient (ADC)] and CRP levels of the three groups were compared. The value of DWI combined with CRP in identifying the time window of acute cerebral infarction was analyzed using the receiver operating characteristic curve (ROC). t and F tests were applied. Results　The ADC of the affected side in the ultra-acute stage group [(0.33±0.08)×10^-3 mm²/s] was significantly lower than those in the acute stage group [(0.40±0.09)×10^-3 mm²/s] and the subacute stage group [(1.56±0.25)×10^-3 mm²/s], with a statistical difference between the 3 groups (F=34.455, P<0.05). In the ultra-acute stage group and the acute stage group, the ADC values of the affected sides were significantly lower than those of the healthy sides (both P<0.05). In the subacute stage group, the ADC value of the affected side was significantly higher than that of the healthy side (P<0.05). The CRP level in the ultra-acute stage group [(9.39±3.03) mg/L] was significantly higher than those in the acute stage group [(6.01±1.27) mg/L] and the subacute stage group [(5.48±1.33) mg/L] (q=16.09 and 712.295; both P<0.05); there was no statistical difference in CRP level between the acute stage group and the subacute stage group (q=1.933; P>0.05). The ROC showed that the area under the curve (AUC), sensitivity, and specificity of ADC value for distinguishing acute ischemic cerebral infarction from ultra-acute phase were 0.587, 100.00%, and 38.38%. The AUC, sensitivity, and specificity of CRP were 0.888, 73.13%, and 96.87%. The AUC, sensitivity, and specificity of ADC value combined with CRP were 0.918, 85.07%, and 86.72%. Conclusions　Both ADC value and serum CRP level in patients with acute ischemic cerebral infarction can be used to identify the time window. ADC has high sensitivity while CRP has high specificity for identifying ultra-acute ischemic cerebral infarction. Combination of the two can optimize the differentiation efficiency.

Key words:

Diffusion-weighted imaging, Magnetic resonance, C-reactive protein, Acute ischemic cerebral infarction

摘要：

目的　磁共振弥散加权成像（DWI）联合血清C反应蛋白（CRP）对急性缺血性脑梗死时间窗的鉴别价值。方法　回顾性分析2021年6月至2023年6月宝鸡市中心医院收治的195例急性缺血性脑梗死患者床资料，其中男111例，女84例，年龄范围57～75岁。按发病至接受磁共振检查前时间分为超急性期组（病程≤6 h）67例、急性期组（病程6～72 h）79例、亚急性期组（≥72~168 h）49例；比较3组患者的DWI检查结果［表观弥散系数（ADC）］及CRP水平，受试者操作特征曲线（ROC）分析DWI联合CRP对急性缺血性脑梗死时间窗的鉴别价值，采用t检验、F检验进行统计分析。结果　超急性期组患侧ADC为（0.33±0.08）×10^-3 mm²/s，低于急性期组的（0.40±0.09）×10^-3 mm²/s、亚急性期组的（1.56±0.25）×10^-3 mm²/s，3组比较差异有统计学意义（F=34.455，P<0.05）；且超急性期组、急性期组患者患侧ADC值低于健侧，但亚急性期组患者ADC值高于健侧，差异有统计学意义（均P<0.05）。超急性期组CRP为（9.39±3.03）mg/L，高于急性期组（6.01±1.27）mg/L、亚急性期（5.48±1.33）mg/L（q=16.09、712.295，均P<0.05）；但急性期组、亚急性期CRP比较差异无统计学意义（q=1.933、P>0.05）。ROC显示ADC鉴别急性缺血性脑梗死超急性期的曲线下面积（AUC）为0.587，灵敏度为100.00%、特异度为38.38%；CRP鉴别急性缺血性脑梗死超急性期的AUC为0.888，灵敏度为73.13%、特异度为96.87%；ADC联合CRP的AUC为0.918，灵敏度、特异度分别为85.07%、86.72%。结论　急性缺血性脑梗死患者的ADC与血清CRP水平均可有效鉴别时间窗，ADC鉴别超急性缺血性脑梗死存在高灵敏度优势，CRP则具有高特异度优势，两者联合可进一步优化鉴别效能。

关键词:

弥散加权成像, 磁共振, C反应蛋白, 急性缺血性脑梗死