摘要目的 探讨磁敏感加权成像技术(SWI)在诊断急性大面积脑梗死出血转化和评估侧支循环重构中的临床应用价值.方法 选取2012年1月至2014年1月我院住院治疗的颈内动脉系统大面积脑梗死患者50例,分别于急性期及恢复期行MRI的T1WI、T2WI、DWI、MRA、SWI序列检查.分析治疗前后SWI序列和MRI常规序列的图像信息,统计分析SWI序列与MR常规序列、磁共振血管造影在检测脑梗死出血转化及显示缺血区侧支循环重构的差异.结果 (1) SWI检出18例出血转化患者(36％),其中出血性脑梗死(HI)型14例(28％),脑实质出血(PH)型4例(8％).常规MRI序列仅检测出出血转化患者11例(22％),其中HI型7例(14％),PH型4例(8％).SWI序列检出脑梗死后出血灶106个,检出率为100％,MRI常规序列仅检出26个,检出率为32.51％,漏检的主要为微出血灶,组间比较差异有统计学意义(x2=21.045,P＜0.05).(2) SWI序列能很好地显示脑梗死区内微血管情况,急性期微血管数目减少或消失,恢复期梗死区周边会有微血管数目增多.微血管数目增多的比率为66％.MRA能发现82％的脑梗死的责任血管.结论 磁敏感加权成像比常规MRI序列更敏感地显示急性大面积脑梗死的出血转化.MRA联合SWI能有效地检出脑梗死的责任血管,且能监测梗死区侧支循环重建情况,对制定大面积脑梗死治疗方案和评估预后具有很高的指导价值.

abstractsObjective To evaluate the clinical application of susceptibility-weighted imaging(SWI) in the early diagnosis of massive cerebral infarction with hemorrhage and analysis of collateral circulation.Methods Fifty patients with massive cerebral infarction underwent MRI (T1WI,T2WI,DWI,MRA and SWI) scan in acute stage and decubation respectively in Hanrison International Peace Hospital from January 2012 to January 2014.Analysis T1WI,T2WI,DWI,MRA and SWI differences in the delection of cerebral infarction with hemorrhage and analysis of Collateral circulation.Record the magnetic resonance angiography hemorrhagic transformation and display the ischemic area of collateral circulation in the detection of cerebral infarction remodeling differences.Results (1)SWI detected out 18 cases of cerebral infarction with hemorrhage (36％),including 14 cases of hemorrhagic infarction(HI) type(28％),4 cases of parenchymal hemorrhage(PH) type 8％).MRI detected 11 cases of cerebral infarction with hemorrhage (22％),including 7 cases of HI type 14％),4 cases of PH type (8％).SWI detected 106 focuses,the detection rate was 100％,MRI detected only 26,and the detection rate was 32.51％,and the missing mainly for micro hemorrhage.There was statistical significance between the groups(x2 =21.045,P＜0.05).(2) SWI can display the condition of micrangium in the area of cerebral infarction clearly.The number of micrangium decreased or disappeared in acute stage,but the micrangium increased in decubation.The ratio of capillary vessels increased to 66％.MRA detected 82％ of criminal vessel in patients with cerebral infarction.Conclusion SWI is more sensitive than conventional MR in the early diagnosis of massive cerebral infarction with hemorrhage.MRA combined with SWI could not only detect the criminal vessel of cerebral infarction area,but also monitor the reconstruction of collateral circulation in the infarction region,and there will be extremely valuable to the treatment massive cerebral infarction and evaluation of prognosis.