MRI、TEG参数诊断ACI溶栓后发生出血性转化的研究

doi:10.7517/issn.1674-0475.221016

摘要/Abstract

摘要： 本研究探讨磁共振成像（MRI）、血栓弹力图（TEG）参数在诊断急性脑梗死（ACI）溶栓后发生出血性转化（HT）的价值。选取采取溶栓方式治疗且发生HT的62例ACI患者作为HT组、选取同期采取溶栓治疗且未发生HT转化的80例ACI患者作为对照组，对比两组患者的MRI参数特征、TEG参数特征，并以最终临床确诊结果作为判断依据，计算MRI参数及TEG诊断ACI患者溶栓后发生HT的价值。结果显示，HT组患者的磁敏感加权成像（SWI）相位图像信号特点主要表现为高信号，HT组的高信号患者占比显著高于对照组（P<0.05），HT组患者的低信号、混杂信号患者占比均低于对照组（P<0.05）。SWI、弥散加权成像（DWI）、T1加权成像（T1WI）诊断HT的灵敏度分别为88.71%、62.90%、69.35%，特异度分别为86.25%、80.00%、82.50%。HT组的凝血综合指数（CI）值显著低于对照组（P<0.05）。SWI、DWI、T1WI诊断ACI溶栓患者发生HT的AUC值分别为0.875、0.715、0.759。TEG参数中CI值诊断ACI溶栓患者发生HT的AUC值为0.720。MRI、TEG参数在诊断ACI溶栓患者发生HT中具有较高的价值。

关键词: 磁共振成像, 血栓弹力图, 诊断, 急性脑梗死, 出血性转化

Abstract: This study investigated the value of magnetic resonance imaging (MRI) and thrombela-stogram (TEG) parameters in the diagnosis of hemorrhagic transformation (HT) after thrombolysis in acute cerebral infarction (ACI). 62 ACI patients with HT who received thrombolytic therapy were selected as HT group, and 80 ACI patients without HT transformation who received thrombolytic therapy at the same time were selected as control group. The MRI parameters and TEG parameters of the two groups were compared, and the final clinical diagnosis results were used as the judgment basis to calculate the value of MRI parameters and TEG in diagnosing HT in ACI patients after thrombolysis. The results showed that the phase signal characteristics of susceptibility weighted imaging (SWI) in HT group were mainly characterized by high signal, the proportion of patients with high signal in HT group was significantly higher than that in control group (P<0.05), and the proportion of patients with low signal and mixed signal in HT group was lower than that in control group (P<0.05). The sensitivity of SWI, diffusion weighted imaging (DWI) and T1-weighted imaging (T1WI) in the diagnosis of HT were 88.71%, 62.90% and 69.35%, respectively, and the specificity were 86.25%, 80.00% and 82.50%, respectively. The coagulation composite index (CI) value of HT group was significantly lower than that of control group (P<0.05). The AUC values of SWI, DWI and T1WI in diagnosing HT in patients with ACI thrombolysis were 0.875, 0.715 and 0.759, respectively. The AUC value of CI value in TEG parameters for diagnosing HT in patients with ACI thrombolysis was 0.720. MRI and TEG parameters have high value in the diagnosis of HT in patients with ACI thrombolysis.

Key words: magnetic resonance imaging, thromboela-stogram, diagnosis, acute cerebral infarction, hemorrhagic transformation

邹丽雯, 汪月, 潘毓玲, 曾鸿君. MRI、TEG参数诊断ACI溶栓后发生出血性转化的研究[J]. 影像科学与光化学, 2023, 41(1): 23-27.

ZOU Liwen, WANG Yue, PAN Yuling, ZENG Hongjun. The Study of MRI and TEG Parameters in the Diagnosis of Hemorrhagic Transformation after Thrombolysis in ACI[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(1): 23-27.

参考文献

[1] Guenego A, Lecler A, Raymond J, et al. Hemorrhagic transformation after stroke:Inter-and intrarater agreement[J]. European Journal of Neurology, 2019, 26(3):476-482.
[2] 刘鸣. 急性脑梗死后出血转化诊断与处理[J]. 中华神经科杂志, 2020, 53(3):213-216.
[3] 刘帆, 张卓, 金铭, 等. 急性脑梗死后出血转化的研究[J]. 脑与神经疾病杂志, 2021, 29(9):586-589.
[4] 杨桂林, 张效杰, 余光权, 等. 磁共振弥散加权成像联合磁共振血管成像在急性脑梗死患者诊断中应用研究[J]. 现代医用影像学, 2022, 31(3):479-481.
[5] 陈旭娜. 磁敏感加权成像对首发急性脑梗死患者出血性转化的诊断价值及相关危险因素分析[D]. 新乡:新乡医学院, 2021.
[6] 闫彬, 刘坤, 张保朝. 血栓弹力图在急性缺血性脑卒中中的应用研究进展[J]. 中华神经医学杂志, 2021, 20(12):1281-1286.
[7] 李丽娜, 林允斌. 急性脑梗死患者血栓弹力图参数与凝血功能的相关性分析[J]. 中国医学创新, 2021, 18(33):1-5.
[8] 彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
[9] 徐伟, 李辉萍, 王振, 等. 80岁及以上急性脑梗死患者静脉溶栓的预后影响因素分析[J]. 中华老年心脑血管病杂志, 2022, 24(5):507-511.
[10] Acampa M, Camarri S, Lazzerini P E, et al. Increased arterial stiffness is an independent risk factor for hemorrhagic transformation in ischemic stroke undergoing thrombo-lysis[J]. International Journal of Cardiology, 2017, 243:466-470.
[11] 杨思敏, 李梦杰, 方贺, 等. 急性缺血性脑卒中出血转化机制及预测因子的研究进展[J]. 华西医学, 2022, 37(6):932-936.
[12] 李艳丽, 周俊超, 刘晓君. 老年急性缺血性脑卒中患者溶栓后出血转化的相关因素分析[J]. 中国实用医刊, 2022, 49(9):13-17.
[13] Nighoghossian N, Hermier M, Berthezène Y, et al. Early diagnosis of hemorrhagic transformation:Diffusion/perfusion-weighted MRI versus CT scan[J]. Cerebrovascular Diseases:Base, Switzerland, 2001, 11(3):151-156.
[14] Yu G, Kim Y J, Jeon S B, et al. Thromboelastography for prediction of hemorrhagic transformation in patients with acute ischemic stroke[J]. The American Journal of Emergency Medicine, 2020, 38(9):1772-1777.
[15] 冯肖. 核磁共振检查在老年急性脑卒中患者使用重组组织型纤溶酶原激活剂后出血转化风险评估中的价值[J]. 陕西医学杂志, 2021, 50(10):1264-1266.
[16] 方丽君, 刘学源. 血栓弹力图在溶栓后出血中的监测意义[J]. 同济大学学报(医学版), 2016, 37(5):114-118, 123.
[17] 张立斯, 程薇, 左玉江. 脑梗死与脑出血急性期应用DWI结合SWI诊断的准确性及临床价值[J]. 医学理论与实践, 2022, 35(3):473-474.
[18] 陈健容. 磁敏感加权成像在早期脑梗塞中微出血的诊断应用[J]. 现代医用影像学, 2022, 31(4):666-668.
[19] 刘芳龙. 血栓弹力图在急性脑梗死患者出血性转化评估中的应用[J]. 实用医技杂志, 2021, 28(11):1331-1333, 1387.
[20] 周帆, 黄云峰. 血栓弹力图在急性脑梗死患者早期神经功能缺损及出血性转化风险性评估中的价值[J]. 实用临床医药杂志, 2019, 23(6):73-76.