Observe on the clinical effect of MRI in vascular dementia after ischemic stroke
-
摘要:
目的 观察缺血性脑卒中后血管性痴呆患者头颅核磁共振(MRI)检测的特征，评价其用于该疾病早期诊断及病情监测的价值。 方法 选择2016年8月—2020年8月于台州市中心医院收治的200例缺血性脑卒中患者为研究对象，将卒中后未发生血管性痴呆的患者纳入对照组，将卒中后发生血管性痴呆的患者纳入研究组，均进行头颅MRI检测，观察脑组织梗死病灶大小，测定大脑白质感兴趣区域的表观弥散系数(ADC)。 结果 全部缺血性脑卒中患者中，血管性痴呆发生率为26.50%；研究组脑组织存在大梗死和中梗死病灶的患者比例(50.94%和56.60%)均显著高于对照组(21.76%和23.81%)，χ2=15.943、19.097；均P < 0.001；研究组左侧、右侧海马体积和大脑左右径检测数值均显著小于对照组，而研究组颞叶钩回间距检测数值显著大于对照组(均P < 0.001)；研究组额叶前部、额叶后部、侧脑室前角区、侧脑室后角区、半卵圆中心和海马区等区域脑白质ADC检测数值均显著低于对照组(均P < 0.001)。 结论 缺血性脑卒中后血管性痴呆患者存在皮质萎缩、脑沟增宽、梗死病灶面积大和脑白质稀疏的特征，头颅MRI检测可有效诊断缺血性脑卒中血管性痴呆的相关临床特征，对早期治疗及预后评估具有一定临床价值。 Abstract:Objective To observe the characteristics of brain magnetic resonance imaging (MRI) in patients with vascular dementia after ischemic stroke and evaluate the value of MRI in the early diagnosis and monitoring of the disease. Methods A total of 200 patients with ischemic stroke who were treated in Taizhou Central Hospital from August 2016 to August 2020 were included in the study. Patients without vascular dementia after stroke were included in the control group, whereas patients with vascular cerebral infatuation after stroke were included in the study group. All patients underwent cranial MRI detection. Infarct size was observed, and the apparent diffusion coefficient (ADC) of the white texture region of interest was measured. Results In all 200 patients with acute ischemic stroke, the incidence of vascular cerebral infatuation was 26.50%. The proportions of patients with large and medium cerebral infarction in the study group (50.94% and 56.60%) were significantly higher than those in the control group (21.76% and 23.81%; χ2=15.943, 19.097; all P < 0.001). The volumes of the left and right hippocampi and the left and right cerebral diameters of the study group were significantly lower than those in the control group, and the distance between the uncinate gyrus of the temporal lobe in the study group was significantly higher than that in the control group (all P < 0.001). The ADC values of the white matter in the frontal area of the frontal lobe, posterior area of the frontal lobe, anterior horn of the lateral ventricle, posterior horn of the lateral ventricle, semioval centre and hippocampus were significantly lower in the study group than in the control group (all P < 0.001). Conclusion Patients with vascular dementia after ischemic stroke have the characteristics of cortical atrophy, widened sulcus, large infarct area and sparse white matter. MRI examination can effectively diagnose the clinical features of vascular dementia after ischemic stroke and has a clinical value for early treatment and prognosis evaluation. -
Key words:
- Magnetic resonance imaging /
- Ischemic stroke /
- Vascular dementia /
- Early diagnosis /
- Clinical value
-
表 1 2组缺血性脑卒中患者MRI检测下脑组织梗死病灶大小情况比较[例(%)]
组别 例数 大梗死 中梗死 小梗死 腔隙性梗死 对照组 147 32(21.76) 35(23.81) 112(76.19) 97(65.99) 研究组 53 27(50.94) 30(56.60) 39(73.58) 33(62.26) χ2值 15.943 19.097 0.143 0.237 P值 ＜0.001 ＜0.001 0.705 0.626 
下载: 导出CSV
表 2 2组缺血性脑卒中患者海马体积、颞叶沟回间距和大脑左右径比较(x±s)
组别 例数 左侧海马体积(cm3) 右侧海马体积(cm3) 颞叶沟回间距(mm) 大脑左右径(mm) 对照组 147 2.58±0.21 2.61±0.25 25.62±3.07 136.82±5.79 研究组 53 2.24±0.18 2.25±0.19 29.51±3.24 131.47±5.46 t值 10.477 9.532 7.793 5.853 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
下载: 导出CSV
表 3 2组缺血性脑卒中患者脑组织不同区域脑白质ADC检测数值比较(x±s)
组别 例数 额叶前部 额叶后部 侧脑室前角区 左侧 右侧 左侧 右侧 左侧 右侧 对照组 147 0.37±0.05 0.43±0.06 0.49±0.06 0.48±0.06 0.38±0.06 0.36±0.05 研究组 53 0.31±0.05 0.36±0.05 0.42±0.06 0.40±0.05 0.29±0.04 0.27±0.04 t值 7.379 7.613 7.542 8.071 9.561 9.824 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 组别 例数 侧脑室后角区 半卵圆中心 海马区 左侧 右侧 左侧 右侧 左侧 右侧 对照组 147 0.41±0.06 0.39±0.06 0.33±0.06 0.36±0.06 0.18±0.03 0.17±0.03 研究组 53 0.30±0.04 0.31±0.05 0.26±0.04 0.27±0.04 0.13±0.02 0.14±0.02 t值 11.841 8.216 7.925 9.703 10.659 7.461 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
下载: 导出CSV
-
[1] GUSTAVSSON A M, WESTEN D, STOMRUD E, et al. Midlife atherosclerosis and development of alzheimer or vascular dementia[J]. Ann Neurol, 2020, 87(1): 52-62. doi: 10.1002/ana.25645 [2] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志, 2010, 43(2): 146-153. doi: 10.3760/cma.j.issn.1006-7876.2010.02.022 [3] 中华医学会神经病学分会. 血管性痴呆诊断标准草案[J]. 中华神经科杂志, 2002, 35(4): 246. doi: 10.3760/j.issn:1006-7876.2002.04.036 [4] 汪东良, 王锦华, 韩威威, 等. 血清学标志物Aβ1-42、sICAM-1、VILIP-1对脑梗死后血管性痴呆的预测价值[J]. 中华全科医学, 2019, 17(2): 225-229. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201902018.htm [5] CHAKRABORTY A, CHATTERJEE M, TWAALFHOVEN H, et al. Vascular endothelial growth factor remains unchanged in cerebrospinal fluid of patients with alzheimer's disease and vascular dementia[J]. Alzheimers Res Ther, 2018, 10(1): 58. doi: 10.1186/s13195-018-0385-8 [6] MOESKOPS P, BRESSER J, KUIJF H J, et al. Evaluation of a deep learning approach for the segmentation of brain tissues and white matter hyperintensities of presumed vascular origin in MRI[J]. Neuroimage Clin, 2017, 17: 251-262. [7] 田金洲, 解恒革, 秦斌, 等. 适用于中国人群的血管性痴呆筛查和诊断框架[J]. 中华内科杂志, 2019, 58(1): 10-16. doi: 10.3760/cma.j.issn.0578-1426.2019.01.003 [8] 王天舒, 杜冉, 滕军放. MRI诊断血管性痴呆和阿尔茨海默病的价值观察[J]. 中国CT和MRI杂志, 2020, 18(5): 59-61, 78. doi: 10.3969/j.issn.1672-5131.2020.05.019 [9] 张钦, 韩剑剑. MRI鉴别诊断阿尔茨海默病和血管性痴呆的价值研究[J]. 湖北民族大学学报(医学版), 2020, 37(2): 46-48. https://www.cnki.com.cn/Article/CJFDTOTAL-FBMZ202002013.htm [10] PROMJUNYAKUL N O, LAHNA D L, KAYE J A, et al. Comparison of cerebral blood flow and structural penumbras in relation to white matter hyperintensities: A multi-modal magnetic resonance imaging study[J]. J Cereb Blood Flow Metab, 2016, 36(9): 1528-1536. doi: 10.1177/0271678X16651268 [11] LAMBERT C, ZEESTRATEN E, WILLIAMS O, et al. Identifying preclinical vascular dementia in symptomatic small vessel disease using MRI[J]. Neuroimage Clin, 2018, 19: 925-938. doi: 10.1016/j.nicl.2018.06.023 [12] 秦雅宏. MRI在鉴别血管性痴呆与阿尔茨海默症患者中的应用研究[J]. 现代医用影像学, 2019, 28(5): 1033-1034. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY201905032.htm [13] SERDAREVIC N, STANCIU A E, BEGIC L, et al. Serum uric acid concentration in patients with cerebrovascular disease (ischemic stroke and vascular dementia)[J]. Med Arch, 2020, 74(2): 95-99. doi: 10.5455/medarh.2020.74.95-99 [14] 顾国强, 熊敏荣, 孙云峰. 缺血性脑卒中后血管性痴呆的临床特点及MRI早期诊断价值[J]. 中国现代医生, 2019, 57(25): 116-119. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS201925040.htm [15] 区尚之, 杨少民, 欧阳裕锋. 缺血性脑卒中后血管性痴呆的MRI影像特点研究[J]. 中国现代药物应用, 2018, 12(2): 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201802017.htm -
点击查看大图
表(3)
计量
- 文章访问数: 171
- HTML全文浏览量: 63
- PDF下载量: 4
- 被引次数: 0
