目的 利用MR磁敏感加权成像(SWI)测定脑静脉血相位值(phase值)、观察梗死病灶周围静脉改变,评价脑梗死后的缺氧状态及局部脑氧代谢改变.方法 选择我院神经内科住院治疗的36例急性脑梗死患者(脑梗死组)及25例头颅MRI检查正常者(对照组)作为研究对象.所有研究对象均行MRI检查,其中梗死患者14d内行MRI检查.MRI检查包括T1W、T2W、DWl及SWl检查.按梗死部位分基底核区及侧脑室旁亚组(21例),脑叶亚组(7例),桥脑亚组(8例);按梗死时间分为第1～7天亚组(17例)和第8～14天亚组(19例).测量对照组及脑梗死组上矢状窦和直窦phase值,测量梗死病灶体积,观察病灶周围静脉,进行美国国立卫生研究院卒中量表(NIHSS)评分.结果 脑梗死组直窭phase值(2574.91±223.20)低于对照组(2908.49±207.56),差异有统计学意义(P＜0.01);基底核区及侧脑室旁、脑叶和桥脑亚组直窦phase值(2523.00±215.80、2668.19±229.66、2629.55±224.79)均低于对照组,差异均有统计学意义(均P＜0.05);脑叶亚组上矢状窦phase值(2205.09±65.73)高于基底核区及侧脑室亚组、桥脑亚组、对照组(2126.55±62.16、2137.24±51.31、2112.94±48.81),差异均有统计学意义(均P＜0.05);脑梗死组中发现梗死病灶周围不同程度的静脉扩张21例,其中第1-7天亚组13例,第8～14天亚组8例;Spearman相关性分析提示病灶周围静脉扩张与梗死体积及梗死时间相关(均P＜0.05).结论 SWI定量测定静脉血phase值,发现梗死灶周围静脉扩张,为临床无创性评价梗死区域脑组织缺氧及局部脑组织血氧代谢提供有价值的参考,有助于急性脑梗死的规范治疗.%Objective To evaluate venous blood oxygen saturation and regional oxygen metabolism changesby MR susceptibility weighted imaging MR-SWI in patients with acute cerebral infarction.Methods Thirty six patients with acute cerebral infraction admitted from January 2012 to June 2014 and 25 heaithy subjects were enrolled in the study.All subjects received MRI examinations,including T1W,T2W,DWI and SWI;for infarcted patients the examination was performed within 14d after clinical onset.The phase values of superior sagittal sinuses,straight sinuses and infarction volume was measured,venous dilatation around lesions was observed,and NIHSS scores were measured or evaluated.Among 36 patients,the infacted location was in basal ganglia region and periventricular region (n=21),cerebral lobe region (n=7) and pons region (n=8),meanwhile,the admission time from onset was 1-7 d in 17 cases,and 8-14 d in 19 cases.Results The phase values of straight sinus in cerebral infarction group(2 574.91 ± 223.20) were significantly lower than those in control group(2 908.49 ± 207.56)(P＜0.001).The phase values of straight sinus in the basal ganglia region and the periventricular region,the cerebral lobe region and the pons region in infarcton group (2 523.00 ± 215.80,2 668.19 ± 229.66,2 629.55 ± 224.79) were lower than those in control group (all P＜ 0.05).The phase values of superior sagittal sinuses (2 205.09 ±65.73) in patients with cerebral lobe infarction significantly increased,compared patients with the basal ganglia region and periventricular region,the pons region infarction and the control group (2 126.55 ±62.16,2 137.24 ±51.31,2 112.94 ±48.81)(P＜0.05).Venous dilatation was observed in 21 infarcted patients,which occurred from d1 to d7 of onset in 13 cases and from d8 to d14 in 8 cases.Spearman relativity analysis revieled that venous dilation was significantly related to the infarction volume and time.The venous dilatation around the lesions was significantly correlated with the infarction volume and the time of onset(P＜0.05).Conclusion SWl can quantitatively measure the phase values of intracranial venous blood and can detect venous dilation around the lesions in patients with acute cerebral infarction,which may provide alternative references for clinical noninvasive assessment of hypoxia of regional brain tissue and oxygen metabolism of partial infarction tissue in patients with cerebral infarction.
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