切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2014, Vol. 02 ›› Issue (01) : 9 -16. doi: 10.3877/cma.j.issn.2095-655X.2014.01.002

所属专题: 文献

专题论述

X线计算机体层摄影术、磁共振成像和脑磁图描记术在急性脑梗死诊断中的应用
孙占用1, 荀丽颖1, 吕佩源1,()   
  1. 1. 050051 石家庄,河北省人民医院神经内科
  • 收稿日期:2013-12-03 出版日期:2014-02-26
  • 通信作者: 吕佩源
  • 基金资助:
    国家留学人员科技活动择优资助项目(人力资源与社会保障部2009-11-6); 河北省自然科学基金(C2009001483)

Application of computed tomography, magnetic resonance imaging, magnetoencephalography in the diagnosis of acute cerebral infarction

Zhanyong Sun1, Liying Xun1, Peiyuan Lyu1,()   

  1. 1. Department of Neurology, Hebei General Hospital, Shijiazhuang 050051, China
  • Received:2013-12-03 Published:2014-02-26
  • Corresponding author: Peiyuan Lyu
  • About author:
    Corresponding Author: Lyu Peiyuan, Email:
引用本文:

孙占用, 荀丽颖, 吕佩源. X线计算机体层摄影术、磁共振成像和脑磁图描记术在急性脑梗死诊断中的应用[J]. 中华诊断学电子杂志, 2014, 02(01): 9-16.

Zhanyong Sun, Liying Xun, Peiyuan Lyu. Application of computed tomography, magnetic resonance imaging, magnetoencephalography in the diagnosis of acute cerebral infarction[J]. Chinese Journal of Diagnostics(Electronic Edition), 2014, 02(01): 9-16.

急性脑梗死是临床常见的缺血性脑血管疾病,具有高发病率、高死亡率及高致残率的特点,早诊断、早治疗是及早阻止疾病发展、改善预后的关键。笔者主要就急性脑梗死在X线计算机体层摄影术(CT)、磁共振成像(MRI)、脑磁图描记术(MEG)等神经影像中的早期表现及相关原理进行阐述。常规CT普及率高、经济、便捷,对脑出血敏感度高,是急性脑梗死与脑出血鉴别首选,缺点是成像对比度差,对脑梗死早期诊断精确性差。CT灌注成像对急性脑梗死的早期诊断和缺血半暗带定位具有更大的优势。MRI是具有多种扫描序列,可对不同状态下脑组织内水分子状态精确分辨,对脑梗死的诊断、分期具有极高的应用价值。临床常规的T1、T2、FLAIR加权像可在起病后数小时观测到异常信号,而DWI序列在局部脑组织缺血后5min即可见信号增强。SWI序列可以检测CT、常规MRI无法显示的微出血灶。MRS成像可以检测多种细胞内化合物成分,这些化合物对急性脑梗死不同时期、不同程度的细胞损伤具有特定意义。MEG可以灵敏检测大脑神经元细胞的异常放电,并能对异常信号发生源精确定位,时间分辨率达ms级,空间分辨率达mm级。MEG通过监测不同功能区的诱发磁场,可以定位病灶,同时灵敏客观反映脑功能损伤情况。但其昂贵的价格、低普及率、对被检查者的配合要求都限制了MEG的应用。目前神经影像学技发展快,随着设备及软件的进一步开发,急性脑梗死诊治水平会有进一步的提高。

As a common type of cerebrovascular disease, acute cerebral infarction has higher incidence, mortality and morbidity.Earlier diagnosis and treatment is a key to prevent the development of diseases and improve prognosis.The author mainly focus on the different roles of CT, MRI and MEG in early stage of acute cerebral infarction.CT has high penetration and quick scanning speed and could accurately identify cerebral hemorrhage and infarction, while low precision limits its use in the early diagnosis of acute cerebral infarction.CT perfusion imaging has the advantage of establishing early diagnosis and infarction position.MRI sequence could separate different kinds of tissue edema, which enhances the applied value of diagnosis and installment of acute cerebral infarction.Normal sequences like T1, T2 and FLAIR can detect abnormal signal in several hours after disease onset, while DWI sequence can see signal enhancement after 5min.Latently, SWI sequence is able to find micro bleeding in the area of perfusion after ischemia, which is difficult to be detected by CT or MRI.MRS can exam different metabolisms to find different type cell damage, but it is unable to locate.MEG is used to monitor neurons′ abnormal discharge, which even more accurate than EEG.Somatosensory evokedmagnetic fields can help locate infarction area, showing function loss through brain damage at the same time.However, its high price and high degree of patient′s adaptability limit its applications.The further development of diagnosis and treatment in acute cerebral infarction will benefit from the progress of neuroimaging.

图6 T2WI序列左侧脑室旁急性梗死影像,左侧脑室旁呈现斑片状T2WI高信号
图9 SWI序列示左顶叶陈旧性出血性梗死灶影像,左顶叶呈现斑片状SWI高信号
图10 正常人SEFs图及脑梗死患者SEFs图,上图:正常人;下图:脑梗死患者,显示诱发波明显降低,杂波增多,ECD箭头(绿色)变小
图11 正常人AEFs图及脑梗死患者AEFs图,上图:正常人;下图:脑梗死患者,显示诱发波峰降低,波形不规整,ECD箭头(绿色)减小,双侧ECD位置对称性
[1]
陈文胜,叶海标,莫金灿. 多发梗死性痴呆CT检查的临床特点分析[J]. 中国医学创新, 2012, 9(27): 75-76.
[2]
孟超,张新卿,孙厚亮, 等. 血管性认知功能损害的临床进展[J]. 中国临床康复, 2004, 8(1): 127-129.
[3]
Fein G,Sclafani V,Tanabe J, et al. Hippocampal and cortical atrophy predict dementia in subcortical ischemic vascular disease[J]. Neurology, 2000, 55(11): 1626-1635.
[4]
宗秋. 再发脑出血的临床特征[J]. 中华老年心脑血管病杂志, 2006, 8(6): 419.
[5]
刘东,李传坤. 重型颅脑损伤术后并发脑梗死34例诊治体会[J]. 陕西医学杂志, 40(1): 57-59.
[6]
孟凡刚,吴承远,朱树干, 等. 11例大面积外伤性脑梗死的早期诊断与治疗[J]. 中国神经精神疾病杂志, 2004, 30(3): 231.
[7]
马青峰,贾建平,薛素芳, 等. 急性脑梗死患者血管异常与CT灌注成像及临床预后关系的研究[J]. 首都医科大学学报, 2010, 31(2): 149-153.
[8]
Oppenheim C,Samson Y,Manai R, et al. Prediction of malimant midge cerebral artery infarction by diffusion-weighted imaging[J]. Stroke, 2000, 3l(9): 2175-2181.
[9]
Thomalla G,Rossbach P,Rosenkranz M, et al. Negative fluid-attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less[J]. Ann Neurol, 2009, 65(6): 724-732.
[10]
Hoehn-Berlage M,Eis M,Back T, et al. Changes of relaxation times (T1, T2) and apparent diffusion coefficient after permanent middle cerebral artery occlusion in the rat: temporal evolution, regional extent, and comparison with histology[J]. Magn Reson Med, 1995, 34(6): 824-834.
[11]
Hajnal JV,Bryant DJ,Kasuboski L, et al. Use of fluid attenuated inversion recovery (FLAIR) pulse sequences in MRI of the brain[J]. J Comput Assist Tomogr, 1992, 16(6): 841-844.
[12]
Noguchi K,Ogawa T,Inugami A, et al. MRI of acute cerebral infarction:a comparison of FLAIR and T2-weighted fast spin-echo imaging[J]. Neuroradiology, 1997, 39(6): 406-410.
[13]
Moseley ME,Kucharczyk J,Mintorovitch J, et al.Diffusion-weighted MR imaging of acute stroke: correlation with T2 weighted and magnetic susceptibility-enhanced MR imaging in cats[J]. AJNR Am J Neuroradiol, 1990, 11(3): 423-429.
[14]
Gauvrit JY,Leclerc X,Pernodet M, et al. Value of MRI in the etiologic diagnosis of cerebral infarction[J]. J Radiol, 2005, 86(9): 1080-1089.
[15]
王子亮,李明泉,包元飞, 等. FLAIR序列在急性缺血性脑梗死中诊断价值的系统评价[J]. 中风与神经疾病杂志, 2013, 30(1): 45-48.
[16]
Beauchamp NJ Jr,Barker PB,Wang PY, et al. Imaging of Acute cerebral Ischemia[J]. Radiology, 1999, 212(2): 307-324.
[17]
Reith W,Hasegawa Y,Latour LL, et al. Multislice diffusion mapping for 3-D evolution of cerebral ischemia in a rat stroke model[J]. Neurology, 1995, 45(1): 172-177.
[18]
严建春,王晓川,金政军, 等. 磁共振扩散加权成像在急性脑梗死中的临床应用价值[J]. 实用放射学杂志, 2006, 22(12): 1438-1440.
[19]
戴国晨,靳令泾,杨振燕. DWI及FLAIR技术在不同时期脑梗死诊断中的应用[J]. 医学影像学杂志, 2004, 14(8): 609-611.
[20]
周根泉,张悦萍,王为珍, 等. 脑梗死后MR弥散加权成像上信号强度变化的随访观察[J]. 临床放射学杂志, 2002, 21(12): 929-932.
[21]
Rudin M,Baumann D,Ekatodramis D, et al. MRI analysis of the changes in apparent water diffusion coefficient, T(2) relaxation time, and cerebral blood flow and volume in the temporal evolution of cerebral infarction following permanent middle cerebral artery occlusion in rats[J]. Exp Neurol, 2001, 169(1): 56-63.
[22]
Burdette JH,Elster AD,Ricci PE.Acute cerebral infarction:quantification of spin-density and T2 "shine-through" phenomenon on diffussion-weighted MR images [J]. Radiology, 1999, 212(2): 333-339.
[23]
Haacke EM,Liang ZP. Challenges of imaging structure and function with MRI.[J]. IEEE Eng Med Biol Mag, 2000, 19(5): 55-62.
[24]
Abduljalil AM,Schmalbrock P,Novak V, et al. Enhanced gray and white matter contrast of phase susceptibility-weighted images in ultra-high-field magnetic resonance imaging[J]. J Magn Reson Imaging, 2003, 18(3): 284-290.
[25]
Reichenbach JR,Haacke EM.High-resolution BOLD venographic imaging:a window into brain function[J]. NMR Biomed, 2001, 14(7-8): 453-467.
[26]
Haacke EM,Xu Y,Cheng YC, et al. Susceptibility weighted imaging(SWI)[J]. Magn Reson Med, 2004, 52(3): 612-618.
[27]
刘亚欧,李坤成,杨延辉, 等. 磁敏感加权成像在颅内肿瘤成像的初步应用[J]. 医学影像学杂志, 2008, 18(1): 4-7.
[28]
Cha S,Knopp EA,Johnson G, et al.Intracranial mass lesions dynamic contrast enhanced susceptibility-weighted echo-planar perfusion MR imaging[J]. Radiology, 2002, 223(1): 11-29.
[29]
Cha S,Knopp EA,Johnson G, et a1.Intracranial mass lesions:dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging[J]. Radiology, 2002, 223(1): 11-29.
[30]
Boulanger JM,Coutts SB,Eliasziw M, et al.Cerebral microhemorrhages predict new disabling or fatal strokes in patients with acute ischemic stroke or transient ischemic attack [J]. Stroke, 2006, 37(3): 911-914.
[31]
杨昂,张雪林. 磁敏感加权成像相位图对脑内顺磁性物质与逆磁性物质的鉴别诊断[J]. 中华放射学杂志, 2009, 43(6): 590-594.
[32]
李元歌,罗泽斌,吴伟全. 磁共振磁敏感加权成像对颅内海绵状血管瘤的诊断[J]. 实用放射学杂志, 2012, 28(8): 1171-1174.
[33]
Reichenbach JR,Barth M,Haacke EM, et al. High-resolution MR venography at 3.0 Tesla[J]. J Comput Assist Tomogr, 2000, 24(6): 949-957.
[34]
Thomas BP,Welch EB,Niederhauser BD, et al.High resolution 7T MRI of the human hippocampus in vivo[J]. J Magn Reson Imaging, 2008, 28(5): 1266-1272.
[35]
周丽,李晨曦,解燕昭, 等.1HMRS成像在急性期脑梗死中的应用[J]. 脑与神经疾病杂志, 2013, 21(4): 278-280.
[36]
Federicl F,Simone IL,Lucivero V, et al. Prognostic value of proton magnetic resonance spectroscopy in ischemic stroke[J]. Arch Neurol, 1999, 55(4): 489-494.
[37]
Sager TN,Laursen H,Fink-Jensen A, et al. N-Acetylaspartate distribution in rat brain striatum during acute brain ischemia[J]. J Cereb Blood Flow Metab, 1999, 19(2): 164-172.
[38]
Demougeot C,Walker P,Beley A, et al. Spectroscopic data following stroke reveal tissue abnormality beyong the regin of T2-weighted hyperintensity[J]. J Neurol Sci, 2002, 199(1-2): 73-78.
[39]
Singhal AB,Ratai E,Benner T, et al.Magnetic resonance spectroscopy study of oxygen therapy in ischemic stroke[J]. Stroke, 2007, 38(10): 2851-2854.
[40]
Stromillo ML,Dotti MT,Battaglini M, et al.Structural and metabolic brain abnormalities in preclinical cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy[J]. J Neurol Neurosurg Psychiatry, 2009, 80(1): 41-47.
[41]
Gaetz W,Otsubo H,Pang EW.Magnetoencephalography for clinical pediatrics:the effect of head positioning on measurement of somatosensory-evoked fields[J]. Clin Neurophysiol, 2008, 119(8): 1923-1933.
[42]
Beisteiner R,Gartus A,Erdler M, et al. Magnetoencephalography indicates finger motor somatotopy [J]. Eur J Neurosci, 2004, 19(2): 465-472.
[43]
Lounasmaa OV,Hamalainen M,Hari R, et al. Information processing in the human brain: Magnetoencephalographic approach[J]. Proc Natl Acad Sci USA, 1996, 93(17): 8809-8815.
[44]
Lewine JD,Andrews R,Chey W, et al. Magnetoencephalographic patterns of epileptiform activity in children with regressive artism spectum disorders[J]. Pediatrics, 1999, 104(3): 405-418.
[45]
Wikstrom H,Roine RO,Salonen O, et al. Somatosensory evoked magnetic fields from the primary Somatosensory cortex(SI) in acute stroke[J]. Clin Neurohysiol, 1999, 110(5): 916-923.
[46]
吕佩源,孙占用,孙吉林, 等. 急性脑梗死患者初级体感皮质中枢脑磁图特征的研究[J]. 中华医学杂志, 2004, 84(4): 282-285.
[47]
吕佩源,孙占用,孙吉林, 等. 急性脑梗死听觉皮层中枢特征研究[J]. 中华神经科杂志, 2003, 36(4): 261-264.
[48]
吕佩源,赵磊,崔文柱, 等. 急性枕叶脑梗死患者视觉皮质中枢脑磁图变化特征[J]. 国际神经病学神经外科学杂志, 2008, 35(1): 1-5.
[49]
陈双庆,蔡庆,沈玉英, 等. 轻度认知功能损害患者扣带后回谷氨酸多体素氢质子磁共振波谱研究[J]. 中华诊断学电子杂志, 2013, 1(1): 31-34.
[1] 丁建民, 秦正义, 张翔, 周燕, 周洪雨, 王彦冬, 经翔. 超声造影与普美显磁共振成像对具有高危因素的≤3 cm肝结节进行LI-RADS分类诊断的前瞻性研究[J]. 中华医学超声杂志(电子版), 2023, 20(09): 930-938.
[2] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志(电子版), 2023, 20(08): 809-815.
[3] 张莲莲, 惠品晶, 丁亚芳. 颈部血管超声在粥样硬化斑块易损性评估中的应用价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 816-821.
[4] 刘冰茹, 刘皓希, 陈莹, 赖世伟, 陈蓉. 疑似乳腺癌的韧带样纤维瘤病一例[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 314-317.
[5] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[6] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[7] 雷漫诗, 邓锶锶, 汪昕蓉, 黄锦彬, 向青, 熊安妮, 孟占鳌. 人工智能辅助压缩感知技术在上腹部T2WI压脂序列中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 551-556.
[8] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[9] 吴钰娴, 冯亚园, 霍雷, 贾宁阳, 张娟. 原发性肝脏淋巴瘤的影像学诊断价值研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 349-353.
[10] 王志文, 郑雪梅, 张庆坤, 王海江. 自发性低颅压综合征75例临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(04): 398-401.
[11] 宁丽娜, 熊杰. 醒脑开窍针刺法结合舌部针刺治疗脑梗死后构音障碍的疗效观察[J]. 中华针灸电子杂志, 2023, 12(04): 146-150.
[12] 丁晶, 李培雯, 许迎春. 醒脑开窍针刺法在神经急重症中的应用[J]. 中华针灸电子杂志, 2023, 12(04): 161-164.
[13] 朱敏, 李法强. 血清GFAP、UCH-L1联合VILIP-1水平对急性脑梗死神经功能预后不良的预测研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 452-457.
[14] 李秦鹏, 王其涛, 朱媛媛, 周琦, 刘笑言, 许勇. 颈动脉彩色多普勒超声、颈部CT血管成像及脑部CT灌注成像在脑梗死并发颈动脉狭窄患者中的应用研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 482-488.
[15] 邱甜, 杨苗娟, 胡波, 郭毅, 何奕涛. 亚低温治疗脑梗死机制的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 518-521.
阅读次数
全文


摘要