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目的探讨表观弥散系数(apparent diffusion coefficient,ADC)对确定急性缺血性卒中缺血半暗带的潜在价值。方法选择发病9h内完成多模式磁共振成像(magnetic resonance imaging,MRI)检查的前循环急性缺血性卒中患者49例。应用自制软件进行灌注加权像(perfusion-weighted imaging,PWI)和弥散加权像(diffusion-weighted imaging,DWI)异常区域的体积测量。缺血半暗带以PWI/DWI错配表示。同时采用全自动图像分析系统,以DWI图像计算得到的ADC图作为输入数据,来判断缺血半暗带的存在(以下简称为ADC方法),然后比较这两种方法在判断缺血半暗带方面的差异。结果入选的49例患者中,存在PWI/DWI错配者为43例,符合ADC方法判断缺血半暗带标准者有41例。这两种方法在判断是否存在缺血半暗带的结果中有41例相符,对判断缺血半暗带的差异无统计学意义(P>0.05)。ADC方法判断缺血半暗带的敏感度为88.4%、特异度为50.0%。结论由于不需做PWI检查,ADC方法对确定缺血半暗带具有潜在的临床实用价值,有可能成为一种简便易行的确定缺血半暗带的方法。
Objective To investigate the potential value of apparent diffusion coefficient (ADC) in determining the ischemic penumbra in acute ischemic stroke. Methods Forty-nine patients with anterior circulation acute ischemic stroke who completed multi-modal magnetic resonance imaging (MRI) within 9 hours after onset of disease were selected. Home-made software was used for volumetric measurements of abnormal areas of perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI). Ischemic penumbra with PWI / DWI mismatch. At the same time using automatic image analysis system to calculate the DWI image ADC map as input data to determine the presence of ischemic penumbra (hereinafter referred to as ADC method), and then compare these two methods in the judgment of ischemic penumbra The difference. Results Among the 49 selected patients, there were 43 cases with PWI / DWI mismatch, and 41 cases were qualified according to the ADC method. The two methods in determining the presence or absence of ischemic penumbra in 41 cases consistent with the judgment of the ischemic penumbra was no significant difference (P> 0.05). ADC method to determine the sensitivity of ischemic penumbra was 88.4%, specificity was 50.0%. Conclusion Because PWI examination is not required, the ADC method has potential clinical value in determining ischemic penumbra and may become a simple and easy method to determine ischemic penumbra.