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目的比较觉醒后缺血性脑卒中和确认发病时间缺血性脑卒中MRI影像特点,明确弥散加权成像(diffusion-weighted imaging,DWI)和液体反转恢复序列(fluid attenuated inversion recovery,FLAIR)失匹配在确定觉醒后缺血性脑卒中患者发病时间的作用。方法选择急性缺血性脑卒中首次发现异常6h内完成头颅MRI检查200例,包括DWI和FLAIR,根据发病时间是否明确分为觉醒后缺血性脑卒中组(觉醒组)87例和确认发病时间缺血性脑卒中组(确认发病组)113例,收集患者一般情况及影像特征,比较2组DWI-FLAIR失匹配在不同时间段特点。结果觉醒组与确认发病组首次出现异常到MRI检查2h内DWI-FLAIR失匹配比较,无显著差异(50.0%vs 70.0%,P=0.181)。随着时间的增加,觉醒组DWI-FLAIR失匹配大幅度减少,确认发病组在出现异常到MRI检查时间4.0h内仍有较高的DWI-FLAIR失匹配存在。觉醒组DWI-FLAIR失匹配在首次出现异常到MRI检查2.1~3.0h、3.1~4.0h、4.1~5.0h明显低于确认发病组(13.6%vs 60.7%,9.5%vs 47.8%,5.9%vs45.0%),差异有统计学意义(P<0.05,P<0.01)。入院神经功能缺损评分和首次出现异常到MRI检查时间为2.1~3.0h、3.1~4.0h、4.1~5.0h、5.1~6.0h与MRI检查DWI-FLAIR失匹配密切相关,是DWI-FLAIR失匹配预测因素。结论首次出现异常到MRI检查2h的觉醒后缺血性脑卒中患者可能适合静脉溶栓治疗。
Objective To compare the MRI features of ischemic cerebral apoplexy after onset of awakening and confirm the onset of ischemic stroke, and to make clear the mismatch between diffusion-weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) In determining the onset of ischemic stroke patients after the onset of time. Methods The first MRI findings of acute ischemic stroke in 6h were completed within 200h, including 200 cases of DWI and FLAIR. According to whether the time of onset was clearly divided into 87 cases of ischemic stroke group (awakening group) after awakening and confirmed the onset time 113 cases of ischemic stroke group (confirmed disease group) were collected. The general situation and imaging features were collected. The DWI-FLAIR mismatch in two groups was compared in different time periods. Results There was no significant difference between the awakening group and the first onset of abnormality in DWI-FLAIR group (50.0% vs 70.0%, P = 0.181). With the increase of time, the DWI-FLAIR mismatch significantly decreased in the awakening group, confirming that there was still a high DWI-FLAIR mismatch in the incidence group within 4.0 hours after the MRI examination. The DWI-FLAIR mismatch in the awake group was significantly lower than that of the confirmed incidence group at 2.1 ~ 3.0h, 3.1 ~ 4.0h and 4.1 ~ 5.0h after the first abnormal MRI examination (13.6% vs 60.7%, 9.5% vs 47.8%, 5.9% vs45 .0%), the difference was statistically significant (P <0.05, P <0.01). Admission neurological deficit score and the first occurrence of abnormal MRI examination time to 2.1 ~ 3.0h, 3.1 ~ 4.0h, 4.1 ~ 5.0h, 5.1 ~ 6.0h and MRI DWI-FLAIR mismatch is closely related to DWI-FLAIR mismatch Predictors. Conclusions The first episode of an ischemic stroke may be suitable for intravenous thrombolysis after awakening 2h after MRI examination.