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目的探讨扩散加权成像(DWI)诊断中脑脚间区急性脑梗死的临床价值。方法对49例中脑脚间区急性脑梗死和51例健康受检者(中脑脚间区在DWI上呈高信号)的常规MRI及DWI资料进行回顾性分析。由两名神经放射学专家共同进行两次评价,第一次仅对DWI和表观扩散系数(ADC)图像进行评价,第二次对常规MRI、DWI和ADC图进行综合评价。计算并比较两次诊断中脑脚间区急性脑梗死的一致性(Kappa值)以及敏感性、特异性、准确性、阳性预测值和阴性预测值。结果与最终诊断结果比较,第一次和第二次评价的一致性分别为低度(K=0.363)和高度(K=0.940)。两次诊断中脑脚间区急性脑梗死的敏感性分别为79.6%和100%(P=0.001),特异性分别为56.9%和94.1%(P=0.000),准确性分别为68.0%和97.0%(P=0.000),阳性预测值分别为63.9%和94.2%(P=0.000),阴性预测值分别为74.4%和100%(P=0.001)。结论 DWI序列诊断中脑脚间区急性脑梗死需与正常扩散高信号鉴别,结合常规MRI可显著提高诊断中脑脚间区急性脑梗死的一致性、敏感性、特异性、准确性、阳性预测值和阴性预测值。
Objective To investigate the clinical value of diffusion-weighted imaging (DWI) in the diagnosis of acute cerebral infarction in the middle cerebral cortex. Methods The MRI and DWI data of 49 patients with acute cerebral infarction in the middle meridian area and 51 healthy subjects (high signal intensity in the midfoot area at DWI) were retrospectively analyzed. Two neuroradiologists performed two evaluations together. For the first time, only DWI and apparent diffusion coefficient (ADC) images were evaluated, and a second comprehensive evaluation of conventional MRI, DWI, and ADC maps was performed. The consistency (Kappa value) and sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated and compared between the two diagnosis of acute cerebral infarction. Results Compared with the final diagnosis, the agreement between the first and second evaluations was low (K = 0.363) and height (K = 0.940), respectively. The sensitivity of the two diagnoses for acute cerebral infarction in the midbrain was 79.6% and 100%, respectively (P = 0.001), with a specificity of 56.9% and 94.1%, respectively (P = 0.000) and accuracy of 68.0% and 97.0%, respectively % (P = 0.000). The positive predictive value was 63.9% and 94.2% respectively (P = 0.000), and the negative predictive value was 74.4% and 100% respectively (P = 0.001). Conclusion DWI sequence diagnosis of acute cerebral infarction need to be distinguished from normal diffusion high signal, combined with conventional MRI can significantly improve the diagnosis of acute cerebral infarction in the midbrain acute cerebral infarction consistency, sensitivity, specificity, accuracy, positive predictive value Value and negative predictive value.