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目的:单体素氢质子磁共振波谱与扩散加权成像的指数表观弥散系数相结合分析急性脑梗死的脑内主要代谢物变化特点。方法:47例临床诊断为急性脑梗死的患者(发病6h后至48h内),以指数表观弥散系数(eADC)升高区及对侧分别为感兴趣区测定1H MRS,观察脑梗死病灶内化合物含量,进一步分析急性脑梗死的主要代谢物变化特点。结果:27例急性腔隙性脑梗死患者中eADC值明显升高区氮—乙酰天冬氨酸(NAA)降低,eADC值升高在50%以上的病例中乳酸检出率增高,且有显著性差异;20例急性非腔隙性脑梗死患者中eADC值明显升高区氮-乙酰天冬氨酸(NAA)降低,eADC值升高在50%以上的病例中乳酸检出率明显增高,没有显著性差异。结论:在脑梗死中联合应用1H MRS与DWI的eADC值能无创性的评价脑梗死局部代谢和形态的动态演变过程,eADC值升高,Lac升高,NAA下降是反映缺血的敏感指标;当eADC值升高超过50%时,1H MRS所能测到Lac敏感性提高,为临床诊断治疗提供依据。
OBJECTIVE: To analyze the changes of brain major metabolites in acute cerebral infarction by combining the exponential apparent diffusion coefficients of proton magnetic resonance spectroscopy and diffusion weighted imaging. Methods: Forty-seven patients with acute cerebral infarction (within 6 hours and 48 hours after onset of disease) were enrolled in this study. 1H MRS were measured in the areas of interest in the exponential apparent diffusion coefficient (eADC) Compound content, further analysis of the characteristics of the main metabolites of acute cerebral infarction. Results: NAA decreased in 27 patients with acute lacunar infarction. The detection rate of lactic acid in patients with eADC increased more than 50% There was a significant difference between the two groups in the incidence of eADC (eADC value) in 20 patients with acute non-lacunar infarction. The detection rate of lactic acid in patients with eADC value above 50% No significant difference. Conclusions: The eADC values of 1H MRS and DWI in noninvasive evaluation of the dynamic changes of local metabolism and morphology of cerebral infarction in patients with cerebral infarction show that eADC, Lac and NAA are sensitive indicators of ischemic stroke. When the eADC value increased more than 50%, 1H MRS can be measured Lac sensitivity increased, providing the basis for clinical diagnosis and treatment.