The Study Of The Value Of ～1HMRS And DWI In Acute Cerebral Infarction

Objective: Acute ischemic cerebral infarction is 75 percents of all the cerebral vascular disease. At present the most available treatment is thrombolysis and organized stroke units. Early diagnosis could make the thrombolysis therapy be in time so as to decrease ischemic necrosis utmost; to evaluate the pathogenetic condition and prognosis perfectly could guide the clinician to choose therapeutic regimen rationally, thus to get best therapeutic effect. So how come to diagnosis early,prognosis rationally have become an important question to breakthrough in present medical research. Nowadays functional MRI has caused widespread attention, it made MRI possible to diagnose the cerebral infarction patient earlier,faster and precise, and also could provide imaging information for clinical treatment and prognosis judgement. The purpose of our research is to observe all the index of 1HMRS and DWI, which belong to FMRI, in acute cerebral infarction patients, and concentrate on the relationship between the changes of the index and the prognosis of the patience, thereby to evaluate the application value of 1HMRS and DWI in cerebral infarction.Methods: Forty-eight patients (mean age 66.9 years, range 45 to 79 years old) presenting within 7days of the onset were studied. All the patients in some degree have neurological impairment such as disorder in limbs,sensory function disturbance or aphasia et al, male 30, female 18. According to the visit time, hyper acute stage (<12h) n=24, acute stage (12~24h) n=16, subacute stage (24h~3d) n=8. Patients with primary cerebral hemorrhage as assessed by computed tomography (CT) or MRI were excluded from the study. Conventional MRI(anteroposterior axes T1WI T2WI, abscissa axis T1WI T2WI),MRA,DWI,MRS were performed on a Siemens Tim--avanto1.5T using a standard. Resonance peaks were assigned with Acetyl aspartic acid (NAA) at 2.01 ppm, choline (Cho) at 3.22 ppm, creatine at 3.94 ppm, and the Lactate at 1.33 ppm, and also got imaging information such as DWI and so on. All the patients'NIHSS score were evaluated when on admission and two months after the onset. Analysis the patients'general state of NIHSS score (admission), metabolism changes of MRS, infarction volume, outcome of DWI and T2WI, NIHSS score (prognosis). The statistics were made by SPSS 11.5, and the difference between measurement data were decided by compared t test, the difference between the numeration data were assessed byχ2 test, correlation analysis use spearman correlation.Results1 All the patients' NIHSS score was average 8.15±5.964 (rage 1 to 22) when on admission and was average 5.02±6.602 (rage 0 to 22) two months after the onset. 2 All of the 48 patients'lesion can be seen on DWI sequence, the positive rate of DWI in infarction detection was 100 percent. At the same time, only 39 patients were detected through T2WI and the positive rate was 81.25%. The other undetected 9 patients were all hyper acute infarction. Contrast these two rate with comparedχ2 test, DWI had higher positive rate in detecting infarction than traditional MRI (χ2=6.4 P<0.01).3 Changes of 1HMRS in cerebral infarction: (1)in the infarction area, increased Lactic acid peak could be seen in all the patience except two, the most early onset of the disease is 2.5 hours; in the opposite mirror imaging did not see the Lactic acid peak except in three patients. The Lactic acid elevated rapidly and lasted in acute and subacute stage, but the amplitude was slightly. (2)NAA in the center of the infarct area was lower than opposite mirror image, compared t test confirmed this with significance (P<0.01). NAA was started to decreased at the hyper acute stage and decreased obviously in acute stage; (3)Cr and Cho in the infarct side were lower and higher than mirror imaging area respectively, but with no statistical significance.4 Correlation analysis of metabolism changes in infarct center and NIHSS score, NIHSS prognosis: (1)Lac in infarct center had positive correlation with NIHSS (prognosis) and infarction volume (r=0.612 P=0.005, r=0.743 P=0.001), had no correlation with NIHSS (admission)( r=0.220 P=0.208) ; (2)NAA in the infarct center had negative correlation with NIHSS (admission), NIHSS (prognosis), infarct volume (r=?0.370 P=0.037,r=?0.354 P=0.047,r=?0.471 P=0.007);(3)the infarct volume had obvious positive correlation with the NIHSS (admission), NIHSS (prognosis) (r=0.389 P=0.028, r=0.422 P=0.016).Conclusion1 1HMRS could show sensitively the change of brain tissue metabolism in super-acute cerebral infarction, thereby,provide important imaging evidence for the early diagnosis of acute cerebral infarction.2 DWI is more sensible than conventional MRI in the diagnosis of super-early period cerebral infarction.3 ~1HMRS associated with DWI could provide the imaging evidence for clinician to evaluate the pathogenetic condition and prognosis general, accordingly to choose therapeutic regimen reasonable and elevate the cure rate utmost.