| Part I Quantitative evaluation on the ischemic penumbra of the hyperacute cerebral infarction by diffusion weighted imaging,perfusion weighted imaging and MR spectroscopy[Abstract] Objective To explore the ischemic penumbra of the hyperacute cerebral infarction by diffusion weighted imaging (DWI),perfusion weighted imaging (PWI) and MR spectroscopy (MRS), trying to produce the quantitative evaluation standards. Methods MRI was performed in 13 patients with clinically diagnosed hyperacute cerebral infarction from 2h to 6h after symptom onset, including DWI, PWI and MRS. All the patients were followed up by T2WI image to determine the final infarct area within 2 to 28 days. Diffusion and perfusion and metabolic changes were measured in the infarct area, ischemic penumbra and control area. Results (1) The average value of apparent diffusion coefficient (ADC) in the infarct center was 7.01×10-4mm2/s and that of rADC was 0.63, as for the ischemic penumbra, the average value of ADC was 9.36×10-4mm2/s, and that of rADC was 0.87. The difference was significan(tP<0.05). (2) PWI demonstrated the regional cerebral blood reduction or absence in 11 patients. However, in two patients with lacunar cerebral infarction, PWI is normal. (3) MRS changes in hyperacute cerebral infarction included elevated Lac peak and decreased NAA peak. (4) If PWI>DWI, the area with slightly decreased ADC value(<22%), elevated Lac and slightly decreased NAA(<14%) might be the ischemic penumbra; while the area with obviously decreased ADC(25%-53%), elevated Lac and obviously decreased NAA (16%-34%)is irreversible infarct area. Conclusion DWI combined with PWI and MRS can diagnose the hyperacute cerebral infarction and evaluate the change of ischemic penumbra.Part II The clinical research on the intracerebral hemorrhage with micro-damage puncture by diffusion weighted imaging and magnetic resonance spectroscopyObjective To observe the changes of the intracerebral hemorrhage (ICH) patient with conservative therapy and micro-damage puncture by diffusion weighted imaging (DWI) and magnetic resonance spectroscopy (MRS), trying to explore the effect of brain edema and clinical value of the ICH patients with micro-damage puncture from the neuroimaging aspect. Methods Twenty patients with ICH were divided into two groups randomly. Micro-damage puncture group (micro-damage puncture group): ten patients accepted the stereo-orientation micro-damage puncture during 6 to 24 hours after symptom onset; control group: ten patients accepted the conservative therapy. All patients did the MRI and functional MRI including DWI and MRS in the 9 to 11 days after the symptom onset. Results The difference of the perihematomal apparent diffusion coefficient (ADC) value between the micro-damage puncture and the control group was significant (P<0.01), and the perihematomal ADC value of the control group was higher than the micro-damage puncture group (P<0.05). The result was analyzed by magnetic resonance spectroscopy. The difference of the perihematomal NAA/Cr value between the focus side and the contralateral corresponding side was significant in the control group(P<0.01), and the focus side decreased 12.6±7.4% as compared with the contralateral corresponding side, four could be seen the obvious Lac peak among all patients. There was no statistically significant difference in the perihematomal NAA/Cr value between the focus side and the contralateral corresponding side in the micro-damage puncture group (P>0.05), no patient showed the Lac peak. Conclusion The micro-damage puncture can clear the hematoma effectively and reduce the formation of brain edema significantly after ICH, the changes of DWI and MRS between the micro-damage puncture group and the control group proved the effect of the micro-damage puncture from the neuroimaging aspect. The neuroimaging not only provided the evidence of the morphostructure but also the objective index of the function.Part III Brain edema monitoring by non-invasive dynamic method in acute cerebral strokeObjective To monitor the change of brain edema dynamicly in acute cerebral stroke patients, trying to find out the effect of micro-damage puncture, and the guiding role of non-invasive dynamic brain edema monitor for the treatment. Methods 43 cases with acute cerebral stroke(all admission within 24 hours after symptom onset)were divided into four groups randomly. 31 cases with intracerebral hemorrhage (ICH group): 15 cases accepted the conservative therapy(conservation group), 16 cases accepted the micro-damage puncture(micro-damage puncture group); 12 cases with cerebral infarct in large areas (infarct group). The changes of comprehensive disturbance coefficient in all cases were detected by non-invasive dynamic brain edema monitor in the 1st, 3rd, 5th, 7th day. Results ICH group: the comprehensive disturbance coefficient in the focus side was lower than the unaffected side in both groups in the first day before operation. With time going on, in the conservation group, the comprehensive disturbance coefficient in the focus side became higher than the unaffected side, which reached its peak in the 3rd day and continued for more than 7days. However, in the micro-damage puncture group, the coefficient in the focus side was higher than the unaffected side in the 3rd day, and then became approximately equal to the unaffected side in the 5th day and basically normal in the 7th day. The comprehensive disturbance coefficient was significantly different in the 3rd, 5th, 7th day (P<0.01). Infarction group: the comprehensive disturbance coefficient in the focus side was higher than the unaffected side at the time of admission, which reached its peak in the 3rd day and continued for more than 7days. Conclusion The comprehensive disturbance coefficient showed the asymmetric changes in both ICH and cerebral infarction in large areas, and took on the dynamic change, which reflects the course of edema formation. The micro-damage puncture can clear the hematoma effectively and reduce the formation of brain edema significantly after ICH. Non-invasive dynamic brain edema monitoring can evaluate the course of brain edema, and play a guiding role to the detection of recurrent hemorrhage and treatment of the patients with acute cerebral stroke to some degree. |
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