| Chapter 1 The application value of DTI and MTI combined with AB-CD2 score in transient ischemic attack(TIA).Objective: To investigate the application value of each index combined with ABCD2 score after the imaging of diffusion tensor imaging(DTI) and magnetization transfer imaging(MTI) were analysised in TIA patients,Methods: The clinical data of 80 cases first episode patients with TIA(diagnostic criteria based on the new define of US in 2009) were collected in December 2013 ~ December 2015 in Hainan Provincial People's Hospital. The TIA patients were classified as low risk, medium risk and high risk groups according to ABCD2 score. We used Siemens 3.0 T superconductive MRI machine to examine the routine sequences, DTI and MTI,which to be followed up in onset after seven and 12 days. The 80 cases by age, sex matched normal controls underwent the same examination.Mean diffusivity(MD), fractional anisotropy(FA), eigen1(E1), eigen2-eigen3(E2-E3) and magnetization transfer ratio(MTR) were measured based on region of interest(ROI), and calculate the relative value. The diagnostic efficiency of each parameter were analyzed.Results:(1) There was 35 cases DWI positive, 45 cases negative in TIA patients, the total positive rate was 43.8%. The infarction of 7 days after the onset was 8.8%, and which of 12 days was 16.3%. The infarction of 7 days, 12 days after the onset of medium risk group(2.5%,7.5%)was lower than high risk group(6.3%,8.8%).(2) The average value of MD, FA, E1, E2-E3 and MTR were lower in affected side compared those of healthy side in DWI positive patients(P<0.05).(3) The MTR of TIA patients was lower compared to healthy volunteers(P<0.05), as well as the bilateral in DWI negative patients. The average value of r MD, r E1, r E2-E3, r MTR were lower(P<0.05) in DWI positive compared to the negative patients. The r MD, r E1, r E2-E3, r MTR of TIA patients was lower compared to the healthy volunteers(P<0.05).(4)The ROC curve showed the area under the curve(AUC) of r E2-E3 was 0.838, and the r MTR was 0.762. The sensitivity of r E2-E3 combined with r MTR to diagnostic TIA was 79.7%, and the specificity was 85.6%.Conclusion :(1)The r E2-E3 and r MTR have good sensitivity and specificity, and which provide evidence-based medicine basis to TIA and ABCD2 score.(2) The r E2-E3 combined r MTR can improve the specificity of diagnosis of TIA, and combined with ABCD2 score have a higher application value in TIA. Chapter 2 The application value of ~1H-MRS and MTI combined withABCD2 score in transient ischemic attackObjective: To investigate the application value of ~1H-magnetic resonance spectroscopy(~1H-MRS) and magnetization transfer imagingin(MTI) combined with ABCD2 score in TIA.Methods: The clinical data of 35 cases first episode DWI negative internal carotid artery TIA patients(diagnostic criteria based on the new define of US in 2009) were collected in December 2013 ~ December 2015 in Hainan Provincial People's Hospital. We used Siemens 3.0 T superconductive MRI machine to examine the routine sequences, ~1H-MRS and MTI. The 35 cases by age, sex matched normal controls underwent the same examination. The N-Acetylaspartate(NAA), Choline(Cho), Creatine(Cr), NAA/Cr, NAA/Cho, Cho/Cr and MTR were measured based on ROI of centrum semiovale of Symptoms and asymptomatic hemisphere, and calculate the relative value. The diagnostic efficiency of each parameter were also analyzed.Results:(1)The infarction of 7 days, 12 days after the onset of medium risk group(5.7%,5.7%)was lower than high risk group(8.6%,11.4%).(2) The average value of Cho in Centrum semiovale of the symptoms was higher(12.25±0.93) mmol/L that those of the homologous area in asymptomatic hemisphere(9.00±1.38) mmol/L.The NAA/Cho and MTR were lower(P < 0.05) in Centrum semiovale of the symptomatic hemisphere((1.76±0.49) mmol/L,(19.11±3.13)%)that those of the homologous area in asymptomatic hemisphere((2.25±0.88) mmol/L,(21.27±4.41)%) in TIA patients.(3) The average value of r Cho in Centrum semiovale of the symptomatic hemisphere was higher(1.40±0.25) that those of the homologous area in asymptomatic hemisphere(1.20±0.11).The NAA/Cho and r MTR were lower(P<0.05) in TIA patients((1.76±0.49),(0.89±0.07)) that those of the healthy volunteers((2.17±0.89),(1.00±0.05)).(4) The ROC curve showed the AUC of NAA/Cho was 0.740, and the r MTR was 0.876. The sensitivity of NAA/Cho combined with r MTR to diagnostic TIA was 65.2%, and the specificity was 88.0.0%.Conclusion :(1)The NAA/Cho and r MTR can early corresponding pathological changes in brain tissue in internal carotid artery TIA patients, and which provide evidence-based medicine basis to TIA and ABCD2 score.(2) The NAA/Cho combined r MTR can improve the specificity of diagnosis of internal carotid artery TIA, and combined with ABCD2 score have a higher application value in TIA. |
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