Comparation of MRI, multi-slice spiral CT and digital subtraction angiography in the clinical diagnosis of acute cerebral infarction
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摘要:
目的探讨MRI、多层螺旋CT（MSCT）与数字减影血管造影（DSA）在急性脑梗死临床诊断中的应用。 方法对本院2019年3月~2020年12月100例疑似急性脑梗死患者的临床资料进行回顾性分析，所有患者均接受MRI、MSCT及DSA检查，以DSA结果为金标准，分析MRI、MSCT诊断结果与DSA结果的一致性，计算MRI、MSCT诊断急性脑梗死的准确度、特异性、敏感度、阳性预测值、阴性预测值。 结果DSA诊断结果显示，100例疑似急性脑梗死患者中，急性脑梗死患者79例，非急性脑梗死患者21例；MRI诊断结果显示，急性脑梗死患者77例，非急性脑梗死患者23例，与DSA诊断结果一致性分析，Kappa值为0.637；MSCT诊断结果显示，急性脑梗死患者71例，非急性脑梗死患者29例，与DSA诊断结果一致性分析，Kappa值为0.524。MRI对急性脑梗死的诊断准确度、敏感度分别为92.00%、93.67%均高于MSCT的82.00%、83.54%（P < 0.05）。MRI对发病24 h内、发病72 h内检出率分别为89.29%、87.50%，高于MSCT的64.29%、70.83%（P < 0.05）。 结论MRI、MSCT对急性脑梗死的诊断结果与DSA具有较好的一致性，但MRI诊断优势更加明显，可为临床尽早拟定治疗方案提供参考。 Abstract:ObjectiveTo explore the comparative analysis of magnetic resonance imaging (MRI), multi-slice spiral CT (MSCT) and digital subtraction angiography (DSA) in the clinical diagnosis of acute cerebral infarction (ACI). MethodsThe clinical data of 100 patients with suspected ACI in the hospital from March 2019 to December 2020 were retrospectively analyzed. All patients underwent MRI, MSCT and DSA. Taking DSA results as the golden standard, consistency of diagnosis results between MRI, MSCT and DSA were analyzed. The accuracy, specificity and sensitivity of MRI and MSCT in the diagnosis of ACI were calculated. ResultsThe diagnosis results of DSA showed that among the 100 patients with suspected ACI, 79 cases with ACI and 21 cases without. The diagnosis results of MRI showed that 77 cases with ACI and 23 cases without. Consistency analysis between DSA and MRI showed that Kappa value was 0.637, indicating good consistency. The diagnosis results of MSCT showed that 71 cases with ACI and 29 cases without. Consistency analysis between DSA and MSCT showed that Kappa value was 0.524, indicating good consistency. The accuracy and sensitivity of MRI in the diagnosis of ACI were higher than those in control group (P < 0.05). The detection rates of onset within 24 h and 72 h by MRI were higher than those by MSCT(P < 0.05). ConclusionThe consistency of diagnosis results between MRI, MSCT and DSA is good for ACI. However, diagnosis advantages of MRI are more significant, which can provide reference for developing clinical treatment regimens as early as possible. -
图 1 急性脑梗死患者MRI及MSCT检查
A：MRI显示左侧颞枕叶见片状等长T1长T2异常信号影；B：MRI显示自由水抑制像呈高信号；C：DWI像左侧颞枕叶见大片状高信号；D：MSCT显示左侧颞枕叶见片状低密度影；E：MSCT显示边缘模糊.
Figure 1. MRI and MSCT examination for patients with acute cerebral infarction.
表 1 MRI、MSCT诊断结果与DSA诊断结果的一致性分析
Table 1. Comparison of diagnosis results between MRI, MSCT and DSA(n)
诊断方法 类型 DSA Kappa值 阳性 阴性 MRI 0.637 阳性 74 3 阴性 5 18 MSCT 0.524 阳性 66 5 阴性 13 16 MSCT: 多层螺旋CT; DSA: 数字减影血管造影. 
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表 2 MRI、MSCT对急性脑梗死的诊断效能
Table 2. Diagnostic efficiency of MRI and MSCT for acute cerebral infarction(%)
诊断方法 准确度 敏感度 特异性 阳性预测值 阴性预测值 MRI 92.00(92/100) 93.67(74/79) 85.71(18/21) 96.10(74/77) 78.26(18/23) MSCT 82.00(82/100) 83.54(66/79) 76.19(16/21) 92.96(66/71) 55.17(16/29) χ2 4.421 4.013 0.618 0.715 3.021 P 0.036 0.045 0.432 0.398 0.082
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表 3 MRI、MSCT对不同发病时间的诊断情况比较
Table 3. Comparison of diagnostic conditions between MRI and MSCT at different onset time[n(%)]
诊断方法 发病时间 24 h内(n=28) 72 h内(n=48) 3~5 d(n=19) >5 d(n=5) MRI 25(89.29) 42(87.50) 5(26.32) 2(40.00) MSCT 18(64.29) 34(70.83) 10(52.63) 4(80.00) χ2 4.139 4.042 2.754 1.667 P 0.042 0.044 0.097 0.197
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