亞急性腦中風的灌流影像及擴散影像的臨床意義和預後

Abstract

背景﹕在台灣地區，每年會發生近2 萬例的腦血管 疾病，並高居十大死亡原因的第二位。其中腦缺血 占其中的60%~75%。並有逐年增加的趨勢。部份病 患會在急性期死亡外，大部份均會慢慢變成亞急性 或慢性。灌流影像及擴散影像近年來一均被認為乃 診斷超急性及急性腦中風的最新及最準確工具，但 有關亞急性病患及臨床意義未見有研究。 方法﹕使用臨床病患分別使用超音波或磁振血管 攝影了解其大血管阻塞情形。並合併同時作H-MRS 灌流影像及擴散影像。然後依其結果作分析，可知 不同病患之灌流影像及擴散影像有不同的模式及 圖形，由此推算病患的預後及可能的變化。 本計劃分為三年﹕ １、第一年﹕收集亞急性腦中風病患約五十名、 並在彼等的檢查結果分別作出基本圖形分 析。 ２、第二年﹕再收集亞急性腦中風病患病患一百 名、並加上述五十名結果成立一小資料庫。 開始分析第一年的五十名的預後。 ３、第三年﹕全面分析前面共一百五十名病患的 結果，並統計彼等間的相關關係。 第二年計劃己在89 年度獲得通過。此乃第二年結 果。

Background: More than 20,000 new cases of cerebrovascular diseases occurred annually in Taiwan area. It becomes the second most common cause of death in this country. Among them, 60% to 75% were ischemic stroke with a trend increasing every year. Except for those cases will die in acute stage, all of the rest become subacute or chronic stage. In recent, diffusion and perfusion imagings are considered as latest and the most accurate tool for the diagnosis of hyper-acute and acute ischemic cerebral diseases. However, their clinical role in the subacute and chronic stage is not studied yet. Method: With Doppler and MRA, we can study the status of the steno-occlusive change of the major cerebral vessels. In the same time, we can perform the H-MRS perfusion and diffusion imaging in them. With analysis of the data, we may categorize the patients into different group according their different combination of the patterns of perfusion and diffusion imagings. From this we can evaluate and predict the prognosis of each patient. This plan can be divided into 3 year: 1. We can collect about 50 cases with subacute infarct, basic analysis according to their perfusion and diffusion imaging can be performed in the 1st year. 2. In the 2nd year, we have to collect 100 more cases and make a data bank, and analysis the prognosis of the first 50 cases. 3. In the 3rd year, we have to analysis the perfusion and diffusion imagings, clinical, and outcome in the 150 patients, and calculate their statistic relationship.