| 邰兆琴,黄清玲,朱万荣,徐小虎,许亚春,吴鹤林.三维ASL联合DWI评估急性脑梗死患者缺血性半暗带及预后[J].中国医学影像技术,2020,36(9):1292~1296 |
| 三维ASL联合DWI评估急性脑梗死患者缺血性半暗带及预后 |
| Evaluation on ischemic penumbra and prognosis of acute cerebral infarction patients with combination of three-dimensional ASL and DWI |
| 投稿时间：2019-08-23 修订日期：2020-03-02 |
| DOI：10.13929/j.issn.1003-3289.2020.09.004 |
| 中文关键词: 脑梗死 预后 磁共振成像 缺血性半暗带 |
| 英文关键词:brain infarction prognosis magnetic resonance imaging ischemic penumbra |
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| 中文摘要: |
| 目的 观察三维动脉自旋标记（ASL）成像联合弥散加权成像（DWI）评估急性脑梗死（ACI）缺血性半暗带（IP）及预后的价值。方法 回顾性分析45例ACI患者的颅脑ASL图像及DWI，根据随访3个月末改良Rankin量表（mRS）评分结果，将患者分为预后好、中等和差组。测量病灶最大层面DWI高信号面积（SDWI）和ASL异常灌注面积（SASL），评估患者是否存在IP；记录梗死病灶（IL）、近病灶边缘脑组织（BNL）及相应对侧区域脑血流量（CBF）和表观弥散系数（ADC）值，计算患侧/对侧相对值（rCBF和rADC）。比较不同预后组内IL与对侧CBF、ADC值差异及各组间rCBF及rADC差异，分析IL及BNL的rCBF对于ACI预后差的单独诊断效能和联合诊断效能，观察rCBF、rADC与mRS评分的相关性。结果 45例ACI中，40例IL区表现为低灌注，将其纳入研究；其中23例存在IP，与不存在IP患者预后差异有统计学意义（χ2=6.742，P=0.034）。不同预后组内IL的CBF和ADC值、预后好组及中等组BNL的CBF值均低于对侧（P均<0.05）。预后差组IL的rCBF与预后好组及预后中等组差异均有统计学意义（P均<0.05），而不同预后组间BNL的rCBF差异无统计学意义（F=3.20，P=0.05）。IL和BNL的rCBF评估ACI预后差的AUC分别为0.92和0.79，最佳界值分别为0.41和0.93，约登指数分别为0.72和0.57；两者联合AUC为0.94，约登指数为0.79。IL的rCBF与mRS评分呈负相关（r=-0.642，P<0.001）。结论 三维ASL联合DWI可用于评估ACI患者IP及预后，为制定ACI治疗方案提供参考。 |
| 英文摘要: |
| Objective To explore the value of three-dimensional arterial spin labeling (ASL) combined with diffusion weighted imaging (DWI) in evaluation on ischemic penumbra (IP) and prognosis of patients with acute cerebral infarction (ACI). Methods Data of 45 ACI patients were retrospectively analyzed. Brain ASL images and DWI of all patients were collected. According to the improved Rankin scale (mRS) score at the end of the third month of follow-up, the patients were divided into good prognosis group, medium prognosis group and poor prognosis group. The presence of IP was assessed according to the measured maximum DWI high signal area (SDWI) and ASL abnormal perfusion area (SASL). The values of cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) of the infarct lesion (IL), brain tissue near the edge of the lesions (BNL) and the corresponding contra area were recorded, and the relative values (rCBF and rADC) of lesion side/contra were calculated. CBF and ADC values of IL of BNL and contra area in different prognostic groups were compared, as well as of rCBF and rADC in different prognostic groups. The diagnostic efficacy of rCBF of IL and BNL for evaluating poor prognosis of ACI patients were analyzed, respectively, so as the combined diagnostic efficacy. The correlation between rCBF or rADC and mRS score were analyzed. Results Totally 40 ACI patients showed hypoperfusion in the IL areas, and IP was present in 23 of them. The difference of prognosis between patients with IP and those without IP was statistically significant (χ2=6.742, P=0.034). CBF and ADC values of IL of 3 groups, the CBF values of BNL in good and medium prognosis groups were lower than those in contra area (all P<0.05). There were statistical differences of rCBF of IL between poor prognosis group and good or medium prognosis group (both P<0.05), while no statistical difference of rCBF of BNL in 3 groups was found (F=3.20, P=0.05). AUC of rCBF of IL or BNL assessing poor prognosis of ACI was 0.92 and 0.79, the optimal cutoff values was 0.41 and 0.93, and the Youden indexs was 0.72 and 0.57, respectively. AUC of combined diagnosis was 0.94, and Youden index was 0.79. The rCBF of IL was negatively correlated with mRS score (r=-0.642, P<0.001). Conclusion Three-dimensional ASL combined with DWI could be used to evaluate IP and prognosis of ACI patients, providing references for the formulation of ACI treatment plan. |
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