三维动脉自旋标记技术在短暂性脑缺血发作中的应用

Application of three dimensional arterial spin labeling in transient ischemic attack

目的探讨三维动脉自旋标记（3D—ASL）技术在短暂性脑缺发作（TIA）中的应用价值。方法选择2014年8月～2015年9月于江苏省扬州市第一人民医院就诊的TIA患者27例．于末次发作24h内行头颅CT、常规磁共振序列、DWI、MRA及3D—ASL检查，其中5例行DSC—PWI检查者。所获得的灌注伪彩图由2名观察者独自观察，手工绘制感兴趣区（ROI）及镜像区，并定量分析相对脑血流量（rCBF）。结果头颅CT皆未显示异常。定性分析显示，27例TIA患者3D—ASL出现局灶性低灌注者23例（85．19％）；定量分析显示，ROIrCBF为（28．98±8．12）mL／（100g·min），镜像区rCBF为（40．58±9．15）mL／（100g·min），两者间差异有统计学意义（t=9．590，P〈0．05）。MRA阳性为14例（51．85％），3D-ASL皆为阳性（100．00％）；MRA阴性为13例，3D—ASL阳性为9例（69．23％）。DWI阳性为10例（37．04％），3D—ASL阳性为9例（90．00％）；DWI阴性为17例，3D—ASL阳性为14例（82．35％）。3例患者经治疗后复查局灶性低灌注见恢复。定性分析两种灌注成像技术检查结果显示，5例（100．00％）患者对低灌注的显示一致；定量分析显示，两种灌注成像技术的ROI与镜像区之间rCBF比值ASL为（0．52±0．17），DSC为（0．56±0．19），两者间差异无统计学意义（t=0．388，P〉0．05）。结论与传统的MRA及DWI阳性率相比，3D—ASL技术对TIA局灶性低灌注的显示更敏感，而且与DSC—PWI对低灌注的显示一致，对TIA患者的诊断、疗效评估及随访具有重要价值。

Objective To investigate the value of three dimensionalarterial spin labeling （3D-ASL） in the patients with transient ischemic attack （TIA）. Methods 27 cases of patients with TIA were selected from August 2014 to September 2015 in the First People＇s Hospital of Yangzhou City, who underwent CT, MRI, 3D-ASL, DWI and MRA within 24 hours of symptom onset, 5 in 27 cases underwent DSC-PWI. Two observers hand drawn ROI and the mirror image area alone and quantitative analyzed the rCBF. Results All head CT showed no abnormal results. Qualitative analysis showed that 27 patients with 3D-ASL were found focal hypoperfusion in 23 cases （85.19%）. Quantitative analysis showed that ROI rCBF was （28.98±8.12） mL/（lO0 g.min）, the mirror image area rCBF was （40.58±9.15） mL/（lO0 g .min）, which had statistically significant difference （t=9.590, P 〈 0.05）. 14 of 27 patients （51.85%） were MRA-positive and all of the 14 were 3D-ASL-positive （100.00%）; 13 patients were MRA-negative and 9 cases （69.23%） had 3D-ASL-posi- tive. 10 of 27 patients （37.04%） were DWI-positive and 9 cases were 3D-ASL-positive （90.00%）; 17 patients were DWI-negative and 14 cases （82.35%） had 3D-ASL-positive. 3 patients after treatment showed recovery of the focal hypoperfusion. Qualitative analysis showed that 5 cases （100.00%） of the two kinds of perfusion imaging technology were consistent with the low perfusion. Quantitative analysis showed that the rCBF ratio between the ROI and the mir- ror area of two kinds of perfusion imaging technology, ASL was （0.52±0.17）, DSC was （0.56±0.19）, and there was no significant difference between the two （t=0.388, P 〉 0.05）. Conclusion Compared with the MRA and DWI, 3D-ASL shows more sensitive of focal hypoperfusion in TIA, and has similar sensitivity with DSC-PWI. It has important value in diagnosis, curative effect evaluation and follow-up of patients with TIA.