动脉自旋标记成像对轻中度急性脑梗死侧支代偿显示的临床应用价值

Clinical value of ASL in the treatment of mild to moderate acute cerebral infarction

目的 :探讨MRI动脉自旋标记(ASL)成像对轻中度急性脑梗死侧支代偿状态及近期预后的临床评估价值。方法 :收集经临床和影像学证实且未经溶栓治疗的35例急性期轻中度缺血性脑卒中患者,采用GE 3.0 T超导MRI扫描仪行常规和三维伪连续式标记(3D-PCASL)序列检查,根据脑血流量伪彩图提示梗死核心区周围是否出现匍匐走行、条状高灌注信号,将35例分为侧支代偿组和对照组,分别对其入院当日与30 d行美国国立卫生研究院卒中量表(NIHSS)评分并分析比较。结果:2组入院当日NIHSS评分差异无统计学意义(P>0.05),侧支代偿组入院当日及30 d临床NIHSS评分好转率、稳定率及进展率分别为76.47%(13/17)、17.65%(3/17)、5.88%(1/17);而对照组入院当日及30 d临床NIHSS评分好转率、稳定率及进展率分别为33.33%(6/18)、27.78%(5/18)、38.89%(7/18);2组近期预后NIHSS评分比较差异有统计学意义(P<0.05)。结论 :通过ASL显示梗死核心区周围血液灌注信息反映侧支循环代偿状态,可为临床评估急性期缺血性脑卒中患者病情现状、近期预后及治疗方案的选择提供依据。

Objective：To study the clinical value of magnetic resonance combined with arterial spin labeling in evaluation of collateral compensatory reserves,and the recent prognosis of patients with acute cerebral infarction. Methods：From December2014 to March 2016,35 cases diagnosed by clinical and radiological professors with acute ischemic stroke were collected in our hospital. Conventional sequences,3D-PCASL of superconducting MRI（GE 3.0） were performed. By applying post-processing software,the minimum density projection of pseudo color map of ASL were analyzed. We divided 35 cases without thrombolytic therapy into collateral compensation reserve group and the control group,and compared on the admission day with NIHSS score30 days after,according to perfusion of infarction core in ASL. Results：There was no statistical significance in two groups of patients on admission NIHSS score difference（P〉 0.05）. Collateral compensation reserve group admission and 30 clinical NIHSS score improvement rate,control rate and progression rate was 76.47%（13/17）,17.65%（3/17）,5.88%（1/17）,respectively;and the control group on the admissio n day and 30 day clinical NIHSS score improved rate,control rate and progression rate was33.33%（6/18）,27.78%（5/18）,38.89%（7/18）,respectively. The two groups were statistically significant prognostic different in NIHSS score（P〈 0.05）. Conclution：By displaying blood perfusion information around infarction core area,ASL can reflect collateral circulation state,provide the basis for clinical evaluation of the status,prognosis and treatment options for patients with acute ischemic stroke.