基于磁共振动脉自旋标记技术指导的急性缺血性卒中静脉溶栓研究

Study on Magnetic Resonance Imaging-Arterial Spin Label-Guided Intravenous Thrombolysis in Acute Ischemic Stroke

目的：探讨磁共振成像（magnetic resonance imaging，MRI）动脉自旋标记技术（arterial spin label，ASL）指导缺血性卒中静脉溶栓治疗的有效性和安全性，探索新的、高效的指导急性缺血性卒中静脉溶栓的技术。方法入选发病至就诊时间大于3 h，在MRI-ASL指导下进行重组组织型纤溶酶原激活物（recombinant tissue plasminogen activator，rt-PA）静脉溶栓的急性缺血性卒中患者，同时选取在MRI灌注加权像（perfusion-weighted imaging，PWI）指导下进行rt-PA静脉溶栓的急性缺血性卒中患者为对照组。比较两组患者的基线资料、既往病史、入院至溶栓时间、影像学检查至溶栓时间、发病90 d的美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分、预后良好[改良Rankin量表（modified Rankin Scale，mRS）0～1分]率及出血转化发生率等。结果 ASL组和PWI组相比，基线数据无显著差异；出血转化率也无显著差异。ASL组影像学检查至溶栓时间短于PWI组[（65±15）min vs（73±11）min，P=0.031]。结论 ASL较PWI技术指导急性缺血性卒中静脉溶栓可以减少延误时间，其安全性和有效性无差异。

Objective To evaluate the effectiveness and safety of magnetic resonance imaging （MRI）-arterial spin label （ASL） guided intravenous thrombolysis in treatment of acute ischemic stroke （AIS）, and to explore a new efifcient method of evaluating the intravenous thrombolysis of AIS. Methods Patients with AIS who were treated with recombinant tissue plasminogen activator （rt-PA） guided by MRI-ASL after 3 hours of symptom onset were enrolled as study group, and patients who were treated with rt-PA guided by MRI-perfusion-weighted imaging （PWI） were chosen as control group. The baseline information, medical history, image to needle time （INT）, National Institutes of Health Stroke Scale （NIHSS） and modiifed Rankin＇s Score （mRS） within 90 d after treatment, the risk of hemorrhagic complications were assessed. Results There were neither signiifcant differences between two groups in the rate of hemorrhagic transformation, nor in the baseline. INT of ASL-group was significantly shorter than that of PWI-group [（65±15） minvs （73±11） min,P=0.031]. Conclusion Compared with MRI-PWI guided intravenous thrombolysis in treatment of AIS, MRI-ASL reduces time delay, and there was no signiifcant differences in the safety and effectiveness.