3D动脉自旋标记灌注成像联合3D磁敏感加权血管成像在急性脑梗死诊治中的应用价值

The value of combined use of 3D arterial spin-labeled perfusion imaging and 3D susceptibility weighted angiography in acute cerebral infarction

目的回顾性分析急性脑梗死磁共振3D动脉自旋标记灌注成像(3D ASL)与3D磁敏感加权血管成像(SWAN)的影像表现,并进一步评价其对溶栓治疗的指导价值。方法采用3.0T MRI扫描仪,63例急性脑梗死患者行常规MRI序列、DWI、MRA、3D ASL及SWAN检查。两名神经影像诊断专家分别独自评价DWI、MRA、3D ASL、SWAN影像表现。结果 52例(82.5%)患者ASL-CBF表现为血流灌注减低,其中38例(73.1%)患者ASL低灌注范围明显大于DWI;16例(30.8%)ASL低灌注患者SWAN像检测到大脑中动脉血栓。11例(17.5%)患者ASL显示明显高灌注。12例(75.0%)ASL低灌注患者和4例(25.0%)ASL高灌注患者,SWAN像显示梗死区内和/或边缘存在出血性低信号。结论3D ASL联合SWAN成像既能评价急性脑梗死患者的脑血流灌注特点、责任动脉内血栓,还能够评价患者潜在出血风险,对急性脑梗死患者溶栓治疗具有重要的指导价值。

Objective To study retrospectively imaging features of 3D arterial spin labeling （ASL） perfusion imaging and 3D susceptibility weighted angiography （SWAN） of acute cerebral infarction （ACI） , and to investigate further the guiding value of combined use of 3D ASL and 3D SWAN in thrombolytic therapy. Methods Conventional MRI scan, DWI, MRA, 3D ASL and 3D SWAN were performed in 63 patients with ACI by using 3.0 T MR scanner. Two experienced neuroradiologists evaluated inde- pendently and separately imaging findings of DWI, MRA, 3D ASL and 3D SWAN of the ACI. Results ASL-CBF perfusi0n maps showed decreases of cerebral blood flow in 52/63 patients with ACI, the size of hypoperfusion on ASL was larger than high signal intensity on DWI in 38/52 patients. Thrombosis within middle cerebral artery was shown by SWAN in 16/52 patients with hy- poperfusion on ASL. Hyperperfusion was observed on ASL in 11/63 patients. Signs of hemorrhage within and/or around hypoper- fusion areas were detected by SWAN in 16/63 patients （ 12 patients with hypoperfusion and 4 patients with hyperperfusion in ASL- CBF）. Conclusion The combined use of 3 D ASL and SWAN can not only evaluate cerebral perfusion features and the thrombo- sis of the responsible arteries of the ACI, but also detect risk factors for potential bleeding, which has important clinical utility in guiding the thrombolytie therapy for ACI patients.