三维动脉自旋标记评价静脉溶栓治疗急性脑梗死疗效的价值

The Value of Three-Dimensional Arterial Spin Labeling in Assessing the Effectiveness of Intravenous Thrombolysis of Acute Stroke

目的探讨三维动脉自旋标记(3D-ASL)评价静脉溶栓治疗急性脑梗死疗效的价值。方法回顾性分析急性脑梗死静脉溶栓治疗的32例患者资料,治疗前、治疗7天后均行扩散加权成像(DWI)及3D-ASL检查,测量病灶在DWI序列呈高信号区域的相对脑血流量(r CBF),并用美国国立卫生研究院卒中量表(NIHSS)评分评估疗效,采用配对t检验比较治疗前后DWI高信号灶内的r CBF的差异,用方差分析ASL/DWI不同匹配组治疗前后NIHSS评分的差异,采用Spearman等级相关分析ASL/DWI不同匹配(ASL>DWI、ASL=DWI、ASL<DWI)与静脉溶栓效果的关系。结果 ASL>DWI组19例、ASL=DWI组10例、ASL<DWI组3例。ASL/DWI不同匹配的急性脑梗死在DWI高信号灶内的r CBF较静脉溶栓前均升高,差异有统计学意义(t=5.091,P<0.05)。ASL>DWI、ASL=DWI组治疗后NIHSS评分比治疗前降低,差异有统计学意义(t=10.363,P<0.001;t=8.392,P<0.001),而ASL<DWI组治疗前后NIHSS评分的差异无统计学意义(t=1.001,P=0.423)。Spearman等级相关分析显示,ASL/DWI不同匹配与静脉溶栓效果呈正相关(r=0.798,P<0.001)。结论 3D-ASL对评价急性脑梗死的静脉溶栓疗效有重要的价值。

Objective To explore the value of three-dimensional arterial spin labeling（3D-ASL） in assessing the effec- tiveness of intravenous thrombolysis of acute stroke. Methods Thirty-two patients with acute stroke were treated by intra- venous thrombolysis. In all patients, diffusion weighted imaging（DWI） and 3D-ASL were performed prior to and on the 7th day after intravenous thrombolysis. The value of relative cerebral blood flow（rCBF） in the hyperintense signal on DWI sequence was measured. The curative effect was evaluated with the score of National Institutes of Health Stroke Scale （ NIH- SS）. The paired t-test was performed to compare the values of rCBF in the hyperintense signal on DWI sequence between prior-treatment and post-treatment. One-way ANOVA was performed to evaluate the statistical difference of the score of NIH- SS among ASL 〉 DWI group, ASL = DWI group and ASL 〈 DWI group before treatment and after treatment. Spearman rank correlation analysis was used to analyze the relationship between different matching of ASL/DWI （ ASL 〉 DWI, ASL = DWI, ASL 〈 DWI, ） and curative effects of intravenous thrombolysis （ basic recovery,marked progress,progress,unchanged,deterioration）. Results There were 19 cases with ASL 〉 DWI, 10 cases with ASL = DWI,3 cases with ASL 〈 DWI. The value of rCBF in the hyperintense signal on DWI sequence of treated patients was significantly higher than prior treatment （ t = 5. 091 ,P 〈0.05）. The NIHSS scores of ASL 〉 DWI and ASL = DWI group after treatment were significantly lower than be- fore treatment （ t = 10. 363, P 〈 0. 001 ; t = 8. 392, P 〈 0.001 ）, while there was no signifieant differenee in ASL 〈 DWI group between pre-treatment and post-treatment （ t = 1.001, P = 0. 423 ）. Spearman rank correlation analysis showed that the different matehing of ASL/DWI were positively correlated with the curative effects of intravenous thrombolysis （ r = 0. 798, P 〈 0. 001 ）. Conclusion The three-dimensional arterial spin labeling has important value for assessing the effectiveness of intravenous thrombolysis in acute stroke.