MR3D-ASL联合IVIM及高分辨MRA对于大面积缺血性脑梗死体积的评估作用

Evaluation of MR3D-ASL combined with IVIM and high-resolution MRA for large-area ischemic cerebral infarction

目的探究磁共振三维动脉自旋标记成像(MR3D-ASL)联合体素内不相干运动成像(IVIM)及高分辨MRA(HRMRA)对于大面积缺血性脑梗死(LAICI)体积的评估作用。方法选择2015年1月至2017年7月安徽省滁州市第一人民医院确诊的50例LAICI患者,通过MR3D-ASL联合IVIM及HRMRA分析患者的脑血流灌注参数变化,评价其应用价值。结果 MR3D-ASL+IVIM+HRMRI的诊断灵敏度、特异度分别为100%(25/25)、100%(25/25),均高于MR3D-ASL[88.00%(22/25)、84.00%(21/25)]及IVIM[72.00%(18/25)、64.00%(16/25)],差异有统计学意义(P<0.05);梗死区的MR3D-ASL表现为脑血流灌注降低,患侧/健侧相对脑血流量(CBF)下降,梗死区CBF较健侧明显降低,差异有统计学意义(P<0.05)。IVIM参数均有不同程度下降,梗死区表观扩散系数(ADC)、扩散系数(D)、假扩散指数(D*)及灌注分数(f)值均降低,以上参数(除D*)与健侧对比,差异均有统计学意义(P<0.05);计算梗死区与健侧比值,rADC、rD、rf、rD*分别与rCBF的相关性分析显示,除rD*,其余均呈正相关(r=0.425、0.382、0.341,P<0.05)。结论 MR3D-ASL联合IVIM及HRMRA诊断LAICI具有较高的灵敏度、特异度,能准确判断脑组织低灌注区。

Objective To explore the role of MR3D-ASL combined with IVIM and high resolution MRA(HRMRA)in the assessment of the volume of large-area ischemic cerebral infarction(LAICI).Methods A total of 50 LAICI patients diagnosed in the First People′s Hospital of Zhangzhou city from January 2015 to July 2017 were selected.The changes of cerebrovascular perfusion parameters were analyzed by MR3D-ASL combined with IVIM and HRMRA to evaluate its application value.Results The diagnostic sensitivity and specificity of MR3D-ASL+IVIM+HRMRI were 100.00%(25/25)and 100.00%(25/25),respectively,which were higher than MR3D-ASL[88.00%(22/25),84.00%(21/25)]and IVIM[72.00%(18/25),64.00%(16/25),the difference was statistically significant(P<0.05);MR3D-ASL in the infarct area showed a decrease in cerebrovascular perfusion,CBF decreased,CBF in the infarct area was significantly lower than that in the contralateral side,and the difference was statistically significant(P<0.05).The IVIM parameters decreased in different degrees,and the ADC,D,D*and f values in the infarct area decreased;except for D*,the parameters above in the infarct area were statistically significant when compared with contralateral side(P<0.05).Except for r D*,the correlation between r ADC,r D,r f and r CBF was statistically significant(P<0.05).Conclusion MR3D-ASL combined with IVIM and HRMRA has a high sensitivity and specificity in the diagnosis of large area ischemic cerebral infarction.It can accurately determine the low perfusion area of brain tissue.