动脉自旋标记磁共振灌注技术预测大动脉粥样硬化性脑卒中进展性的研究

Value of arterial spin labeling using magnetic resonance perfusion in predicting progression of large atherosclerotic AIS

目的探讨动脉自旋标记(ASL) MRI在预测动脉粥样硬化性脑卒中患者病情进展的价值.方法选择急性缺血性脑卒中患者93例,根据入院后72h内美国国立卫生研究院卒中量表(NIHSS)评分变化,分为进展组44例和非进展组49例.患者发病48h内行包括磁共振血管成像(MRA)和ASL序列的MRI检查,ASL图像上获得脑血流量(CBF)值,计算相对脑血流(rCBF)等.用NIHSS评分对脑卒中严重程度进行评估,采用多因素logistic回归分析影响脑卒中患者进展的临床因素和影像指标.结果进展组病灶侧CBF和rCBF显著低于非进展组[(31.83±10.26)ml/(100 g·min) vs (48.78±22.11)ml/(100 g·min),P<0.01;0.76±0.39 vs 1.21±0.52,P<0.01],入院NIHSS评分显著高于非进展组[(7.52±3.62)分vs (5.65±3.06)分,P<0.01],颅内血管狭窄比例显著高于非进展组(70.5% vs 22.4%,P<0.01).多因素logistic回归分析显示,rCBF(OR=4.035,95%CI:1.868~10.425,P=0.001)、颅内血管狭窄(OR=0.233,95%CI:0.069~0.739,P=0.015)、入院NIHSS评分(OR =0.765,95%CI:0.591~0.953,P=0.026)与脑卒中进展有关.结论大动脉粥样硬化性缺血性脑卒中急性期ASL检测出低灌注、MRA发现有血管狭窄、入院NIHSS评分>7分的患者更容易出现病情进展.

Objective To study value of arterial spin labeling(ASL)using magnetic resonance perfusion in predicting the progression of acute ischemic stroke(AIS).Methods Ninety-three AIS patients were divided into progressive AIS group(n=44)and non-progressive AIS group(n=49) according to their NIHSS score.They underwent MRA and ASL for the measurement of their CBF and rCBF.The severity of AIS in two groups was assessed according to the NIHSS score. The risk factors and imaging data influencing the progression of AIS were analyzed by multivariate logistic regression analysis.Results The CBF and rCBF were significantly lower while the NIHSS score on admission and the incidence of intracranial arteriostenosis were significantly higher in progressive AIS group than in non-progressive AIS group[31.83±10.26 ml/(100 g· min) vs 48.78±22.11 ml/(100 g·min),P <0.01;0.76±0.39 vs 1.21±0.52,P <0.01;7.52± 3.62 vs 5.65±3.06,P <0.01;70.5% vs 22.4%,P <0.01].Multivariate logistic regression analysis showed that rCBF, intracranial arteriostenosis and NIHSS score on admission were the risk factors for the progression of AIS(OR=4.035,OR =0.233,OR =0.765).Conclusion The incidence of large atherosclerotic AIS detected by ASL is lower than that detected by magnetic resonance perfusion,MRA can show the intracranial arteriostenosis,and NIHSS score >7 on admission is a risk factor for the progression of AIS.