联合3D-ASL和DWI评价静脉溶栓治疗早期急性脑梗死疗效的价值

Value of combined 3D-ASL and DWI in evaluating the efficacy of intravenous thrombolysis in treatment of early acute cerebral infarction

目的探讨联合三维动脉自旋标记(3D-ASL)和弥散加权成像(DWI)评价静脉溶栓治疗早期急性脑梗死疗效的价值。方法选取2017年9月~2019年3月在我院溶栓治疗的急性脑梗死患者36例(发病4.5 h内),所有患者均于溶栓前及溶栓7 d后进行美国国立卫生研究院卒中量表(NIHSS)评估及磁共振DWI和3D-ASL检查,测量溶栓治疗前后DWI高信号区脑血流量(CBF)值和表观弥散系数(ADC)值。根据3D-ASL/DWI匹配情况进行分组,对各组治疗前后数据进行配对t检验。结果根据3D-ASL/DWI匹配情况分为三组:(1)3D-ASL>DWI组(16例):患者溶栓治疗前后ADC值、CBF值及NIHSS评分比较,差异均有统计学意义(P<0.01),总有效率为100.0%;(2)3D-ASL=DWI组(15例):患者溶栓治疗前后ADC值、CBF值及NIHSS评分比较,差异均有统计学意义(P<0.01),总有效率为86.7%;(3)3D-ASL<DWI组(5例):患者溶栓治疗前后ADC值、CBF值及NIHSS评分比较,差异均无统计学意义(P>0.05),总有效率为0.0%;对36例患者疗效与所在不同组别进行Spearman相关性分析,结果表明3D-ASL/DWI不同匹配与静脉溶栓疗效显著相关(P<0.01)。结论多模态磁共振成像下,获取3DASL/DWI不同匹配组溶栓治疗前后数据的变化,证明潜在半暗带的存在有利于患者预后,对临床溶栓治疗和预后评估具有客观的指导作用。

Objective To explore the value of combined three-dimensional arterial spin labeling(3 D-ASL) and diffusion weighted imaging(DWI) in evaluating the efficacy of intravenous thrombolysis in treatment of early acute cerebral infarction. Methods Thirty-six patients with acute cerebral infarction treated with thrombolysis in our hospital from September 2017 to March 2019 were selected(within 4.5 h hours after the onset). All the patients were evaluated with National Institutes of Health Stroke Scale(NIHSS) and given MR DWI and 3 D-ASL before and 7 days after thrombolytic therapy. The cerebral blood flow(CBF) values in hyperintense region on DWI and apparent diffusion coefficient(ADC)values before and after thrombolytic therapy were measured. The patients were divided into groups according to the3 D-ASL/DWI match situation, and the paired t test was applied to the data before and after treatment in all groups.Results The patients were divided into three groups according to the 3 D-ASL/DWI match situation:(1)The group with3 D-ASL>DWI(16 patients), the ADC values, CBF values and NIHSS scores before and after thrombolytic therapy were compared, with statistically significant differences(P<0.01), and the overall response rate was 100.0%;(2)The group with3 D-ASL=DWI(15 patients), the ADC values, CBF values and NIHSS scores before and after thrombolytic therapy were compared, with statistically significant differences(P <0.01), and the overall response rate was 86.7%;(3)The group with 3 D-ASL<DWI(5 patients), the ADC values, CBF values and NIHSS scores before and after thrombolytic therapy were compared, without statistically significant differences(P>0.05), and the overall response rate was 0.0%;It was found that the correlation was significant through Spearman correlation analysis of the different match of 3 D-ASL/DWI and the effect of intravenas thrombolysis(P<0.01). Conclusion Under the multimodality MRI, the changes of data before and after thrombolysis in different match groups prove that the existence of potential penumbra is conducive to patients’ prognosis, and has objective guidance function in evaluating the clinical thrombolytic therapy and prognosis.