3D ASL与SWI对急性缺血性脑卒中缺血半暗带的评估差异比较

Comparison of 3D ASL and SWI in Assessment of Ischemic Penumbra in Acute Ischemic Stroke

【目的】探讨磁敏感加权成像(SWI)与三维动脉自旋标记技术(3D ASL)对急性缺血性脑卒中(AIS)的缺血半暗带(IP)的评估差异。【方法】选择2016年10月至2019年5月本院收治的78例AIS患者,通过SWI显示AIS患者的突出皮质静脉(PCV)和3D ASL技术显示AIS患者的脑血流量(CBF)减低区来评估IP,采用修改后的艾伯塔卒中计划早期CT评分(ASPECTS)对两种方法显示的IP进行计分,对两种方法显示的IP评分结果进行比较,并对不同程度IP的临床资料进行对比分析。【结果】SWI显示不同程度PCV患者组间性别、年龄、发病时间、糖尿病、高血压及基线NIHSS评分比较,差异均无统计学意义(P>0.05)。ASL显示不同范围CBF降低区组间的性别、年龄、发病时间、糖尿病、高血压及基线NIHSS评分比较,差异均无统计学意义(P>0.05)。78例患者PCV评估IP范围的评分为(5.06±2.28)分,CBF减低区评估IP范围的评分为(6.03±2.33)分,PCV评分低于CBF减低区评分,差异有统计学意义(t=2.46,P=0.02<0.05)。【结论】SWI的PCV征能间接提示AIS脑部IP的存在,而3D ASL显示的CBF减低区能更直接、全面显示脑组织的缺血情况,3D ASL在显示IP方面较SWI更具有优势。

【Objective】To investigate the differential diagnosis of ischemic penumbra(IP)in acute ischemic stroke(AIS)by susceptibility weighted imaging(SWI)and three-dimensional arterial spin labeling(3D ASL).【Methods】Seventy-eight AIS patients admitted to our hospital from October 2016 to may 2019 were selected.Through the display of prominent cortical vein(PCV)in AIS patients by SWI and the decreased cerebral blood flow(CBF)area of AIS patients to evaluate IP,the modified alberta stroke program early CT score(ASPECTS)was used to score the IP displayed by the two methods,the results of the IP scores displayed by the two methods were compared and the clinical data of different degrees of IP were compared and analyzed.SWI showed that there was no significant difference in gender,age,onset time,diabetes mellitus,hypertension and baseline NIHSS scores between different PCV groups(P>0.05).ASL showed that there was no significant difference in gender,age,onset time,diabetes mellitus,hypertension and baseline NIHSS scores between groups in different CBF reduction areas(P>0.05).The PCV score of 78 patients was(5.06±2.28)and that of CBF decreased area was(6.03±2.33).The PCV score was lower than that of CBF decreased area(f=2.46,P=0.02<0.05).【Results】There were no significant differences in clinical datum between IP groups at different degrees(P>0.05).The score of PCV for IP was lower than that of CBF reduction area,and the difference was statistically significant(t=2.46,P<0.05).【Conclusion】The PCV sign of SWI can indirectly indicate the presence of brain IP in AIS,while the decreased CBF area displayed by 3D ASL can more directly and comprehensively show the cerebral ischemia,and 3D ASL has more advantages than SWI in displaying IP.