磁共振3D-ASL、DWI及MRA技术诊断短暂性脑缺血发作及观察侧支循环形成的临床应用

Clinical application of magnetic resonance 3D-ASL,DWI and MRA in diagnosis of transient ischemic attack and observation of collateral circulation arterioles

目的探讨3D-ASL、DWI、MRA在短暂性脑缺血发作(TIA)的诊断价值。方法选取我院2018年5月~2020年1月收治的TIA患者51例,均行常规MRI、弥散加权成像(DWI)、磁敏感成像(SWI)、磁共振血管成像(MRA)及3D-ASL检查。分析患者常规MRI及DWI有无异常信号,MRA显示脑动脉形态及有无狭窄;对3D-ASL图像进行后处理得到全脑血流量(CBF)图,分析ASL-CBF图有无异常灌注;在明确灌注减低区,观察低灌注区域有无动脉穿行伪影。结果51例TIA患者的常规MRI及DWI序列均无阳性表现,MRA提示血管管腔狭窄≤25%的9例,管腔狭窄在25%~50%的15例,50%~75%的17例,≥75%的10例。3D-ASL(PLD的数值为1.5s)可以看出,出现脑灌注减低情况的患者32例,占62.74%;3D-ASL(PLD的数值为2.5 s)的数值情况可以看出,脑灌注减低22例(43.13%)。结论3D-ASL有助于早期发现TIA患者局部脑组织灌注异常及程度。3D-ASL结合MRA更好显示血管硬化及有无侧枝循环小血管。

Objective To observe the diagnostic value of 3D-ASL,DWI and MRA in transient ischemic attack and the formation of collateral circulation of small arteries.Methods 51 TIA patients admitted to the second affiliated hospital of hebei north university from May 2018 to January 2020 were selected and underwent conventional MR,diffusion-weighted imaging(DWI),magnetic sensitive imaging(SWI),magnetic resonance angiography(MRA)and 3D-ASL examinations.Patients were analyzed for abnormal signals in routine MR and DWI,and MRA showed cerebral artery morphology and stenosis.The 3D-ASL images were post-processed to obtain the whole brain blood flow(CBF)figure,and the asL-CBF figure was analyzed for abnormal perfusion.In the clearly defined hypoperfusion area,the arterial traveling artifact was observed in the hypoperfusion area.Results None of the 51 TIA patients showed positive results on conventional MRI and DWI sequences.MRA indicated 9 cases with luminal stenosis≤25%,15 cases with luminal stenosis by 25%~50%,17 cases with luminal stenosis by 50%~75%,and 10 cases with luminal stenosis≥75%.3D-ASL(PLD=1.5 s)showed reduced cerebral perfusion in 32 cases(62.74%),and 3D-ASL(PLD=2.5 s)showed reduced cerebral perfusion in 22 cases(43.13%).Conclusion 3D-ASL is helpful for early detection of local brain perfusion abnormalities and degree in PATIENTS with TIA.The combination of 3D-ASL and MRA can better show arteriosclerosis and the presence or absence of collateral circulation small vessels.