ASL技术联合SWI技术在急性脑卒中应用价值

Application Value of ASL Technique Combined with SWI Technique in Acute Stroke

目的探讨磁共振动脉自旋标记成像(ASL)技术联合磁敏感加权成像(SWI)技术在急性脑卒中的应用价值,为急性脑卒中诊治提供参考依据。方法选取我院2018年1月至2019年5月收治的80例急性缺血性脑卒中患者(72h内),所有患者均进行SWI、3D-PCASL序列检查和GE3.0T超导磁共振常规序列,通过软件进行后处理,得出3D-ASL伪彩图和SWI最小密度投影图。通过患者梗死核心区周围引流静脉形态学显示情况,将患者分为正常显示组和引流静脉明显观察组,分别对两组患者入院当天15d后进行NIHSS评分;分析3D-ASL伪彩图,根据梗死核心区周围条形匍匐走行条状高灌注信号的出现与否,将患者分为对照组和侧支代偿组,分析两组患者入院当天和15d后进行NIHSS评分,观察3D-ASL伪彩图中梗死核心区灌注状态的高低,将患者分为低灌注组和高灌注组,联合SWI提示HT的发生率,统计HT发生率与梗死核心区不同灌注状态之间的联系。结果正常显示组进展、稳定和好转比例分别为0/8、2/8和6/8,引流静脉明显观察组进展、稳定和好转比例分别为7/25、6/25和12/25,引流静脉明显观察组与正常显示组入院当天与入院15d后进行的NIHSS评分差异无统计学意义(P>0.05);侧支代偿组近期进展、稳定和好转比例分别为1/16、4/16和11/16,对照组进展、稳定和好转比例分别为6/15、5/15和4/15,对照组与侧支代偿组入院当天与15d后进行的NIHSS评分差异无统计学意义(P>0.05);低灌注组HT发生比例为6/30,高灌注组HT发生比例为8/8,低灌注组和高灌注组差异有统计学意义(P<0.001)。结论ASL通过梗死核心周围区域血液灌注提示的信息,能够真实客观呈现出血液动力学改变,ASL和SWI的联合,可以更好地评估侧支循环代偿建立状态、IP范围、HT、责任血管等相关信息,对于了解急性脑卒中患者缺血梗死及短期预后评估提供客观依据,便于制定更加精准化、个性化的治疗方案。

Objective To investigate the application value of magnetic resonance a rterial spin-labeled imaging(ASL)combined with susceptibility weighted imaging(SWI)in acute stroke,and to provide reference for the diagnosis and treatment of acute stroke.Methods 80 patients with acute ischemic stroke admitted to our hospital from January 2018 to May 2019(within 72 h)were selected.All patients underwent SWI,3D-PCASL sequence examination,and GE 3.0 T superconducting magnetic resonance for routine sequence.After post-processing by software,a 3D-ASL pseudo-color map and SWI minimum density projection were obtained.The patients were divided into a standard display group and a prominent observation group according to the morphological display of drainage veins around the infarct core area.NIHSS scores were conducted on the day of admission and 15 days after admission respectively.Analysis of 3D-ASL pseudo-color map,according to the infarct core bar crawl walk around line strip high perfusion signals the emergence of it or not,the patients were divided into a control group,and compensatory group,analysis of two groups of patients admitted to hospital on the same day and NIHSS score after 15 days,to observe the 3D-ASL perfusion status of the pseudo color map of infarction core,divided the patients into low perfusion group and high perfusion,joint SWI prompt the incidence of HT,the statistical incidence of HT and infa rction core link between different perfusion status.Results The proportions of progress,stability,and improvement in the standard display group were 0/8,2/8 and 6/8,respectively.The proportions of progress,stability and improvement in the drainage vein observation group were 7/25,6/25 and 12/25,respectively.There was no statistically significant difference in NIHSS scores between the drainage vein observation group and the normal display group on admission and 15 days after admission(P>0.05).The proportion of recent progress,stability,and improvement in the side support group were 1/16,4/16,and 11/16,respectively,while the proportion of progress,sta bility and improvement in the control group were 6/15,5/15,and 4/15,respectively.There was no significant difference in NIHSS scores between the control group and the side support group on admission and 15 days after admission(P>0.05).The incidence ratio of HT in the low perfusion group was 6/30,and that in the high perfusion group was 8/8.The difference between the low perfusion group and the high perfusion group was statistically significant(P<0.001).Conclusion ASL through infarction core area around the blood perfusion of prompt information,the realistic objective presents the hemodynamic changes,the combination of ASL and SWI can better evaluate the compensatory collateral circulation to establish status,IP range,HT,responsible blood vessels,and other relevant information,to understand the acute cerebral ischemic infarction in patients with stroke and short-term prognosis assessment,provide the objective basis,leading to more accurate and personalized treatment options.