ASL评估脑梗死灶血脑屏障通透性及预测血管开通后出血转化的价值

Values of arterial spin labeling in evaluating blood-brain barrier permeability in cerebral infarction lesions and predicting hemorrhage transformation after endovascular recanalization

目的分析动脉自旋标记(ASL)对前循环亚急性缺血性脑卒中患者脑梗死灶血脑屏障通透性的评估作用,并探讨ASL成像分型预测血管开通后患者发生出血转化的价值。方法前瞻性连续纳入自2021年1月至2021年9月于河南省人民医院国家高级卒中中心接受血管内治疗的前循环亚急性缺血性脑卒中患者进行研究。患者分别于术前24 h内及术后即刻完成ASL序列、动态对比增强(DCE)序列MRI检查及Xper CT检查并进行成像分型,于术后24~48 h内复查头颅CT平扫观察出血转化情况并依据有无出血转化发生分为出血转化组与未出血转化组,对比2组患者间ASL序列参数相对脑血流量(rCBF)值、DCE序列参数容积转运常数(K^(trans))及ASL、DCE和Xper CT成像分型的差异,采用加权Kappa系数检验ASL、DCE和Xper CT成像分型间的一致性。结果研究共纳入22例患者,其中5例术后发生出血转化。出血转化组患者的rCBF值(1.57±0.18)、K^(trans)[0.072(0.0455,0.117)/min]明显高于未出血转化组[1.14±0.04、0.032(0.024,0.039)/min],差异均有统计学意义(P<0.05)。2组患者间ASL、DCE、Xper CT成像分型分布的差异亦有统计学意义(P<0.05),其中6例ASL成像分型Ⅲ型患者中4例发生出血转化,6例DCE成像分型Ⅲ型患者中4例发生出血转化,5例Xper CT成像分型Ⅲ型患者中4例发生出血转化。22例患者中ASL序列与DCE序列的成像分型一致性强(加权Kappa系数=0.941,95%CI:0.862~1.020,P<0.001)。结论ASL对前循环亚急性缺血性脑卒中患者脑梗死灶血脑屏障通透性的评估作用较强,ASL成像分型Ⅲ型患者发生出血转化的风险相对较高。

Objective To assess the role of arterial spin labeling(ASL)in detecting the blood-brain barrier(BBB)permeability of cerebral infarction lesions in patients with anterior circulation subacute ischemic stroke(SIS),and to evaluate the value of ASL in predicting hemorrhagic transformation(HT)of SIS patients after endovascular recanalization.Methods A prospective analysis was performed.Patients with anterior circulation SIS who received endovascular treatment(EVT)in our hospital from January 2021 to September 2021 were enrolled.At 24 h before EVT and immediately after EVT,MRI scans of ASL sequences and dynamic contrast-enhanced magnetic resonance(DCE)sequence were completed,and Xper CT was performed;accordingly,imaging typing was performed.Head CT scan was performed 24-48 h after EVT to observe HT;according to the presence or absence of HT,these patients were divided into HT group and non-HT group;the relative cerebral blood flow(rCBF)values of ASL sequence parameters,volume transfer constant(K^(trans))of DCE sequence parameters and the differences of ASL,DCE and Xper CT imaging types between the two groups were compared.The weighted Kappa coefficient was used to test the consistency among ASL,DCE and Xper CT imaging types.Results Among 22 eligible patients,5 patients occurred HT(5/22,22.72%).As compared with those in the non-HT group(1.14±0.04;0.032[0.024,0.039]/min),patients in the HT group had significantly higher rCBF value(1.57±0.18)and K^(trans)(0.072[0.0455,0.117]/min,P<0.05).There were significant differences in the distribution of ASL,DCE and Xper CT imaging types between the two groups(P<0.05);among them,4 out of 6 patients with ASL imaging type III,4 out of 6 patients with DCE imaging type III,and 4 out of 5 patients with Xper CT imaging type III had HT.ASL sequence and DCE sequence had a high consistency in the imaging types(Kappa coefficient=0.941,95%CI:0.862-1.020,P<0.001).Conclusion ASL can effectively evaluate the BBB permeability of cerebral infarction lesions in patients with anterior circulation SIS;patients with ASL imaging type III have a relatively high risk of HT.