双参数动脉自旋标记成像在评估急性缺血性卒中侧支循环和预后中的应用价值

Application value of arterial spin labeling imaging with dual parameters in evaluating collateral circulation and prognosis of acute ischemic stroke

目的探讨双参数动脉自旋标记(arterial spin labeling imaging,ASL)成像对急性缺血性卒中(acute ischemic stroke,AIS)侧支循环和预后评估的应用价值。材料与方法回顾性分析2020年6月至2021年7月南京市第一医院神经内科收治的35例AIS患者的多模态MRI和数字减影血管造影(digital subtraction angiography,DSA)数据。根据梗死灶在双反转时间(inversion time,TI)(1500 ms、2510 ms)的ASL灌注情况,将AIS患者分为3组:早期高灌注组(G1,n=8)、晚期高灌注组(G2,n=6)及非高灌注组(G3,n=21)。采用美国介入和治疗神经放射学学会/介入放射学学会(American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology,ASITN/SIR)侧支循环评价系统对侧支循环状态进行评估(侧支循环良好:3~4级;侧支循环不良:0~2级),采用改良Rankin量表(modified Rankin scale,mRS)对出院后3个月预后进行评估(预后良好:≤2分;预后不良:>2分)。最后,应用统计学方法分析3组患者侧支循环差异及预后情况。结果与G3组相比,G1和G2组的入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较低(G1:2.38±1.69;G2:7.33±1.37;G3:14.81±4.86)、侧支循环良好比例较高(G1:100.00%;G2:83.33%;G3:38.10%)、预后良好比例较高(G1:100.00%;G2:50.00%;G3:42.86%)。G1组和G2组两组侧支循环良好比例无明显差异(100.00%vs.83.33%;P=0.180),但G1组预后良好率明显高于G2组(100.00%vs.50.00%;P=0.013)。Spearman相关分析显示G1、G2、G3三组与侧支循环分级呈正相关(r=0.720;P<0.001),与预后mRS评分呈负相关(r=-0.843;P<0.001)。结论双TI的ASL成像能有效评估AIS患者侧支循环状况和预后情况,为临床制订治疗决策提供了重要依据。

Objective:To explore the value of arterial spin labeling(ASL)imaging with dual parameters in evaluating the collateral circulation and prognosis for patients with acute ischemic stroke(AIS).Materials and Methods:From June 2022 to July 2022,multi-modal MRI and digital subtraction angiography(DSA)data of 35 AIS patients from Nanjing First Hospital were retrospectively analyzed.All patients were divided into three groups:high perfusion at early stage group(G1,n=21),high perfusion at later stage group(G2,n=8)and no-high perfusion group(G3,n=6)based on the ASL[inversion time(TI)=1500 ms,2510 ms]imaging features of the infarct lesions.Collateral circulation was divided into good collateral circulation(grade 3-4)and poor collateral circulation(grade 0-2)according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR).The prognosis was divided into good outcome(≤2 points)and poor outcome(>2 points)according to modified Rankin Scale(mRS)at 3-month follow-up.The differences of collateral circulation and prognosis among three groups were analyzed using statistical methods.Results:Compared with G3,G1 and G2 had lower National Institutes of Health Stroke Scale(NIHSS)score,better collateral circulation and good outcome.There was no significant difference in the collateral circulation between G1 and G2(100.00%vs.83.33%;P=0.180),while the rate of good outcome in G1 was significantly higher than that in G2(100.00%vs.50.00%;P=0.013).Spearman correlation analysis showed that G1,G2,G3 were positively correlated with collateral circulation grade(r=0.720;P<0.001),and negatively correlated with prognosis mRS score(r=-0.843;P<0.001).Conclusions:ASL imaging with double inversion time could effectively evaluate the collateral circulation and prognosis of AIS patients,and provide vital evidence for therapeutic decision-making.