磁共振成像DWI联合3D-ASL对急性脑梗死的诊断效能及在血流动力学评估中的应用

Diagnostic efficacy of MRI DWI combined with 3D-ASL for acute cerebral infarction and its application in hemodynamic evaluation

目的:探讨磁共振成像(MRI)DWI联合3D-ASL对急性脑梗死(ACI)的诊断效能及在血流动力学评估中的应用价值。方法:收集因ACI就诊的80例患者的临床资料,全部入选者均接受1.5T/3.0T MRI进行扫描,分别分析患者脑梗死的DWI、3D-ASL图像表现,并评估DWI联合3D-ASL检查ACI是否具有更高的诊断价值。结果:有49例ACI患者在DWI图像上显示为弥散受限,面积为(673±319)mm2,68例患者在3D-ASL图像上显示为低灌注,低灌注面积为(1953±803)mm2,其中面积ASL>面积DWI的患者有62例,存在缺血半暗带。在DWI图像上显示为弥散受限的患者中,左侧高信号者的CBF绝对值均低于右侧(22.34±4.36 vs 40.58±9.01,P<0.001),右侧高信号者的CBF绝对值均低于左侧(19.48±5.67 vs 46.01±11.15,P<0.001)。DWI联合3D-ASL检查诊断ACI的灵敏度、特异度、阳性预测值和阴性预测值均高于单独DWI检查。结论:DWI联合3D-ASL检查评估ACI中梗死灶和缺血半暗带具有很大的应用价值。

Objective To investigate the efficacy of magnetic resonance imaging(MRI)diffusion-weighted imaging(DWI)combined with 3D-arterial spin labeling(3D-ASL)in the diagnosis of acute cerebral infarction(ACI)and its application value in hemodynamic assessment.Methods Eighty cases of ACI were analyzed.All patients were examined with 1.5T/3.0T MRI.The DWI and 3D-ASL image findings of patients with cerebral infarction were analyzed,and the diagnostic value of DWI combined with 3D-ASL for cerebral infarction was evaluated.Results Out of 80 ACI patients,49 patients had diffusion limitation on DWI images,with an average area of(673±319)mm2;and 3D-ASL hypoperfusion was found in 68 patients,with an average hypoperfusion area of(1953±803)mm2.Ischemic penumbra existed in 62 patients who had larger areaASL than areaDWI.In patients with diffusion limitation on DWI images,the absolute value of CBF of the left-sided hyperintensity was lower than that of the right-sided(22.34±4.36 vs 40.58±9.01,P<0.001),and the absolute value of CBF of the right-sided hyperintensity was lower than that of the left-sided(19.48±5.67 vs 46.01±11.15,P<0.001).Compared with DWI alone,DWI combined with 3D-ASL had higher sensitivity,specificity,positive predictive value and negative predictive value in the diagnosis of ACI.Conclusion DWI combined with 3D-ASL has significant application value in the evaluation of infarct focus and ischemic penumbra in ACI.