3D-pCASL对单侧大脑中动脉重度狭窄脑组织灌注的评价价值

Evaluation value of 3D-pCASL on cerebral perfusion in patients with severe unilateral middle cerebral artery stenosis

目的探讨3D-pCASL对单侧大脑中动脉重度狭窄脑组织灌注情况的评价价值。方法选取经诊治的65例单侧大脑中动脉重度狭窄患者,其中短暂性脑缺血发作35例(TIA组),脑梗死30例(脑梗死组),另选择同期30例健康志愿者为对照组。所有受检者均接受常规颅脑MRI检查及3D-pCASL(PLD=1525和PLD=2525)检查,测量并比较三组受检者各感兴趣区CBF及∆CBF的差异,采用受试者工作特征(ROC)曲线分析CBF(PLD=1525)、CBF(PLD=2525)及∆CBF对脑梗死的诊断价值。结果组内比较,TIA组及脑梗死组病变区CBF均显著低于镜像区,∆CBF均显著高于镜像区,差异有统计学意义(P<0.05)。与CBF(PLD=1525)比较,三组各感兴趣区CBF(PLD=2525)均显著升高,差异有统计学意义(P<0.05)。组间比较,TIA组病变区、脑梗死组病变区与对照组比较,CBF(PLD=1525)、CBF(PLD=2525)均显著降低,∆CBF显著升高,差异均有统计学意义(P<0.05)。脑梗死组病变区CBF(PLD=1525)、CBF(PLD=2525)均显著低于TIA组病变区,∆CBF亦明显低于TIA组病变区,差异均有统计学意义(P<0.05)。ROC分析显示CBF(PLD=2525)对应曲线下面积最大,为0.807,约登指数0.586,以CBF=33.19 ml/100g·min为最佳界值,对应敏感度70.0%,特异度88.6%。结论单侧大脑中动脉重度狭窄所致TIA及脑梗死患者脑组织存在不同程度的低灌注情况,3D-pCASL能够显示患者脑组织血流灌注特征,其中CBF(PLD=2525)的评价价值更高。

Objective To explore the value of 3D-pCASL in evaluating cerebral perfusion in patients with severe unilateral middle cerebral artery stenosis.Methods 65 patients with severe unilateral middle cerebral artery stenosis treated were selected as the research objects,including 35 patients with TIA and 30 patients with cerebral infarction,Another 30 healthy volunteers were selected as the control group.All subjects underwent routine brain MRI and 3D-pCASL(PLD=1525 and PLD=2525).The differences of CBF and∆CBF in each region of interest of the three groups were compared.The diagnostic value of CBF(PLD=1525),CBF(PLD=2525)and∆CBF for cerebral infarction was analyzed by subject operating characteristic(ROC)curve.Results The CBF in the lesion area of TIA group and cerebral infarction group was significantly lower than that in the mirror area,∆CBF was significantly higher than that in the mirror area,The differences were statistically significant(P<0.05).Compared with CBF(PLD=1525),the CBF(PLD=2525)in each region of interest in the three groups increased significantly.The differences were statistically significant(P<0.05).Compared with the control group,the CBF(PLD=1525)and CBF(PLD=2525)decreased significantly in the lesion area of TIA group and cerebral infarction group,∆CBF increased significantly,and the differences were statistically significant(P<0.05).The CBF(PLD=1525)and CBF(PLD=2525)in the lesion area of cerebral infarction group were significantly lower than that in TIA group,and∆CBF was also significantly lower than that in TIA group.The differences were statistically significant(P<0.05).ROC analysis showed that the area under the corresponding curve of CBF(PLD=2525)was the largest,which was 0.807,and the Jordan index was 0.586,Taking CBF=33.19 ml/100g·min as the best boundary value,the corresponding sensitivity was 70.0%,and the specificity was 88.6%.Conclusion There were different de grees of Cerebral hypoperfusion in patient with TIA and cerebral infarction caused by severe stenosis of unilateral middle cerebral artery,3D-pCASL can display the characteristics of blood perfusion of patients'brain tissue.Among them,CBF(pld=2525)has higher evaluation value.