三维动脉自旋标记技术评估急性脑梗死病人侧支循环形成的临床价值

Clinical Value of 3D-arterial Spin Labeling for the Evaluation of Collateral Circulation in Patients with Acute Cerebral Infarction

目的:探讨三维动脉自旋标记(3D-ASL)技术评估急性脑梗死(AIS)病人侧支循环形成的临床价值。方法:选取本院神经内科2020年3月—2022年3月收治的AIS病人103例,根据侧支循环情况分为侧支循环良好组(39例)和侧支循环不良组(64例)。所有病人均接受磁共振成像(MRI)弥散加权成像(DWI)序列检查和3D-ASL检查。比较不同标记时间梗死区、健侧镜像区脑组织血流量(CBF)值;比较梗死区不同标记时间、健侧镜像区不同标记时间CBF值;比较侧支循环良好组和侧支循环不良组表观扩散系数(ADC)值和CBF值,不同标记时间CBF值,梗死区、健侧镜像区不同标记时间CBF变化值(△CBF)。绘制受试者工作特征曲线(ROC)比较ADC值、PLD=2.5 s时CBF值对AIS病人侧支循环良好的诊断价值。结果:健侧镜像区、梗死区PLD=2.5 s时的CBF值高于PLD=1.5 s时(P<0.05);PLD=1.5 s和PLD=2.5 s时,健侧镜像区CBF值高于梗死区(P<0.05)。侧支循环良好组梗死区ADC值高于侧支循环不良组(P<0.05)。PLD=1.5 s时,侧支循环良好组和侧支循环不良组CBF值比较,差异无统计学意义(P>0.05);PLD=2.5 s时,侧支循环良好组CBF值高于侧支循环不良组(P<0.05)。侧支循环良好组梗死区△CBF值高于侧支循环不良组(P<0.05)。ROC曲线显示,ADC值与PLD=2.5 s时CBF值联合应用诊断AIS侧支循环形成良好的敏感度为78.25%,特异度为93.78%,AUC值为0.915[95%CI(0.878,0.953)],均高于两种方法单独检测。结论:3D-ASL技术在AIS病人侧支循环形成的评估中具有较高的临床价值,CBF值(PLD=2.5 s)联合DWI序列ADC值测定可提高对侧支循环形成良好的诊断效能。

Objective:To investigate the clinical value of 3D-arterial spin labeling(3D-ASL)for the evaluation of collateral circulation in patients with acute cerebral infarction(AIS).Methods:A total of 103 AIS patients were selected and divided into normal collateral circulation group(39 cases)and poor collateral circulation group(64 cases)according to the condition of collateral circulation.All patients were tested with MRI diffusion weighted imaging(DWI)sequence examination and 3D-ASL examination.CBF values at different labeling times in infarct area and different labeling times in contralateral mirror area were compared.The apparent diffusion coefficient(ADC)and CBF values of patients with normal collateral circulation and patients with poor collateral circulation were compared,and the CBF values of patients with normal collateral circulation and patients with poor collateral circulation at different labeling times were compared.The changes of CBF(△CBF)in infarcted area and contralateral mirror area were compared between patients with normal collateral circulation and patients with poor collateral circulation.The receiver operating characteristic curve(ROC)was drawn to compare the normal diagnostic value of CBF value in AIS patients at ADC=2.5 s and PLD=2.5 s.Results:CBF value of contralateral mirror area were higher than that of infarct area at PLD=1.5 s and PLD=2.5 s(P<0.05),while CBF value of contralateral mirror area and infarct area at PLD=2.5 s was higher than that at PLD=1.5 s(P<0.05).ADC value of infarct area of the normal collateral circulation group were higher than that of the poor collateral circulation group(P<0.05),and CBF value at PLD=2.5 s was higher than that of poor collateral circulation group(P<0.05).There was no significant difference in CBF between normal collateral circulation group and poor collateral circulation group(P>0.05).When PLD=2.5 s,CBF value of normal collateral circulation group was higher than that of poor collateral circulation group(P<0.05).The value of△CBF of infarct area of normal collateral circulation group was higher than that of the poor collateral circulation group(P<0.05).ROC curve showed that the combination of ADC value and CBF value at PLD=2.5 s showed sensitivity 78.25%,specificity 93.78%and AUC value 0.915(95%CI 0.878~0.953),which were higher than those detected by the two methods alone.Conclusion:3D-ASL technique shows a high clinical value in the evaluation of collateral circulation formation in patients with AIS.CBF value(PLD=2.5 s)combined with DWI sequence ADC value can improve the diagnostic efficiency of collateral circulation formation.