三维动脉自旋标记及磁共振血管造影弥散加权成像技术在诊断急性脑梗死缺血半暗带的价值研究

The value of three-dimensional arterial spin labeling,MRA and DWI techniques in the diagnosis of ischemic penumbra in acute cerebral infarction

目的 探究三维动脉自旋标记(3D-ASL)及磁共振血管造影(MRA)、弥散加权成像(DWI)技术在急性脑梗死缺血半暗带(IP)中的诊断价值。方法 选择我院2020年6月至2022年8月收治的急性脑梗死患者100例,均行3D-ASL、MRA、DWI技术检查。分析ASL与DWI检出率、ASL与MRA检出率及MRA检出血管狭窄程度。结果 参与本次研究的100例急性脑梗死患者中,行DWI检查均可见弥散受限高信号,检出率可达100%,其中73例患者为大面积脑梗死,行ASL检查时可见灌注异常;另27例患者均为小面积脑梗死,ASL检查可见11例脑部灌注显示。大面积脑梗死ASL>DWI组患者检出IP概率高于小面积脑梗死患者,差异有统计学意义(P<0.05);ASL<DWI组及ASL≈DWI组患者在不同梗死情况中IP检出率对比,差异无统计学意义(P>0.05)。发生小面积脑梗死的27例患者中经MRA检出2级狭窄5例,3级狭窄6例,行ASL检查时可见病灶区域均呈低灌注表现,16例患者在ASL检查中均未见明显异常。而发生大面积脑梗死的73例患者中经MRA检出0~2级狭窄56例,行ASL检查可见高低不等灌注及高灌注各2例,52例患者均表现为低灌注。经MRA检查检出3级狭窄17例,行ASL检查可见内低周高灌注及高灌注各2例,其余13例均表现为低灌注。ASL<DWI组MRA狭窄中以4级为主,ASL≈DWI组MRA狭窄以2~3级为主,ASL>DWI组狭窄以0~1级为主。结论3D-ASL、MRA、DWI在IP诊断中能够及时明确病灶灌注情况及病灶位置,同时还可明确责任血管情况,对判断IP病情提供可靠的诊断依据,值得推广应用。

Objective To explore the diagnostic value of three-dimensional arterial spin labeling(3D-ASL),magnetic resonance angiography(MRA),and diffusion-weighted imaging(DWI)techniques in the ischemic penumbra(IP)of acute cerebral infarction.Methods One hundred patients with acute cerebral infarction admitted to our hospital from June 2020 to August 2022 were selected,and all underwent 3D-ASL,MRA,and DWI technology examinations.Analyze the detection rates of ASL and DWI,ASL and MRA,and the degree of vascular stenosis detected by MRA.Results Among the 100 patients with acute cerebral infarction who participated in this study,DWI examination showed diffuse restricted high signal,with a detection rate of 100%.Among them,73 patients had a large area of cerebral infarction,and perfusion abnormalities were observed during ASL examination;the other 27 patients all had small area cerebral infarction,and ASL examination showed 11 cases with cerebral perfusion.The probability of detecting IP in patients with large area cerebral infarction(ASL>DWI)was higher than that in patients with small area cerebral infarction,with a statistical difference(P<0.05),there was no statistically significant difference(P>0.05)in the IP detection rate between the ASL<DWI group and the ASL≈DWI group in different infarct situations.Among the 27 patients with small area cerebral infarction,5 cases with grade 2 stenosis and 6 cases with grade 3 stenosis were detected by MRA.During ASL examination,the lesion area showed hypoperfusion,and the remaining 16 patients showed no significant abnormalities in ASL examination.Among the 73 patients with extensive cerebral infarction,56 cases were detected as grade 0-2 stenosis by MRA,and 2 cases were found to have varying levels of perfusion and high perfusion on ASL examination.The remaining 52 patients all showed low perfusion.17 cases with grade 3 stenosis were detected by MRA examination,and 2 cases with low peripheral high perfusion and 2 cases with high perfusion were detected by ASL examination.The remaining 13 cases all showed low perfusion.In the ASL<DWI group,MRA stenosis was mainly grade 4,in the ASL≈DWI group,MRA stenosis was mainly grade 2-3,and in the ASL>DWI group,stenosis was mainly grade 0-1.Conclusion 3D-ASL,MRA,and DWI can timely clarify the perfusion and location of lesions in IP diagnosis,as well as the responsible vascular conditions.They provide reliable diagnostic basis for judging the condition of IP and are worthy of promotion and application.