多期延迟PCASL对进展性脑梗死预后评估

Evaluation for Prognosis of Progressive Cerebral Infarction Using Multi-phase Delay PCASL

目的运用多期ASL技术联合DWI技术评估进展性脑梗死(PIS)临床预后。方法前瞻性纳入急性缺血性脑卒中患者共55例行DWI及3D-PCASL检查,计算梗死区DWI高信号面积及血流灌注CBF值,根据临床治疗效果,55例患者分成PIS组和非PIS组,比较不同组别各参数值是否存在差异,绘制ROC曲线,计算各参数值对进展性脑梗死诊断能效及判断预后价值。结果55例急性脑梗死患者中,20例为PIS,35例为非PIS。PIS组与非PIS组相比,CBF值均有统计学意义(P<0.05),其中1.5s-PLD CBF值:PIS组为(14.82±5.15)mL/100mg/min,非PIS组为(28.42±11.64)mL/100mg/min;2.0s-PLD CBF值:PIS组为(23.96±9.51)mL/100mg/min,非PIS组为(33.79±13.52)mL/100mg/min;2.5s-PLD CBF值:PIS组为(30.51±11.22)mL/100mg/min,非PIS组为(38.67±12.86)mL/100mg/min。DWI梗死面积:PIS组为(886.24±12.32)mm²,非PIS组为(900.76±1087.21)mm²,两组相比无统计学意义(P>0.05)。ROC曲线分析表明,1.5s-PLD诊断PIS能效最好,当CBF取值19.29时,其曲线下面积最大,AUC为0.89,其诊断敏感性为80%,特异性为85%。结论多期PLD可以准确预测PIS,当PLD为1.5s时,其衍生CBF值为19.29 mL/100mg/min时敏感性和特异性均高于其它灌注参数值,可以作为判断PIS参数指标。

Objective To evaluate the prognosis of progressive cerebral infarction(PIS)through using multi-phasic post labeling delay(PLD)pseudo-continuous arterial spin labeling technique(PCASL)combined with diffusion-weighted imaging(DWI).Methods A total of 55 patients with acute cerebral infarction diagnosed by clinical and DWI were prospectively included in DWI and multi-phase delayed PCASL examination.The high signal area of DWI and the CbF value of blood perfusion in the infarcted area were calculated.The patients were divided into progressive cerebral infarction group and non-progressive cerebral infarction group.The differences of parameters in different groups were compared,Receiver Operating Characteristic(ROC)curve was drawn,and the diagnostic efficiency and prognostic value of each parameter were evaluated.ResultsOf the 55 patients with acute cerebral infarction,20 were PIS,35 were non-PIS.The values of CbF were statistically significant in PIS group and non-PIS group(P<0.05).The CbF value of 1.5s-PLD was(14.82±5.15)mL/100mg/min in PIS group and(28.42±11.64)mL/100mg/min in non-PIS group;The CbF value of 2.0s-PLD was(23.96±9.51)mL/100mg/min in PIS group and(33.79±13.52)mL/100mg/min in non-PIS group.The CbF value of 2.5s-PLD was(30.51±11.22)mL/100mg/min in PIS group and(38.67±12.86)mL/100mg/min in non-PIS group.The infarct size of DWI was(886.24±12.32)mm²in PIS group and(900.76±1087.21)mm²in non-PIS group respectively,and there was no significant difference between the two groups(P>0.05).ROC curve analysis indicated that the 1.5s-PLD CbF value was most effective in the diagnosis of PIS.The largest area under curve(AUC)was 0.89 at a CbF value of 19.29 mL/100mg/min,and the sensitivity and the specificity were 80%and 85%,respectively.ConclusionThe multiphasic PLD method demonstrates high accuracy in predicting progressive cerebral infarction(PIS).When the PLD is set to 1.5 seconds,the derived cerebral blood flow(CbF)value of 19.29 mL/100mg/min exhibits superior sensitivity and specificity compared to other perfusion parameters.Therefore,it can serve as a reliable indicator for identifying PIS.