Cerebral perfusion in patients with unilateral internal carotid artery occlusion by dual post-labeling delays arterial spin labeling imaging

BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic resonance imaging(MRI)technique is used.Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.AIM To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.METHODS Twenty hospitalized patients with ICAO and sex-and age-matched controls were included in the study.Regional CBF was measured by Dr.Brain's ASL software.The present study evaluated differences in global,middle cerebral artery(MCA)territory,anterior cerebral artery territory,and Alberta Stroke Program Early Computed Tomography Score(ASPECTS)regions(including the caudate nucleus,lentiform nucleus,insula ribbon,internal capsule,and M1-M6)and brain lobes(including frontal,parietal,temporal,and insular lobes)between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.RESULTS When comparing CBF between ICAO patients and controls,the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s;the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s,and it was lower in 9 brain regions at PLD 2.5 s;the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s.The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s.The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions,whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions.The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s,and in M6 at PLD 2.5 s.CONCLUSION Unilateral ICAO results in hypoperfusion in the global and MCA territories,especially in the ASPECTS area.Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.

Reliability of Three Dimentional Pseudo-continuous Arterial Spin Labeling:A Volumetric Cerebral Perfusion Imaging with Different Post-labeling Time and Functional State in Health Adults

Objective To evaluate the reliability of three dimensional spiral fast spin echo pseudo-continuous arterial spin labeling(3 D pc-ASL) in measuring cerebral blood flow(CBF) with different post-labeling delay time(PLD) in the resting state and the right finger taping state.Methods 3 D pc-ASL and three dimensional T1-weighted fast spoiled gradient recalled echo(3 D T1-FSPGR) sequence were applied to eight healthy subjects twice at the same time each day for one week interval. ASL data acquisition was performed with post-labeling delay time(PLD) 1.5 seconds and 2.0 seconds in the resting state and the right finger taping state respectively. CBF mapping was calculated and CBF value of both the gray matter(GM) and white matter(WM) was automatically extracted. The reliability was evaluated using the intraclass correlation coefficient(ICC) and Bland and Altman plot.Results ICC of the GM(0.84) and WM(0.92) was lower at PLD 1.5 seconds than that(GM, 0.88; WM, 0.94) at PLD 2.0 seconds in the resting state, and ICC of GM(0.88) was higher in the right finger taping state than that in the resting state at PLD 1.5 seconds. ICC of the GM and WM was 0.71 and 0.78 for PLD 1.5 seconds and PLD 2.0 seconds in the resting state at the first scan, and ICC of the GM and WM was 0.83 and 0.79 at the second scan, respectively.Conclusion This work demonstrated that 3 D pc-ASL might be a reliable imaging technique to measure CBF over the whole brain at different PLD in the resting state or controlled state.

难治性癫痫患者海马灌注的3D-ASL成像评估

目的探讨难治性癫痫患者采用磁共振动脉自旋标记(ASL)技术评估海马灌注情况的价值。方法筛选2019-11-2021-11郴州市第一人民医院的105例受试者,均行海马3D-ASL检查,分为3组(单侧颞叶异常放电组、单侧海马硬化组、健康对照组),分析海马脑血流量(CBF)值与难治性颞叶癫痫的关系。结果健康对照组、单侧颞叶异常放电组患侧与健侧海马、单侧海马硬化组患侧与健侧海马的CBF值分别为(52.13±0.95)mL/(100 g·min)、(49.03±5.28)mL/(100 g·min)、(54.97±1.63)mL/(100 g·min)、(39.41±2.01)mL/(100 g·min)、(48.03±1.69)mL/(100 g·min),除健康对照组与单侧颞叶异常放电组健侧、单侧颞叶异常放电组健侧与单侧海马硬化组健侧比较无统计学差异外,其余组间比较差异均有统计学意义(P<0.00625)。对比健康对照组与单侧颞叶异常放电组患侧得出cut-off值,ROC曲线的最佳临界点为45.81。结论ASL技术在全身及系统性疾病中有一定的诊断价值,难治性颞叶癫痫患者的海马灌注量变化相较于影像学改变更早,有利于临床早期诊断和治疗。

常规磁共振序列联合ASL在儿童局灶性皮层发育不良中的诊断价值

目的:分析局灶性皮质发育不良(FCD)患儿常规MRI序列及动脉自旋标记(ASL)的扫描图像,探讨其对FCD的诊断价值。方法:回顾性分析2021年7月至2023年8月经病理确诊为FCD的30例患儿MRI图像,包括常规MRI T1WI、T2WI、FLAIR序列及ASL扫描序列,分析FCD不同分型的MRI影像学特点,并对ASL图像经后处理获得病变区脑血流量(CBF)值及同水平对侧正常区CBF值进行比较,计算常规MRI序列及常规MRI序列联合ASL扫描序列诊断FCD的准确率。结果:常规MRI序列评估结果阳性21例,准确率为70%。FCD I型6例,主要表现为局部脑组织容积偏小,灰白质模糊;FCD II型7例,以皮层增厚,皮层及皮层下片状T1WI稍低信号,T2WI高信号,T2-FAIR高信号为主,典型者呈Tansmantle征;FCD III型8例,合并海马硬化、肿瘤、血管畸形。常规MRI序列及ASL联合扫描示27例灌注异常,准确率为90%,27例病灶区CBF值[(48.15±6.00)mL/(100g·min)]低于对侧正常区CBF值[(79.66±6.53)mL/(100g·min)](t=18.458,P<0.001)。结论:不同分型FCD具有特征性影像表现,但I型病灶较隐匿,II型典型表现出现概率少,容易漏诊,III型容易被合并病灶掩盖,ASL扫描序列有助于FCD病灶的检出及定位,与常规MRI序列联合检查可进一步提高诊断FCD的准确率。

Arterial spin labeling in neuroimaging

Arterial spin labeling(ASL) is a magnetic resonance imaging technique for measuring tissue perfusion using a freely diffusible intrinsic tracer.As compared with other perfusion techniques,ASL offers several advantages and is now available for routine clinical practice in many institutions.Its noninvasive nature and ability to quantitatively measure tissue perfusion make ASL ideal for research and clinical studies.Recent technical advances have increased its sensitivity and also extended its potential applications.This review focuses on some basic knowledge of ASL perfusion,emerging techniques and clinical applications in neuroimaging.

多PLD ASL成像预测急性缺血性脑卒中机械取栓术后远期神经功能良好的价值

目的探讨多标记后延迟(post labeling delay,PLD)时间的动脉自旋标记(arterial spin labeling,ASL)成像预测急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术后远期神经良好的价值。材料与方法回顾性纳入2021年6月至2023年11月于首都医科大学宣武医院急性卒中绿色通道行机械取栓治疗的AIS患者病例。所有患者机械取栓前均接受头部CT平扫、CT灌注(CT perfusion,CTP)及CT血管成像(CT angiography,CTA),术后24小时内均行扩散加权成像(diffusion weighted imaging,DWI)及多PLD ASL成像(PLD=1.00 s、1.22 s、1.48 s、1.78 s、2.15 s、2.62 s、3.32 s)。依据术后患侧与健侧脑组织低灌注区域体积分为良好灌注组和低灌注组,比较两组的临床一般资料。采用改良Rankin量表(modified Rankin Scale,mRS)评价患者术后90天神经功能预后,定义0~2分为神经功能良好,通过二元logistic回归、受试者工作特征(receiver operating characteristic curve,ROC)曲线分析多PLD ASL预测患者术后90天神经功能良好的价值。结果共纳入机械取栓术后的AIS患者32例,其中良好灌注组14例(43.8%),低灌注组18例(56.2%)。良好灌注组7天内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(4.10±3.76)显著低于低灌注组(7.80±4.51)(P=0.02);?NIHSS(8.10±4.99)显著高于低灌注组(4.20±3.81)(P=0.016);90天功能良好发生率(92.9%)显著高于低灌注组(50.0%)(P=0.019)。32例患者中22例实现90天神经功能良好(68.8%)。校正年龄、NIHSS入院、术前缺血半暗带等因素后发现术后多PLD ASL良好灌注是90天神经功能良好的独立预测指标(OR=14.246;95%CI:1.090~186.273,P=0.043),ROC曲线下面积为0.828(95%CI:0.666~0.990),预测90天神经功能良好的敏感度为75.0%,特异度为87.0%。结论术后24小时内多PLD ASL良好灌注与低灌注组间近期及远期神经功能预后均有显著差异,且术后24小时内多PLD ASL良好灌注是患者90天神经功能预后良好的独立预测指标。

Pulsed arterial spin labeling effectively and dynamically observes changes in cerebral blood flow after mild traumatic brain injury

Cerebral blood flow is strongly associated with brain function, and is the main symptom and diagnostic basis for a variety of encephalopathies. However, changes in cerebral blood flow after mild traumatic brain injury remain poorly understood. This study sought to observe changes in cerebral blood flow in different regions after mild traumatic brain injury using pulsed arterial spin labeling. Our results demonstrate maximal cerebral blood flow in gray matter and minimal in the white matter of patients with mild traumatic brain injury. At the acute and subacute stages, cerebral blood flow was reduced in the occipital lobe, parietal lobe, central region, subcutaneous region, and frontal lobe. Cerebral blood flow was restored at the chronic stage. At the acute, subacute, and chronic stages, changes in cerebral blood flow were not apparent in the insula. Cerebral blood flow in the temporal lobe and limbic lobe diminished at the acute and subacute stages, but was restored at the chronic stage. These findings suggest that pulsed arterial spin labeling can precisely measure cerebral blood flow in various brain regions, and may play a reference role in evaluating a patient＇s condition and judging prognosis after traumatic brain injury.

基于3D-ASL、DKI序列探讨脑小血管病脑白质高信号及其半暗带与认知障碍的相关性研究

目的探讨不同亚型脑白质高信号(white matter hyperintensity,WMH)及脑白质高信号半暗带(white matter hyperintensity penumbra,WMH-P)内血流灌注、微结构损伤与认知障碍的关系。方法前瞻性连续纳入2021年5月—2023年3月就诊于唐山市工人医院,WMH为改良Fazekas分级Ⅰ~Ⅱ级的脑小血管病(cerebral small vessel disease,CSVD)患者,进行包括三维动脉自旋标记(threedimensional arterial spin labeling,3D-ASL)、弥散峰度成像(diffusion kurtosis imaging,DKI)序列在内的3.0 T MRI扫描。分析患者深部脑白质高信号(deep white matter hyperintensity,DWMH)感兴趣区(region of interest,ROI)(界定为ROI^(1))及其WMH-P感兴趣区(内层为ROI^(1-1),外层为ROI^(1-2)),脑室旁脑白质高信号(periventricular white matter hyperintensity,PVWMH)感兴趣区(界定为ROI^(2))及其WMH-P感兴趣区(内层为ROI^(2-1),外层为ROI^(2-2))内血流灌注指标——脑血流量(cerebral blood flow,CBF),以及反映微结构改变的指标——轴向扩散系数(axial diffusivity,AD)、平均扩散系数(mean diffusivity,MD)、径向扩散系数(radial diffusivity,RD)、轴向峰度(axial kurtosis,AK)、平均峰度(mean kurtosis,MK)、径向峰度(radial kurtosis,RK)、各向异性分数(fraction anisotropy,FA)。评估患者的认知功能,用Spearman相关分析计算不同亚型WMH(DWMH和PVWMH)及其WMH-P内上述反映血流灌注和微结构改变的指标与认知障碍严重程度的相关性。结果共纳入61例CSVD患者,平均年龄(61±1)岁。DWMH(ROI1)内RD值(r=0.296)与认知障碍严重程度呈正相关,MK值(r=-0.287)、RK值(r=-0.315)与认知障碍严重程度呈负相关;其WMH-P内AD值(ROI^(1-1):r=0.274;ROI^(1-2):r=0.261)、MD值(ROI^(1-1):r=0.370;ROI^(1-2):r=0.387)、RD值(ROI^(1-1):r=0.411;ROI^(1-2):r=0.430)与认知障碍严重程度呈正相关,A K值(R OI 1-1:r=-0.270;ROI^(1-2):r=-0.297)、M K值(ROI^(1-1):r=-0.367;ROI^(1-2):r=-0.325)、R K值(ROI^(1-1):r=-0.379;ROI^(1-2):r=-0.309)、FA值(ROI^(1-1):r=-0.286;ROI^(1-2):r=-0.256)与认知障碍严重程度呈负相关。PVWMH(ROI2)内MK值(r=0.354)、RK值(r=0.293)与认知障碍严重程度呈正相关;其WMH-P内各微结构改变的指标与认知障碍严重程度的相关性均无统计学意义。WMH及WMH-P内CBF值与认知障碍严重程度的相关性均无统计学意义。结论CSVD患者DWMH及其WMH-P、PVWMH内微结构损伤与认知障碍存在弱相关性,但PVWMH周围WMH-P内的微结构与认知障碍无相关性;WMH及WMH-P内血流灌注与认知障碍无相关性。

基于TASL的急性前循环缺血性脑卒中药物治疗预后因素分析

目的探讨基于血管选择性动脉自旋标记(territorial arterial spin labeling,TASL)技术的急性前循环缺血性脑卒中(acute anterior circulation ischemic stroke,AACIS)药物治疗预后因素的影响性分析。材料与方法回顾性连续纳入确诊AACIS患者136例并根据其治疗后90 d的预后情况分为预后良好(70例)与预后不良(66例)两组。记录责任血管狭窄度、疗前选择性脑血流量(territorial cerebral blood flow,TCBF)、疗后TCBF_(10 d)、相对选择性脑血流量(relative CBF,rTCBF)以及病灶体积,同时收集患者的基线美国国立卫生研究院卒中量表评分(National Institute of Health Stroke Scale,NIHSS)、卒中分型、年龄、性别、身体质量指数等风险因素信息,将上述指标纳入统计模型。对两组间的计量资料使用Mann-Whitney U检验、计数资料使用χ^(2)检验统计其单因素差异性,对具有统计学意义的指标进行多因素联合logisitic回归分析,使用受试者工作特性曲线(receiver operating characteristic curve,ROC)对结果进行诊断效能评判。结果单因素分析中,年龄(Z=16.022)、基线NIHSS评分(Z=148.400)、卒中分型(Z=49.640)、责任血管狭窄度(Z=27.193)、TCBF_(疗前)(Z=693.000)、rTCBF(Z=18.874)及病灶体积(Z=-10.140)差异均有统计学意义(P<0.05)。多因素联合分析中,年龄(OR=0.108)、基线NIHSS评分(OR=0.615)、卒中分型中的穿支动脉疾病(OR=90.154)、TCBF_(疗前)(OR=4.611)及病灶体积(OR=0.138)对预后具有显著影响(P<0.05),且5者联合对预后预测的判定方法切实有效(P<0.05),ROC曲线下面积为0.962,具有较高价值。责任血管灌注的改变对预后无显著影响(P>0.05)。结论在药物保守治疗方法下,患者90 d预后更易受到年龄、基线NIHSS评分、卒中种类、CBF_(疗前)及病灶体积的影响,并不依赖于责任血管的灌注改善情况。

APT成像与3D-ASL成像在脑膜瘤分型中的鉴别价值

目的 探讨酰胺质子转移成像(APT)与三维动脉自旋标记(3D-ASL)在脑膜瘤术前分型中的鉴别价值。方法 选取25例经病理确诊的脑膜瘤患者,术前行3D-ASL、APT及常规MRI检查,分析不同分型脑膜瘤的常规MRI表现,计算并比较各组间脑膜瘤的肿瘤区域血流量(TBF)、相对脑血流量(rCBF)、肿瘤区域APT值、对侧相应位置CBF对侧值、APT对侧值。结果 纤维型脑膜瘤TBF、rCBF值低于内皮型脑膜瘤、过渡型脑膜瘤,且差异均有统计学意义(P=0.009、0.013<0.05);内皮型脑膜瘤与过渡型脑膜瘤之间差异不显著。纤维型脑膜瘤APT值与内皮型脑膜瘤差异具有统计学意义(P=0.040<0.05)。过渡型及内皮型脑膜瘤MRI平扫信号有其特点。结论 APT成像与3D-ASL成像有利于术前鉴别纤维型、内皮型及过渡型脑膜瘤。

基于压缩感知EPI的ASL技术在健康志愿者脑灌注成像中的应用研究

目的探讨基于联合压缩感知(Compressed Sensing,CS)平面回波成像(Echo Planer Imaging,EPI)的动脉自旋标记(Arterial Spin Labeling,ASL)技术,即EPICS-ASL序列在脑灌注成像中的应用价值,并与传统EPI-ASL序列进行比较。方法前瞻性收集30例志愿者行EPICS-ASL和传统EPI-ASL序列扫描。在ASL原始图上选取基底节、灰质、白质、脑干和小脑作为感兴趣区(Region of Interest,ROI),测量并计算各ROI的信噪比(Signal to Noise Ratio,SNR)和灰质/白质对比噪声比(Contrast to Noise Ratio,CNR灰质/白质);2名医师独立双盲采用4分法主观评估两组图像质量。采用配对t检验比较两组图像的SNR和CNR灰质/白质,采用秩和检验比较两组图像主观评分结果。结果客观评价,EPICS-ASL组各ROI的SNR和CNR灰质/白质均优于EPI-ASL组各ROI的SNR和CNR灰质/白质(均P<0.001);主观评价,EPICS-ASL组的图像质量评分也优于EPI-ASL组(均P<0.001)。结论EPICS-ASL序列显著优于传统EPI-ASL序列的图像SNR和CNR,图像质量更高,具有进一步临床应用的潜力。

Three-dimensional-arterial spin labeling perfusion correlation with diabetes-associated cognitive dysfunction and vascular endothelial growth factor in type 2 diabetes mellitus rat

BACKGROUND Type 2 diabetes mellitus(T2DM) has been strongly associated with an increased risk of developing cognitive dysfunction and dementia.The mechanisms of diabetes-associated cognitive dysfunction(DACD) have not been fully elucidated to date.Some studies proved lower cerebral blood flow(CBF) in the hippocampus was associated with poor executive function and memory in T2DM.Increasing evidence showed that diabetes leads to abnormal vascular endothelial growth factor(VEGF) expression and CBF changes in humans and animal models.In this study,we hypothesized that DACD was correlated with CBF alteration as measured by three-dimensional(3D) arterial spin labeling(3D-ASL) and VEGF expression in the hippocampus.AIM To assess the correlation between CBF(measured by 3D-ASL and VEGF expression) and DACD in a rat model of T2DM.METHODS Forty Sprague-Dawley male rats were divided into control and T2DM groups.The T2DM group was established by feeding rats a high-fat diet and glucose to induce impaired glucose tolerance and then injecting them with streptozotocin to induce T2DM.Cognitive function was assessed using the Morris water maze experiment.The CBF changes were measured by 3D-ASL magnetic resonance imaging.VEGF expression was determined using immunofluorescence.RESULTS The escape latency time significantly reduced 15 wk after streptozotocin injection in the T2DM group.The total distance traveled was longer in the T2DM group;also,the platform was crossed fewer times.The percentage of distance in the target zone significantly decreased.CBF decreased in the bilateral hippocampus in the T2DM group.No difference was found between the right CBF value and the left CBF value in the T2DM group.The VEGF expression level in the hippocampus was lower in the T2DM group and correlated with the CBF value.The escape latency negatively correlated with the CBF value.The number of rats crossing the platform positively correlated with the CBF value.CONCLUSION Low CBF in the hippocampus and decreased VEGF expression might be crucial in DACD.CBF measured by 3D-ASL might serve as a noninvasive imaging biomarker for cognitive impairment associated with T2DM.

ASL-MRI对局部晚期鼻咽癌诱导化疗反应及近期疗效的早期预测价值

目的:通过动脉自旋标记磁共振成像(ASL-MRI)监测局部晚期鼻咽癌(LA-NPC)诱导化疗前、后的肿瘤血流量(TBF),探讨ASL-MRI早期预测LA-NPC诱导化疗反应及近期疗效的价值。方法:收集38例初诊LA-NPC患者,于诱导化疗前、后行ASL-MRI,以获得诱导化疗前TBF(Pre-TBF)和诱导化疗后TBF(Post-TBF),并计算诱导化疗前、后的TBF变化值(ΔTBF)及变化率(ΔTBF%)。在诱导化疗后,将完全缓解(CR)和部分缓解(PR)归为反应组,疾病稳定(SD)及疾病进展(PD)归为非反应组。在放疗后3个月评估近期疗效,分为CR组和非CR组(PR、SD及PD)。采用单因素及多因素二分类logistic回归分析TBF参数对诱导化疗效果及近期疗效的影响。采用受试者工作特性(ROC)曲线确定诊断效能。结果:38例患者中诱导化疗反应组23例(60.5%),非反应组15例(39.5%)。放疗后3个月CR组22例(57.9%),非CR组16例(42.1%)。诱导化疗反应组在放疗后3个月的CR率显著高于非反应组(73.9%vs.33.3%,P=0.02)。38例患者Pre-TBF显著高于Post-TBF(Z=4.227,P<0.001)。诱导化疗反应组Pre-TBF、ΔTBF及ΔTBF%显著高于非反应组(均P<0.05);放疗后3个月CR组的Pre-TBF、ΔTBF及ΔTBF%显著高于非CR组(均P<0.05)。多因素二分类logistic回归结果显示,Pre-TBF是诱导化疗效果的独立影响因素(P=0.027),ROC曲线下面积为0.745(P=0.012);T分期及ΔTBF%是近期疗效的独立影响因素(均P<0.05),ΔTBF%的ROC曲线下面积为0.807(P=0.001)。结论:治疗前LA-NPC肿瘤血流高灌注提示更好的疗效,Pre-TBF可以预测LA-NPC诱导化疗效果,ΔTBF%可以预测LA-NPC近期疗效。

Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia

BACKGROUND Early thrombolytic therapy is crucial to treat acute cerebral infarction,especially since the onset of thrombolytic therapy takes 1-6 h.Therefore,early diagnosis and evaluation of cerebral infarction is important.AIM To investigate the diagnostic value of magnetic resonance multi-delay threedimensional arterial spin labeling(3DASL)and diffusion kurtosis imaging(DKI)in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.METHODS Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included.All patients in the acute stage underwent magnetic resonance-based examination,and the data were processed by the system’s own software.The apparent diffusion coefficient(ADC),average diffusion coefficient(MD),axial diffusion(AD),radial diffusion(RD),average kurtosis(MK),radial kurtosis(fairly RK),axial kurtosis(AK),and perfusion parameters post-labeling delays(PLD)in the focal area and its corresponding area were compared.The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging(T2WI)was analyzed.RESULTS The DKI parameters of focal and control areas in the study subjects were compared.The ADC,MD,AD,and RD values in the lesion area were significantly lower than those in the control area.The MK,RK,and AK values in the lesion area were significantly higher than those in the control area.The MK/MD value in the infarct lesions was used to determine the matching situation.MK/MD<5 mm was considered matching and MK/MD≥5 mm was considered mismatching.PLD1.5s and PLD2.5s perfusion parameters in the central,peripheral,and control areas of the infarct lesions in MK/MD-matched and-unmatched patients were not significantly different.PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and-unmatched patients were significantly lower than those in peripheral and control areas.The MK and MD maps showed a lesion area of 20.08±5.74 cm^(2) and 22.09±5.58 cm^(2),respectively.T2WI showed a lesion area of 19.76±5.02 cm^(2).There were no significant differences in the cerebral infarction lesion areas measured using the three methods.MK,MD,and T2WI showed a good correlation.CONCLUSION DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction.3DASL can effectively determine the changes in perfusion levels in the lesion area.There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

3D-ASL对舌肿物的诊断价值及与病理学特征的相关性分析

目的 :探讨3D动脉自旋标记灌注成像技术(3D arterial spin labeling,3D-ASL)、肿瘤血流(tumor blood flow,TBF)与舌部肿物组织病理学特征之间的相关性。方法:前瞻性分析2019年12月—2021年12月上海交通大学医学院附属第九人民医院临床拟诊为舌部肿物的患者55例,术前均行颌面部常规MRI平扫、3D-ASL、扩散加权成像(diffusion-weighted imaging,DWI)和动态增强(dynamic contrast-enhanced,DCE)序列扫描。计算病灶的TBF,术后组织切片用CD34及Ki67染色以评估微血管密度(microvessel density,MVD)。利用SPSS 26.0软件中的Mann-Whitney U检验分析不同疾病间的TBF,以及TBF和MVD的相关性。结果:舌异位甲状腺(ectopic thyroid,ET)在ASL的TBF伪彩图上均表现为整体红色的高灌注区(100%),且高灌注的面积最大(100%)。舌鳞状细胞癌(squamous cell carcinoma,SCC)早期高灌注比例较高(13例,13/15,86.7%)。测量瘤体血流最大区域TBFmax、TBFmean、ADC值之间的差异具有统计学意义(P<0.05)。所有肿瘤中MVD与TBFmean、TBFmax呈强正相关(rs=0.89、0.93,R2=0.70、0.84,P<0.01)。结论:3D-ASL可无创评估舌部肿瘤血流,利于区别良、恶性肿瘤。SCC分级越高,高灌注出现越少,可反映出受肿瘤侵犯的程度。

3D-ASL的rCBF max值在儿童后颅窝肿瘤鉴别诊断中的价值

目的:探讨三维动脉自旋标记成像(3D-ASL)参数rCBF_(max)对儿童后颅窝肿瘤的诊断价值。方法:回顾性分析2018年1月-2022年12月在本院经手术病理证实的52例后颅窝肿瘤患儿的临床和术前MRI资料(平扫、增强和3D-ASL)。其中,髓母细胞瘤28例,毛细胞星形细胞瘤11例,室管膜瘤13例。测量肿瘤实性区域的最大脑血流量(CBF_(max))值,并计算最大相对脑血流量(rCBF_(max)=CBF_(max)/CBF_(健侧正常脑灰质))。采用Kruskal-Wallis检验比较3组肿瘤的rCBF_(max)值,采用ROC曲线和约登指数来确定rCBF_(max)鉴别肿瘤病理类型的最佳阈值、敏感度、特异度和曲线下面积(AUC)。结果:室管膜瘤的rCBF_(max)值最高,为1.53(1.27,2.04),毛细胞星形细胞瘤的rCBF_(max)值最低,为0.69(0.56,0.76),髓母细胞瘤的rCBF_(max)值为0.90(0.84,1.00)。三组肿瘤的rCBF_(max)值比较,差异有统计学意义(P<0.001)。ROC曲线分析显示鉴别室管膜瘤与髓母细胞瘤的rCBF_(max)最佳阈值为1.13,相应的诊断敏感度为100%,特异度为82.1%,AUC为90.7%;鉴别髓母细胞瘤与毛细胞星形细胞瘤的rCBF_(max)最佳阈值为0.80,相应的诊断敏感度为85.7%,特异度为100%,AUC为97.1%。结论:3D-ASL定量参数rCBF_(max)对常见儿童后颅窝肿瘤的鉴别诊断具有较高的临床应用价值。

3D-ASL对急性缺血性脑卒中保守治疗远期预后的预测价值

目的研究动脉自旋标记(arterial spin labeling,ASL)对于急性缺血性脑卒中(acute ischemic stroke,AIS)预后的临床实用价值。方法招募河北医科大学第一医院诊断为AIS患者,计算相对脑血流量(relativa cerebral blood flow,rCBF)。于起病3个月后,对患者进行电话随访,依照改良Rankins评分量表(modified Rankin Scale,mRS)进行预后评估,定义mRS评分0~2分者预后良好,3~6分者预后不良。比较2组间临床基线资料、灌注水平的差异。通过二元Logistic分析急性缺血性脑卒中患者不良预后的相关征象。描绘ROC曲线分析不同灌注水平对预后的预测价值,并计算最佳截断点。结果共纳入36例AIS患者,预后良好组20例,预后不良组16例。临床及影像资料单因素分析显示,入院NIHSS评分、灌注水平对AIS预后存在统计学差异。二元Logistic分析表明低灌注(OR=0.149,95%CI:0.030~0.743,P=0.020)是AIS预后不良的独立危险因素。通过rCBF值预测脑卒中预后的ROC曲线下面积为0.7266(P=0.0210;95%CI:0.5270~0.9261),最佳界点为61.50%,敏感性95.00%,特异性62.50%。结论脑卒中患者急性期ASL可有效预测保守治疗后远期预后,当梗死区域正常灌注,倾向于预后良好,低灌注者往往预后不良,而梗死区域出现高灌注与临床预后无明显相关性。

3D-ASL技术在高级别脑胶质瘤术后复发的价值研究

目的探讨三维动脉自旋标记灌注成像(3D-ASL)在高级别脑胶质瘤术后肿瘤复发的应用价值。方法回顾性分析2019年12月—2021年12月河北省涿州市医院经穿刺活检或手术病理证实的31例高级别脑胶质瘤术后复发患者作为研究对象。全部患者行磁共振平扫、增强扫描、3D-ASL检查,测量高级别脑胶质瘤术后复发区域、对侧正常脑组织脑血流量(CBF),分为复发组CBF、正常组CBF,进行统计学分析。通过常规磁共振检查阅片与常规磁共振检查联合3D-ASL阅片分别诊断,分析诊断符合率进行统计学比较。结果高级别脑胶质瘤术后复发组CBF明显高于正常组CBF,差异有统计学意义(P<0.05);常规磁共振检查联合3D-ASL阅片诊断高级别脑胶质瘤术后复发的诊断符合率较常规磁共振检查阅片显著提高,差异有统计学意义(P<0.05)。结论3D-ASL技术在高级别脑胶质瘤术后复发中有较高的诊断效能,具有重要的临床应用价值。

3D-pCASL评估单侧大脑中动脉慢性重度狭窄患者脑血流动力学可行性研究

目的 探讨3D-pCASL评估单侧大脑中动脉重度狭窄患者脑血流动力学改变的可行性。方法收集CTA或M R A检查提示一侧大脑中动脉重度狭窄(血管腔狭窄70%-99%)患者32例,分别行3D-pCASL(PLD选择1.5s、2.5s)及DSC-PWI检查;在患侧DSC-达峰时间(TTP)异常最显著层面及镜面对照区分别测量两个PLD脑血流量(CBF)及DSC-PWI的CBF、脑血容量(CBV)、平均通过时间(MTT)和TTP,采用配对t检验比较两侧脑区各参数的差异。计算血管狭窄侧与镜面对照脑区相对值,采用Pearson相关检验分析各参数间相关性。同时测量AS L-PLD 1.5s CBF和DSC-TTP灌注异常区域的面积并行配对t检验。结果与对照脑区比较,32例患者异常灌注脑区ASL-PLD 1.5s及2.5s CBF、DSC-CBF、 DSC-MTT、DSC-TTP参数值间差异具有统计学意义(t值分别为-29.94、-20.07、-11.83、14.33、13.48,P值均<0.01);DSC-CBV间无统计学意义(t=-1.51,P=0.143);异常灌注脑区ASL-PLD 1.5s CBF与ASL-PLD 2.5s CBF间差异具有统计学意义(t=5.84,P<0.01)。标准化后ASLPLD 1.5s rCBF与DSC-rMTT、DSC-rTTP呈负相关(r值分别为-0.71、-0.79,P值均<0.01),ASL-PLD2.5s rCBF与DSC-rC BF差异无统计学意义(t=-1.85,P>0.05)。DSC-TTP与ASL-PLD 1.5s CBF灌注减低区域面积差异无统计学意义(t=1.834,P>0.05)。结论3D-pCASL(PLD 1.5s及2.5s)灌注成像可以评价单侧大脑中动脉重度狭窄患者脑血流动力学的改变情况,并且具有定量及无需注射钆对比剂的优点。

CTP联合3D-ASL在缺血性脑卒中诊断与预后评估中的作用

目的分析CT灌注成像(CTP)联合三维动脉自旋标记(3D-ASL)在缺血性脑卒中诊断与预后评估中的临床应用价值。方法以2022-12—2023-12在三亚市人民医院就诊的缺血性脑卒中疑似患者120例为对象,所有患者均接受CTP、3D-ASL、DSA检查,以DSA检查为确诊标准,比较CTP、3D-ASL及二者联合诊断缺血性脑卒中及评估预后的灵敏度、特异度、准确性,制作3种方法诊断缺血性脑卒中及评估预后的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)。结果120例疑诊缺血性脑卒中患者中,确诊74例(61.67%),排除46例(38.33%)。74例缺血性脑卒中患者中,预后良好32例(43.24%),预后较差42例(56.76%)。CTP、3D-ASL、CTP联合3D-ASL诊断缺血性脑卒中及评估预后的效能有差异,CTP联合3D-ASL检查的灵敏度(93.75%)、特异度(95.24%)、准确率(94.59%)最高(P<0.05)。CTP、3D-ASL、CTP联合3D-ASL诊断缺血性脑卒中和评估预后的AUC值分别为0.7725、0.8234、0.9143和0.7946、0.8122、0.8883,差异有统计学意义(P<0.05)。结论CTP联合3D-ASL能够显著提高诊断缺血性脑卒中和评估预后的灵敏度、特异度、准确率,临床应用价值较高。