SWI与ASL联合应用对轻中度急性脑梗死诊断及预后评估的价值

目的探讨3.0 T MR磁敏感加权成像(SWI)与动脉自旋标记成像(ASL)对于急性缺血性脑卒中缺血半暗带(IP)、侧支代偿储备、出血转化(HT)、责任血管及近期预后评估的临床应用价值。材料与方法 35例急性缺血性脑卒中患者行常规MR序列、SWI和3D-PCASL检查,通过软件进行后处理,得出SWI最小密度投影图和3D-ASL伪彩图。观察35例患者梗死核心区周围引流静脉形态学改变,分为引流静脉明显显示组和正常显示组,分别对两组入院当日及15 d NIHSS评分进行分析。将未经溶栓治疗的33例患者,依据3D-ASL伪彩图提示梗死核心区周围是否出现匍匐走行条状高灌注信号,分为侧支代偿组和对照组,并对其入院当日与15 d后NIHSS评分进行分析。依据3D-ASL提示的梗死核心区灌注状态不同,分为高灌注组和低灌注组,结合SWI提示HT的发生率,统计分析梗死核心区不同灌注状态与HT发生之间的关联。结果梗死区周围引流静脉明显显示组预后好转、稳定及进展比例分别为13/27、6/27和8/27;正常显示组预后好转、稳定及进展比例分别为6/8、2/8和0/8,两组近期预后进展差异有统计学意义(P=0.0432)。侧支代偿组与对照组入院当日NIHSS评分差异无统计学意义(t=0.886,P=0.392),侧支代偿组近期预后好转、稳定及进展比例为13/17、3/17和1/17;而对照组近期预后好转、稳定及进展比例为5/16、4/16和7/16,两组15 d后NIHSS评分差异有统计学意义(t=2.296,P=0.039)。梗死核心高灌注组HT发生比例为6/6,低灌注组HT发生比例为5/29,两组差异有显著统计学意义(P=0.000)。结论 SWI与ASL联合MR常规序列检查,能够更好评估IP范围、侧支循环代偿建立状态、责任血管及HT等相关信息,对于了解急性脑卒中患者缺血梗死现状及近期预后评估提供客观依据。

The value of susceptibility weighted imaging combined with arterial spin labeling in diagnosis and prognosis in mild-to-moderate acute ischemic cerebral stroke

AbstractObjective:To study the clinical diagnostic value of 3.0 T magnetic resonance susceptibility weighted imaging (SWI) combined with arterial spin labeling (ASL) in ischemic penumbra (IP), collateral compensatory reserves, hemorrhage transformation (HT), responsible blood vessels and the recent prognosis of patients with acute cerebral infarction.Materials and Methods:Thirty-ifve patients with acute ischemic stroke underwent conventional MR sequences, SWI and 3D-PCASL check. Then the SWI minimum intensity projection and 3D-ASL pseudo color pictures were obtained by postprocessing with the software. According to drainage morphological changes around infarction core, 35 cases were divided into the obvious display group and the normal display group. Respectively, the NIHSS score of the two groups on the day of admission and the 15th day was analysed. Thirty-three patients without thrombolytic therapy, according if creeping line strip high perfusion signal existed in the 3D-ASL pseudo color pictures that surrounding the infarction core area, were divided into the collateral compensative group and the control group, and on the day of admission and after 15 d NIHSS scores were analyzed respectively on the day of admission and the 15th day. According to the difference of perfusion state in the infarct core area 3D-ASL suggested, 35 cases were divided into high perfusion group and low perfusion group. Combined with the incidence of HT SWI, the relationship between different perfusion status in the core area of infarction and the occurrence of HT was statistically analysed.Results:The obvious display group showed the prognosis, stability and progress in proportion respectively for 13/27, 6/27 and 8/27, while the normal display group showed that respectively for 6/8, 8 and 0/8, the progress difference of short-term prognosis of two groups was statistically significant (P=0.0432). The NIHSS score difference between the collateral compensative group and the control group was not statistically signiifcant (t=0.886,P=0.392). The collateral compensative group showed the recent prognosis improvement, stability and progress in proportion respectively for 13/17, 3/17 and 1/17, while the control group showed that respectively for 5/16, 4/16 and 7/16, and between the two groups after 15 d NIHSS score differences had statistical signiifcance (t=2.296,P=0.039). The incidence of HT in the infarction core high perfusion group was 6/6, while the proportion of HT in the low perfusion group was 5/29, and the difference between the two groups was statistically signiifcant (P=0.000).Conclusions:MRI imaging combined with ASL as well as SWI, can better evaluate cell oxygen metabolic state, blood perfusion, HT and so on, the IP range, collateral compensatory reserves and short-term prognosis, which provide the basis for clinical diagnosis and treatment.