4D-ASL在缺血性脑卒中疗效评价中的应用价值

doi:10.7517/issn.1674-0475.230707

摘要/Abstract

摘要： 探索四维动脉自旋标记(4D-ASL)在缺血性脑卒中(CIS)疗效评价中的应用价值。选取2021年8月至2023年1月期间就诊于陈家桥医院的48例发病7天内的CIS患者,分别于治疗前后行三维动脉自旋标记(3D-ASL)、4D-ASL磁共振血管造影(MRA)和功能独立性评定(FIM)评分,记录梗死核心区、健侧镜像区的脑血流量(CBF),分析治疗前后的CBF值的关系。依据3D-ASL图像梗死区周围的点状或带状高信号来判断侧支循环,分析有、无侧支循环的相对CBF(rCBF)与FIM的相关性。4D-ASL MRA观察脑血管形态。结果显示,治疗前、后梗死核心区的CBF值低于健侧镜像区的CBF值,且治疗前CBF值低于治疗后CBF值,差异具有统计学意义(P＜0.05)。治疗前的rCBF、FIM评分低于治疗后的rCBF、FIM评分,治疗前后的rCBF与FIM评分呈正相关,差异具有统计学意义(P＜0.05)。在梗死核心区周围,有侧支循环的rCBF高于无侧支循环的rCBF,差异有统计学意义(P＜0.05)。4D-ASL MRA显示侧支血管12例,与3D-ASL的符合率为75%。4D-ASL技术可有效评估CBF和侧支循环情况,动态显示脑血管形态,达到类数字减影血管造影效果,4D-ASL在CIS疗效评价中有一定的预测价值。

关键词: 动脉自旋标记, 四维动脉自旋标记, 缺血性脑卒中, 脑血流量, 侧支循环

Abstract: This article explores the application value of four-dimensional arterial spin labeling (4D-ASL) in evaluating the efficacy of cerebral ischemic stroke (CIS). Forty-eight patients with CIS who were hospitalized in Chenjiaqiao Hospital from August 2021 to January 2023 within 7 days after the onset of the disease were selected to receive three-dimensional arterial spin labeling (3D-ASL), 4D-ASL magnetic resonance angiography (MRA) and functional independence measure (FIM) scores before and after treatment, respectively. The cerebral blood flow (CBF) in the infarct core area and contralateral mirror area were recorded, and the relationship between the CBF values before and after treatment was analyzed. The collateral circulation was judged according to the dotted or banded high signal around the infarct area of 3D-ASL image, and the correlation between relative CBF (rCBF) and FIM 277 with and without collateral circulation was analyzed. The morphology of cerebral vessels was observed by 4D-ASL MRA. The results showed that the CBF values in the core area of the infarction before and after treatment were lower than those in the contralateral mirror area, and the CBF values before treatment were lower than those after treatment, with a statistically significant difference (P<0.05). The rCBF and FIM scores before and after treatment were lower than those after treatment. The rCBF and FIM scores before and after treatment were positively correlated, and the difference was statistically significant (P<0.05). Around the core infarction area, rCBF with collateral circulation was higher than that without collateral circulation (P<0.05). 4D-ASL MRA showed collateral vessels in 12 cases, and the coincidence rate with 3D-ASL was 75%. 4D-ASL technology can effectively evaluate CBF and collateral circulation, dynamically display the morphology of cerebral vessels, and achieve the effect of digital subtraction angiography. 4D-ASL has certain predictive value in the evaluation of CIS efficacy.

Key words: arterial spin labeling, four-dimensional arterial spin labeling, cerebral ischemic stroke, cerebral blood flow, collateral circulation

林小翼, 万平华, 雷达, 李蔚翔, 张宗利. 4D-ASL在缺血性脑卒中疗效评价中的应用价值[J]. 影像科学与光化学, 2023, 41(5): 277-282.

LIN Xiaoyi, WAN Pinghua, LEI Da, LI Weixiang, ZHANG Zongli. The Application Value of 4D-ASL in Evaluating the Efficacy of Cerebral Ischemic Stroke[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(5): 277-282.

参考文献

[1] Rattanawong W,Ongphichetmetha T,Hemachudha T,et al. Neurofilament light is associated with clinical outcome and hemorrhagic transformation in moderate to severe ischemic stroke[J]. Journal of Central Nervous System Disease,2023,15:11795735221147212.
[2] 艾莉,彭亚飞,鲁宏,等. 3D-ASL对急性脑梗死侧支循环建立的评估价值初探[J].中国CT和MRI杂志,2021,19(12):10-12,38.
[3] Alqahtani S A,Alnaami I,Alhazzani A,et al. Correlation between pre-treatment collateral status and short-term functional outcome in patients with mild to moderate stroke after reperfusion therapy in a local primary stroke center in the southwestern part of Saudi Arabia[J]. Cureus,2023,15(1):e33997.
[4] Akiyama T,Morioka T,Shimogawa T,et al. Arterial spin-labeling magnetic resonance perfusion imaging with dual postlabeling delay in internal carotid artery steno-occlusion:Validation with digital subtraction angiography[J]. Journal of Stroke and Cerebrovascular Diseases,2016,25(9):2099-2108.
[5] 魏田敏,王超伟,李青,等.三维动脉自旋标记技术对缺血性脑卒中患者缺血半暗带和侧支循环的评估价值[J]. 心脑血管病防治,2021,21(6):598-600.
[6] He Q M,Li G M,Jiang M E,et al. Predicting a favorable (mRS 0-2) or unfavorable (mRS 3-6) Stroke outcome by arterial spin labeling and amide proton transfer imaging in post-thrombolysis stroke patients[J]. Journal of Personalized Medicine,2023,13(2):248.
[7] 张亚运,李珍,苗重昌. 功能磁共振3D-ASL和DWI模式对缺血性脑卒中患者颅内血流动力学及梗死情况的应用价值[J]. 中国CT和MRI杂志,2022,20(6):32-35.
[8] 陈玲,李涛,罗雪,等.磁共振三维动脉自旋标记成像在急性缺血性脑梗死的定量研究[J]. 实用放射学杂志,2020,36(10): 1544-1547.
[9] 李娟,邵广瑞,黄玲,等. ASL联合t-ASL技术在评估单侧大脑中动脉闭塞后侧支循环中的应用[J]. 实用放射学杂志,2022,38(7):1061-1064.
[10] 周杰,王开乐,张欣. 多模态MRI评估急性缺血性脑梗死侧支循环的临床分析[J]. 中国CT和MRI杂志,2022,20(5): 26-29.
[11] 中华医学会放射学分会质量管理与安全管理学组中华医学会放射学分会磁共振学组. 动脉自旋标记脑灌注MRI技术规范化应用专家共识[J]. 中华放射学杂志,2016,50(11):817-824.
[12] Zhou J G,Fu D Y,Meng Y,et al. Application of three-dimensional arterial spin labeling technique in the assessment of cerebral blood perfusion in patients with middle cerebral artery occlusion: analysis of clinical implications and prognostic factors[J]. Disease Markers,2022,2022:1-8.
[13] Phellan R,Lindner T,Helle M,et al. Segmentation-based blood flow parameter refinement in cerebrovascular structures using 4-D arterial spin labeling MRA[J]. IEEE Transactions On Bio-medical Engineering,2020,67(7):1936-1946.
[14] Togao O,Hiwatashi A,Obara M,et al. 4D ASL-based MR angiography for visualization of distal arteries and leptomeningeal collateral vessels in moyamoya disease:A comparison of techniques[J]. European Radiology,2018,28(11):4871-4881.
[15] Iryo Y, Hirai T, Nakamura M, et al. Evaluation of intracranial arteriovenous malformations with four-dimensional arterial-spin labeling-based 3-T magnetic resonance angiography[J].Journal of Computer Assisted Tomography,2016,40(2):290-296.
[16] Iryo Y, Hirai T, Nakamura M, et al. Collateral circulation via the circle of Willis in patients with carotid artery steno-occlusive disease:Evaluation on 3-T 4D MRA using arterial spin labelling[J]. Clinical Radiology,2015,70(9): 960-965.
[17] Wang M X,Yang Y B,Wang Y,et al. Vessel-selective 4D MRA based on ASL might potentially show better performance than 3D TOF MRA for treatment evaluation in patients with intra-extracranial bypass surgery:A prospective study[J]. European Radiology,2021,31(7):5263-5271.
[18] Wu D,Zhou Y R,Zhang G L,et al. Collateral circulation predicts 3-month functional outcomes of subacute ischemic stroke patients:A study combining arterial spin labeling and MR angiography[J]. European Journal of Radiology,2023,160:110710.