赵文超;宋雨;唐晨虎;吴雪;马东;姜亦伦;

• 1:南京中医药大学附属南京市中西医结合医院放射科
• 2:南京中医药大学附属南京市中西医结合医院超声科
• 3:无锡市锡山人民医院神经内科

摘要(Abstract)：

目的探讨磁共振三维准连续式动脉自旋标记(3D pseudo-continuous arterial spin labeling,3D-pCASL)成像在急性脑梗死患者中的临床应用价值。材料与方法分析急性脑梗死患者84例(脑梗死组),其中脑梗死组根据溶栓后有无出血转化,分为出血转化组(35例)和无出血转化组(49例)。另选取50例健康志愿者作为对照组。所有患者都经磁共振3D-pCASL检查,并进行统计学分析。结果脑梗死患者在常规MRI序列图像上呈现大脑半球大片低灌注区,远端血管分支未见显示,扩散加权成像(diffusion weighted imaging,DWI)均表现为明显高信号,ADC图像均表现为明显低信号。脑梗死患者病灶位于右侧大脑半球者54例,病灶位于左侧大脑半球者30例。脑梗死核心区相对脑血流量(relative cerebral blood flow,rCBF)绝对值和ADC值较对侧镜像区降低,且两侧rCBF绝对值和ADC值均低于健康对照组(P<0.05)。以3D-pCASL图像后处理参数rCBF进行ROC曲线分析,ROC下面积为0.915。出血转化组患者脑梗死核心区边缘rCBF绝对值和ADC值较无出血转化组高(P<0.05),以3D-pCASL图像后处理参数rCBF进行ROC曲线分析,ROC下面积为0.926。结论磁共振3D-pCASL可显示急性脑梗死患者梗死病灶的血液动力学状态的信息,结合rCBF可客观反映脑组织缺血梗死灌注改变,并对治疗后出血转化的预判有一定价值,为临床诊断提供影像学依据。

关键词(KeyWords)： 磁共振成像;三维准连续式动脉自旋标记;脑卒中;短暂性脑缺血发作;扩散加权成像

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赵文超;宋雨;唐晨虎;吴雪;马东;姜亦伦;

Email:

DOI:

参考文献(References)：

• [1]Dai W,Fong T,Jones RN,et al.Effects of arterial transit delay on cerebral blood flow quantification using arterial spin labeling in an elderly cohort.J Magn Reson Imaging,2017,45:472-481.DOI:10.1002/jmri.25367.
• [2]Yu S,Ma SJ,Liebeskind DS,et al.ASPECTS-based reperfusion status on arterial spin labeling is associated with clinical outcome in acute ischemic stroke patients.J Cereb Blood Flow Metab,2018,38(3):382-392.DOI:10.1177/0271678x17697339.
• [3]Madai VI,Martin SZ,von Samson-Himmelstjerna FC,et al.Correction for susceptibility distortions increases the performance of arterial spin labeling in patients with cerebrovascular disease.J Neuroimaging,2016,26(4):436-444.DOI:10.1111/jon.12331.
• [4]Leng X,Lan L,Liu L,et al.Good collateral circulation predicts favorable outcomes in intravenous thrombolysis:a systematic review and mate-analysis.Eur J Neurol,2016,23:1738-749.DOI:10.1111/ene.13111.
• [5]Yu S,Liebeskind DS,Dua S,et al.Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke.J Cereb Blood Flow Metab,2015,35(4):630-637.DOI:10.1038/jcbfm.2014.238.
• [6]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 Stroke Cerebrova Dis,2016,25:2099-2108.DOI:10.1016/j.jstrokecerebrovasdis.2016.06.005.
• [7]Hwang YH,Kwon YS,Lee YH.STA-distal ACA bypass using a contralateral STA interposition graft for symptomatic ACA stenosis.JCerebrovasc Endovasc Neurosurg,2018,20(3):191-197.DOI:10.7461/jcen.2018.20.3.191.
• [8]Fujiwara Y,Matsuda T,Kanamoto M,et al.Comparison of long-labeled pseudo-continuous arterial spin labeling (ASL) features be-tween young and elderly adults:special reference to parameter selection.Acta Radiologica,2017,58:84-90.DOI:10.1177/0284185116632387.
• [9]Jeong DK,Hwang SK.A case of posterior inferior cerebellar artery infarction after cervical chiropractic manipulation.Korean JNeurotrauma,2018,14(2):159-163.DOI:10.13004/kjnt.2018.14.2.159.
• [10]Wang W,Jiang B,Sun H,et al.Prevalence,incidence,and mortality of stroke in China:Results from a nationwide population-based survey of 480687 adults.Circulation,2017,135(8):759-771.DOI:10.1161/CIRCULATIONAHA.116.025250.
• [11]Wolman DN,Iv M,Wintermark M,et al.Can diffusion and perfusionweighted imaging alone accurately triage anterior circulation acute ischemic stroke patients to endovascular therapy.J Neurointerv Surg,2018,10(12):1132-1136.DOI:10.1136/neurintsurg-2018-013784.
• [12]Eisenhut M.In diabetic ketoacidosis brain injury including cerebral oedema and infarction is caused by interleukin-1.Med Hypotheses,2018,12(121):44-46.DOI:10.1016/j.mehy.2018.09.005.
• [13]Jiang L,Su HB,Zhang YD,et al.Collateral vessels on magnetic resonance angiography in endovascular-treated acute ischemic stroke patients associated with clinical outcomes.Oncotarget,2017,8(46):81529-81537.DOI:10.18632/oncotarget.21081.
• [14]Huh IY,Han IS,Lee HK,et al.Recurrent thrombosis after carotid endarterectomy secondary to activated protein C resistance and essential thrombocytosis:A case report.Medicine(Baltimore),2018,97(44):e13118.DOI:10.1097/MD.0000000000013118.
• [15]Mosimann PJ,Kaesmacher J,Gautschi D,et al.Predictors of unexpected early reocclusion after successful mechanical thrombectomy in acute ischemic stroke patients.Stroke,2018,49(11):2643-2651.DOI:10.1161/STROKEAHA.118.021685.
• [16]Dong X,Bai C,Nao J.Influential factors and clinical significance of fluid-attenuated inversion recovery vascular hyperintensities in transient ischemic attacks of carotid arterial system.Neuroradiology,2017,59(11):1093-1099.DOI:10.1007/s00234-017-1906-z.
• [17]Hoving JW,Marquering HA,Majoie CBLM,et al.Volumetric and spatial accuracy of computed tomography perfusion estimated ischemic core volume in patients with acute ischemic stroke.Stroke,2018,49(10):2368-2375.DOI:10.1161/STROKEAHA.118.020846.
• [18]Sakai Y,Delman BN,Fifi JT,et al.Estimation of ischemic core volume using computed tomographic perfusion.Stroke,2018,49(10):2345-2352.DOI:10.1161/STROKEAHA.118.021952.
• [19]Yoo J,Baek JH,Park H,et al.Thrombus volume as a predictor of nonrecanalization after intravenous thrombolysis in acute stroke.Stroke,2018,49(9):2108-2115.DOI:10.1161/STROKEAHA.118.021864.
• [20]Luo S,Yang L,Luo Y.Susceptibility-weighted imaging predicts infarct size and early-stage clinical prognosis in acute ischemic stroke.Neurol Sci,2018,39(6):1049-1055.DOI:10.1007/s10072-018-3324-3.
• [21]Reijmer YD,van den Heerik MS,Heinen R,et al.Microstructural white matter abnormalities and cognitive impairment after aneurysmal subarachnoid hemorrhage.Stroke,2018,49(9):2040-2045.DOI:10.1161/STROKEAHA.118.021622.
• [22]Chen ML,Gupta A,Chatterjee A,et al.Association between unruptured intracranial aneurysms and downstream stroke.Stroke,2018,49(9):2029-2033.DOI:10.1161/STROKEAHA.118.021985.
• [23]Kim D,Lee H,Jung JM,et al.Hypointensity on susceptibility-weighted images prior to signal change on diffusion-weighted images in a hyperacute ischemic infarction:A case study.Investig Magn Reson Imaging,2018,2(22):131-134.DOI:10.13104/imri.2018.22.2.131.
• [24]Zhuang FJ,Chen Y,He WB,et al.Prevalence of white matter hyperintensities increases with age.Neural Regen Res,2018,13(12):2141-2146.DOI:10.4103/1673-5374.241465.
• [25]Wang T,Zhu L,Hu C,et al.The diagnostic value of susceptibilityweighted imaging for ischemic penumbra in patients with acute ischemic stroke.Technol Health Care,2017,25(Suppll 1):449-457.DOI:10.3233/THC-171348.