磁共振DTI联合3D-pcASL灌注成像在急性脑梗死预后判断中的应用  

The application of magnetic resonance DTI combine with 3D-pcASL in judging prognosis of acute cerebral infarction

作　　者：潘文艳[1] 陈飞[1] 戴真煜[1] 董从松[1] 姚立正[1] 刘洋[1] 张志平[1] PAN Wenyan;CHEN Fei;DAI Zhenyu;DONG Congsong;YAO Lizheng;LIU Yang;ZHANG Zhiping(Department of Radiology,Affiliated Yancheng Hospital of Southeast University Medical College,Yancheng 224001,P.R.China)

机构地区：[1]东南大学医学院附属盐城医院影像科,江苏盐城224001

出　　处：《医学影像学杂志》2018年第8期1230-1233,共4页Journal of Medical Imaging

基　　金：江苏省"六大人才高峰"资助(编号:WSN-103);江苏省盐城市医学科技发展计划(编号:YK2015097)

摘　　要：目的探讨磁共振(MR)弥散张量成像(DTI)和三维伪连续动脉自旋标记(3D-pcASL)灌注成像在急性缺血性脑梗死(ACI)预后判断中的临床应用价值。方法回顾性分析我院51例单侧ACI患者(随访≥3月)的初次MR检查的DTI和3D-pcASL。依据随访3月末改良Rankin量表(mRS)评分将患者分为预后较好(A组)、预后中等(B组)和预后较差(C组)三组。在各项异性指数(FA)、平均弥散系数(DCavg)和脑血流量(CBF)参数图上选取病灶和相应对侧为感兴趣区(ROI),记录各参数值并计算病灶/对侧相对参数值(r FA、r DCavg和r CBF)。比较FA、DCavg和CBF在病灶与对侧间的差异,分析r FA、r DCavg和r CBF在三组间的差异和最佳诊断界值。结果三组脑梗死病灶区FA、DCavg和CBF值均低于对侧(P <0. 05)。A-B-C组脑梗死r FA和r CBF值逐渐减低(P <0. 05),其中r FA在A-B组间无统计学差异,r CBF在B-C组间无统计学差异。ROC曲线示r CBF值在A-B组间最佳诊断界值分别为0. 453;r FA值在B-C组间最佳诊断界值为0. 699。结论 FA、DCavg及CBF值在ACI中有其自身的改变规律;其中r FA和r CBF可有助于临床对ACI患者预后的判断。Objective To explore the clinical application value of magnetic resonance（MR） diffusion tensor imaging（DTI）and 3 D pseudo continuous arterial spin labeling（3 D-pcASL） perfusion imaging in judging prognosis of acute ischemic cerebral infarction（ACI）. Methods We retrospectively analysed DTI and 3 D-pcASL images of 51 patients with unilateral ACI（≥ 3 months follow up） from our hospital. The patients were divided into three groups of good prognosis（group A）,medium prognosis（group B） and poor prognosis（group C） according to the 3-month follow up results of modified Rankin scale（mRS）. We set the regions of interest（ROI） of infarction lesions and the contra on fractional anisotropy（FA）,average diffusion coefficient（DCavg）and cerebral blood flow（CBF） parameters mapping,and recorded the parameters values and calculate the relative parameters value（r FA,r DCavg and r CBF） of infarction lesion to the contra. We compared the differences of FA,DCavg and CBF values between infarction lesions and the contra,also analysed the differences and the best diagnosis cutoff of r FA,r DCavg and r CBF values among three groups. Results The FA,DCavg and CBF value of cerebral infarction lesions were lower than the contral in all three groups（P 0. 05）. The r FA and r CBF value were gradually decreased from Group A,B to C（P 0. 05）,but there were no difference of r FA value between Group A and B and the r CBF value between Group B and C. ROC curve showed the best diagnosis cut off value of r CBF was 0. 453 between Group A and B,the best diagnosis cut off value of r FA was 0. 699 between Group B and C. Conclusion The FA,DCavg and CBF value have their own change mode in ACI,among them,the r FA and r CBF values could be benefit for judging prognosis of patients with ACI in clinic.

关 键 词：磁共振成像 弥散张量成像 动脉自旋标记 急性脑梗死 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]