磁共振3D-pcASL技术在超急性脑梗死缺血半暗带检测及预后判断中的应用  

The application of magnetic resonance 3D-pcASL technique in the detection of ischemic penumbra and the prognostic estimation of hyper-acute cerebral infarction

作　　者：刘洋[1] 戴真煜[1] 陈飞[1] 姚立正[1] 董从松[1] 张志平[1] 胡建斌[1] LIU Yang;DAI Zhenyu;CHEN Fei;YAO Lizheng;DONG Congsong;ZHANG Zhiping;HU Jianbin(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1242-1245,共4页Journal of Medical Imaging

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

摘　　要：目的评价磁共振(MR)三维伪连续动脉自旋标记(3D-pcASL)在超急性缺血性脑梗死理论缺血半暗带检测及临床预后判断中的应用价值。方法搜集我院29例超急性期缺血性脑梗死,随访12周以上,并回顾分析其MR图像。根据随访徒手肌力测试(MMT)分成预后好组(A组)和预后差组(B组)。计算理论缺血半暗带(IP)采用最大梗死层面脑血流(CBF)异常灌注(SCBF)减去DWI图梗死面积(SDWI)。分别比较两组理论IP区CBF与对侧的差异,并分析理论IP区病灶/对侧相对CBF(r CBF)在两组间的差异及诊断效能。结果 27例患者存在理论IP(SCBF> SDWI),另外2例患者SCBF≈SDWI。两组梗死区和IP区的CBF均较对侧明显降低(P <0. 05)。A组IP区r CBF高于B组(P <0. 05)。ROC曲线示IP区r CBF在两组间最佳诊断界值为0. 428。结论 3D-pcASL技术在临床工作中可用于理论缺血半暗带计算并有效判断患者预后及最佳治疗方案的选择。Objective To evaluate the application value of magnetic resonance（MR） 3 D pseudo continuous arterial spin labeling（3 D-pcASL） in the detection of ischemic penumbra and clinical prognostic estimation of hyper-acute ischemic cerebral infarction. Methods We collected 29 cases of hyper-acute ischemic cerebral infarction in our hospital,followed up for more than12 weeks,and retrospectively analyzed MR images. Based on the follow up results of manual muscle test（MMT）,the patients were divided into good prognosis group（group A） and bad prognosis group（group B）. The abnormal perfusion area（SCBF） on cerebral blood flow（CBF） images subtract infarction area on DWI images（SDWI） was used to calculate the theoretical ischemic penumbra（IP）. We compared the differences of CBF between theoretical IP and contra of both groups,respectively,and analyzed differences of the theoretical IP lesions/contra relative CBF（r CBF） between two groups,also the diagnostic efficiency of r CBF. Results 27 patients had theoretical IP（SCBF SDWI）,and the other 2 patients were SCBF≈SDWI. The CBF of infarction area and IP was lower than contra in both two groups（P〈0. 05）. The r CBF of IP in group A was higher than that in group B（P〈0. 05）. ROC curve showed the best diagnostic cut off value of r CBF of IP was 0. 428 between two groups. Conclusion The 3 D-pcASL technique can be used in calculating the theoretical IP in clinical work and evaluating the prognosis of patients effectively,which is beneficial to early doctor-patient communication and the selection of best treatment project.

关 键 词：磁共振成像 动脉自旋标记 脑血流量 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]