MR三维动脉自旋标记、双指数模型弥散加权成像评估急性前循环大血管闭塞患者再通后再灌注损伤风险  

Application of MR 3D-ASL and bi-exponential model DWI in evaluating the risk of reperfusion injury in patients with acute anterior circulation large vessel occlusion after vascular recanalization

作　　者：陈峰[1] 王洁[2] 甘解华[1] 王高燕[2] 卢苗青[1] 赵嘉林[1] 陈勇[1] CHEN Feng;WANG Jie;GAN Jiehua;WANG Gaoyan;LU Miaoqing;ZHAO Jialing;CHEN Yong(Department of Neurology,Ningbo Medical Center LI Huili Hospital,Ningbo,Zhejiang Province 315040,China)

机构地区：[1]宁波市医疗中心李惠利医院神经内科,浙江315040 [2]宁波市医疗中心李惠利医院影像科,浙江315040

出　　处：《介入放射学杂志》2021年第12期1210-1214,共5页Journal of Interventional Radiology

基　　金：浙江省医药卫生科技计划项目(2018KY706)。

摘　　要：目的探讨MR三维动脉自旋标记(3D-ASL)、双指数模型弥散加权成像(DWI)对急性前循环大血管闭塞脑梗死患者血管再通治疗后再灌注损伤风险的评估作用。方法回顾性分析2018年6月至2020年6月在宁波市医疗中心李惠利医院接受取栓治疗的36例脑梗死患者。根据术后临床和功能MRI表现,将患者分为高灌注组和无高灌注组。比较不同灌注患者临床特征、脑血流量(CBF)、表观弥散系数(ADC)等参数差异。结果36例患者中无高灌注组22例(61.1%),高灌注组14例(38.9%)。单因素分析显示,无高灌注组患者年龄、术前美国国立卫生研究院卒中量表(NIHSS)评分,术后绝对CBF、相对CBF(rCBF)、ADC_(fast)、ADC_(slow)均低于高灌注组(P<0.05)。Spearman相关性分析显示,CBF与ADC_(fast)呈显著正相关(r=0.697,P<0.01)。二元logistic回归分析显示ADC_(fast)是预测患者术后高灌注的独立危险因素(P<0.05),受试者工作特征曲线(ROC)分析显示最佳阈值为51.2×10^(-4)mm^(2)/s。结论MR 3D-ASL、双指数DWI技术可较好地评估急性脑梗死患者血管再通术后再灌注损伤风险。Objective To discuss the application of MR 3-dimentional arterial spin labeling(3D-ASL and bi-exponential model diffusion-weighted imaging(DWI)in evaluating the risk of reperfusion injury in patients with acute anterior circulation large vessel occlusion after vascular recanalization.Methods The clinical data of 36 patients with cerebral infarction,who received vascular recanalization at the Ningbo Medical Center LI Huili Hospital of China between June 2018 and June 2020,were retrospectively analyzed.Based on the postoperative clinical manifestations and functional MRI findings,the patients were divided into high-perfusion group and non-high-perfusion group.The clinical features,cerebral blood flow(CBF),and apparent diffusion coefficient(ADC)were compared between the two groups.Results Of the 36 patients,non-high-perfusion group had 22(61.1%)and high-perfusion group had 14(38.9%).Univariate analysis showed that the age,preoperative NIHSS score,postoperative absolute CBF,postoperative relative CBF(rCBF),ADC_(fast)and ADC_(slow)in the nonhigh-perfusion group were obviously lower than those in the high-perfusion group(P<0.05).Spearman correlation analysis indicated that CBF had a significant parallel relationship with ADC_(fast)(r=0.697,P<0.01).Binary logistic regression analysis revealed that ADC_(fast)was an independent risk factor for predicting postoperative hyperperfusion(P<0.05).Analysis of receiv er operating characteristic curve(ROC)demonstrated that the optimal threshold was 51.2×10^(-4)mm^(2)/s.Conclusion MR 3D-ASL and bi-exponential model DWI can effectively evaluate the risk of reperfusion injury in patients with acute cerebral infarction after vascular recanalization.

关 键 词：三维动脉自旋标记 脑血流量 双指数模型弥散加权成像 动脉取栓术 再灌注损伤 

分 类 号：R743[医药卫生—神经病学与精神病学]