多PLD ASL成像预测急性缺血性脑卒中机械取栓术后远期神经功能良好的价值  

Efficacy of multidelay arterial spin labeling MRI in predicting long-term favorable neurological function in acute ischemic stroke patients after mechanical thrombectomy

作　　者：段琳言 於帆 王静娟 张苗[1,2] 卢洁 DUAN Linyan;YU Fan;WANG Jingjuan;ZHANG Miao;LU Jie(Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院放射与核医学科,北京100053 [2]磁共振成像脑信息学北京市重点实验室,北京100053

出　　处：《磁共振成像》2024年第10期86-92,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：宣武医院汇智人才工程-支持计划-领军人才项目(编号:HZ2021ZCLJ005)。

摘　　要：目的探讨多标记后延迟(post labeling delay,PLD)时间的动脉自旋标记(arterial spin labeling,ASL)成像预测急性缺血性脑卒中(acute ischemic stroke,AIS)患者机械取栓术后远期神经良好的价值。材料与方法回顾性纳入2021年6月至2023年11月于首都医科大学宣武医院急性卒中绿色通道行机械取栓治疗的AIS患者病例。所有患者机械取栓前均接受头部CT平扫、CT灌注(CT perfusion,CTP)及CT血管成像(CT angiography,CTA),术后24小时内均行扩散加权成像(diffusion weighted imaging,DWI)及多PLD ASL成像(PLD=1.00 s、1.22 s、1.48 s、1.78 s、2.15 s、2.62 s、3.32 s)。依据术后患侧与健侧脑组织低灌注区域体积分为良好灌注组和低灌注组,比较两组的临床一般资料。采用改良Rankin量表(modified Rankin Scale,mRS)评价患者术后90天神经功能预后,定义0~2分为神经功能良好,通过二元logistic回归、受试者工作特征(receiver operating characteristic curve,ROC)曲线分析多PLD ASL预测患者术后90天神经功能良好的价值。结果共纳入机械取栓术后的AIS患者32例,其中良好灌注组14例(43.8%),低灌注组18例(56.2%)。良好灌注组7天内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(4.10±3.76)显著低于低灌注组(7.80±4.51)(P=0.02);?NIHSS(8.10±4.99)显著高于低灌注组(4.20±3.81)(P=0.016);90天功能良好发生率(92.9%)显著高于低灌注组(50.0%)(P=0.019)。32例患者中22例实现90天神经功能良好(68.8%)。校正年龄、NIHSS入院、术前缺血半暗带等因素后发现术后多PLD ASL良好灌注是90天神经功能良好的独立预测指标(OR=14.246;95%CI:1.090~186.273,P=0.043),ROC曲线下面积为0.828(95%CI:0.666~0.990),预测90天神经功能良好的敏感度为75.0%,特异度为87.0%。结论术后24小时内多PLD ASL良好灌注与低灌注组间近期及远期神经功能预后均有显著差异,且术后24小时内多PLD ASL良好灌注是患者90天神经�Objective:To explore the efficacy of multidelay arterial spin labeling imaging(ASL)MRI in predicting long-term favorable neurological function after mechanical thrombectomy in patients with acute ischemic stroke(AIS).Materials and Methods:Patients who received mechanical thrombectomy in the AIS Greenway Department of Xuanwu Hospital,Capital Medical University from June 2021 to November 2023 were retrospectively analyzed.All patients underwent noncontrast CT,CT perfusion(CTP),and CT angiography(CTA)before mechanical thrombectomy.Diffusion weighted imaging(DWI)and multidelay ASL MRI[post labeling delay(PLD)=1.00,1.22,1.48,1.78,2.15,2.62,3.32 s]were performed within 24 hours after surgery.Patients were divided into good perfusion group and poor perfusion group according to the volume of hypoperfusion in the affected side and unaffected side.Clinical data of the two groups were compared.The modified Rankin Scale(mRS)was used to evaluate the 90 d post-surgery neurological function prognosis of patients.0~2 was defined as favorable function.The value of multidelay ASL MRI in predicting favorable neurological function at 90 d after surgery was analyzed by binary logistic regression model and receiver operating characteristic(ROC)curve.Results:A total of 32 patients with AIS after mechanical thrombectomy were included,with 14(43.8%)in good perfusion group and 18(56.2%)in poor perfusion group.Compared to poor perfusion group,NIHSS7 d(4.10±3.76 vs.7.80±4.51,P=0.02)was significantly lower in good perfusion group,ΔNIHSS(8.10±4.99 vs.4.20±3.81,P=0.016)and the incidence of favorable neurological function at 90 d(92.9%vs.50.0%,P=0.019)were significantly higher in good perfusion group.Of the 32 patients,22 achieved favorable neurological function at 90 d(68.8%).After adjusting age,NIHSS at admission,pre-surgery ischemic penumbra,the binary logistic regression showed that 24-hour post-surgery good perfusion in multidelay ASL MRI was an independent predictor of favorable neurological function at 90 d(OR=14.246;95%CI:1.090-186

关 键 词：急性缺血性卒中 动脉自旋标记成像 磁共振成像 机械取栓 预后 标记后延迟时间 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]