酰胺质子转移成像可较好诊断急性缺血性脑卒中患者的缺血半暗带  

Amide proton transfer imaging can effectively diagnose the ischemic penumbra in acute ischemic stroke patients

作　　者：赵子晴 徐红卫[1] ZHAO Ziqing;XU Hongwei(Department of Imaging,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院影像科,河南郑州450052

出　　处：《分子影像学杂志》2024年第12期1361-1366,共6页Journal of Molecular Imaging

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202302011)。

摘　　要：目的评估酰胺质子转移成像(APT)对急性缺血性脑卒中患者的缺血半暗带的诊断价值,并对患者预后进行预测。方法回顾性收集2023年1~11月于郑州大学第五附属医院接受治疗的急性缺血性脑卒中患者58例,所有患者均行3T MRI常规序列、动脉自旋标记技术及APT检查。结合弥散加权成像及动脉自旋标记测量核心梗死区(IC)、缺血半暗带区(IP)及对侧正常白质区(CNAWM)的APT值,并分析差异。患者入院第1天由神经内科医生应用美国国立卫生研究院卒中量表(NIHSS)对患者进行评分,3月后电话随访患者预后情况,评估患者改良Rankin评分量表(mRS)评分,应用评分衡量患者神经功能的恢复情况并将其分为预后良好组(n=24,mRS<2分)和预后不良组(n=34,mRS≥2分),比较两组临床资料,计算两组IC和CNAWM区域的APT值,并计算IC和对侧CNAWM信号强度的差异(ΔAPT);绘制ROC曲线,计算基于ΔAPT值的AUC;分析ΔAPT与NIHSS评分的相关性。结果APT可以用于区分患者IC、IP、CNAWM区(P<0.05)。预后良好组和不良组患者IC区域的APT值、ΔAPT值差异有统计学意义(P<0.001);两组患者的NIHSS评分差异有统计学意义(P<0.001),两组患者的其余临床资料以及CNAWM区域的APT值差异无统计学意义(P>0.05)。ΔAPT能较好预测患者预后(AUC=0.732,截断值为1.00,95%CI:0.605~0.860)。ΔAPT与患者入院第1天的NIHSS评分存在相关性(r=0.569,P<0.001)。结论APT可以用来更精确定义患者的缺血半暗带并预测患者预后情况。Objective To evaluate the diagnostic utility of amide proton transfer(APT)imaging for assessing the ischemic penumbra in patients with acute ischemic stroke and to predict patient prognosis.Methods Fifty-eight patients with acute ischemic stroke who were treated at the Fifth Affiliated Hospital of Zhengzhou University from January to November 2023 were retrospectively analyzed.All patients underwent routine 3T MRI sequences,including arterial spin labeling and APT examinations.The infarct core(IC),ischemic penumbra(IP),and contralateral normal-appearing white matter(CNAWM)were measured using diffusion weighted imaging and arterial spin labeling.APT values and their differences were analyzed.Neurologists assessed the patients using the National Institutes of Health Stroke Scale(NIHSS)on the first day of admission.Patient prognosis was followed up via telephone after three months,assessing modified Rankin Scale(mRS)scores to evaluate neurological recovery.Patients were divided into good prognosis group(n=24,mRS<2)and poor prognosis group(n=34,mRS≥2).Clinical data and APT values for the IC and CNAWM were compared between the two groups.The difference in APT signal intensity between the IC and contralateral CNAWM(ΔAPT)was calculated.Then the analysis of variance was performed,and ROC curve were plotted to determine the AUC based onΔAPT values.Additionally,correlations betweenΔAPT and NIHSS scores were analyzed.Results APT imaging effectively differentiated between the IC,IP and CNAWM regions(P<0.05).The difference in APT values between the IC region and theΔAPT values of patients in the good and poor prognosis groups was also statistically significant(P<0.001).Additionally,there was a statistically significant difference in NIHSS scores between the two groups(P<0.001).In contrast,no significant differences were found in the remaining clinical data as well as the APT values in the CNAWM region between the two groups(P>0.05).TheΔAPT values served as a better predictor of patient prognosis(AUC=0.732,cut-off value

关 键 词：急性缺血性脑卒中 改良Rankin评分量表 酰胺质子转移成像 动脉自旋标记技术 磁共振成像 缺血半暗带 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]