不同侧支循环状态下SWI对急性脑梗死血流灌注的评估价值  

Correlation between SWI prominent cortical venous sign and CT perfusion in acute cerebral infarctionwith different collateral circulation

作　　者：赵松 何业举 耿左军[1] 朱青峰[1] 袁涛[1] 杨磊[1] 刘丹 ZHAO Song;HE Ye-ju;GENG Zuo-jun(Department of Ra-diology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院医学影像科,河北石家庄050000 [2]河北中医药大学中西医结合学院医学影像教研室,河北石家庄050000

出　　处：《放射学实践》2025年第2期211-217,共7页Radiologic Practice

基　　金：河北省重点研发计划项目(20377789D);河北省卫生健康委医学科学研究课题计划(20210446)。

摘　　要：目的:探讨急性脑梗死(ACI)患者在不同侧支循环状态下,磁敏感加权成像(SWI)上突出皮质静脉(PCV)征和脑灌注成像上低灌注区达峰时间(T_(max))及相对脑血流量(rCBF)之间的相关性。方法:以2021年8月-2023年8月就诊于本院的58例单侧大脑中动脉(MCA)供血区ACI患者为研究对象,患者出现症状后2.0~4.5 h完成相关影像学检查,平均(3.0±0.7)h。入院时所有患者行脑CTP成像、一站式动态CTA(dCTA)及磁共振SWI检查。首先依据达峰时间(T_(max))彩图,设定T_(max)≥6 s为低灌注区,然后分别基于SWI的PCV分布范围及T_(max)低灌注区域进行阿尔伯特项目早期CT评分(ASPECTS),基于SWI对扩张静脉进行评级;在脑血流量(CBF)参数图内对应的SWI评级层面,获取患侧及相应健侧CBF值,计算患侧相对CBF(rCBF)值;通过dCTA观察侧支循环,将患者分为侧支循环不良组和良好组。分别采用Pearson相关分析对两组中PCV分布范围与T_(max)低灌区ASPECTS评分进行相关性研究,采用Spearman相关分析对SWI图像上扩张静脉等级与rCBF值的相关性进行评估。结果:PCV与T_(max)之间ASPECTS评分呈正相关(r=0.598,P=0.000),且不良组中两者间的相关系数显著高于良好组(0.843 vs.0.442,P=0.007);良好组中PCV征的ASPECTS评分高于T_(max)图低灌注区(7.67±1.97 vs.4.79±1.22),且两者间的差异有统计学意义(P=0.000)。SWI扩张静脉等级与rCBF值呈负相关(r=-0.469,P=0.000)。结论:在急性脑梗死患者中,PCV分布范围与T_(max)参数图低灌注范围具有很好的相关性,可作为评估脑低灌注状态的影像标记物,但是在侧支循环良好情况下,PCV的评估结果会偏低,因此SWI不能取代CTPI;SWI上扩张静脉等级可以反映脑组织血流量减低。Objective:To investigate the correlation among the prominent cortical venous(PCV)sign on magnetic sensitivity weighted imaging(SWI)and the time to peak(T_(max))of low perfusion area on perfusion weighted imaing and relative cerebral blood flow(rCBF)in patients with acute cerebral infarction(ACI)under different pial collateral circulation conditions.Methods:ACI patients with the unilateral middle cerebral artery(MCA)blood supply area in our hospital from August 2021 to August 2023 were selected as the study objects.Relevant imaging examinations were completed within 2.0~4.5 hours after onset of the symptoms,with an average time of about(3.0±0.7)hours.Brain CTP imaging,one-stop dynamic CT angiography(dCTA)and SWI examination were completed immediately after admission,Firstly,the low perfusion area with T_(max)≥6s was set according to the color map of peak time(T_(max)).Then,the Albert early CT score(ASPECTS)was performed based on the PCV distribution range of SWI and T_(max) low perfusion area,and the dilated veins were rated based on SWI.At the SWI rating level corresponding to the cerebral blood flow(CBF)parameter diagram,the CBF values of the affected side and the corresponding healthy side were obtained,and the relative CBF(rCBF)values were calculated.Pial collateral circulation was observed by dCTA,and the patients were divided into poor collateral circulation group and good collateral circulation group.Pearson correlation analysis was used to evaluate the correlation between the PCV distribution range and the involvement range of ASPECTS scores in low T_(max) irrigation areas in the two groups,and Spearman correlation analysis was used to evaluate the correlation between the grade of dilated veins in SWI images and rCBF value.Results:PCV was positively correlated with T_(max) ASPECTS scores(r=0.598,P=0.000),and the correlation coefficient of the poor group was significantly higher than that of the good group(r:0.843 vs.0.442),and the difference between the two groups was statistically significant(P=0.007).

关 键 词：磁敏感加权成像 急性脑梗死 动态CT血管造影 CT灌注成像 血流灌注 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]