DWI联合3D-ASL检测急性缺血性脑卒中缺血半暗带  

Detection of Ischemic Penumbra in Acute Ischemic Stroke Using DWI Combined with 3D-ASL

作　　者：曹爽 柳琦 赵亚娥[1] 徐长青[1] CAO Shuang;LIU Qi;ZHAO Ya'e;XU Changqing(Department of Radiology,Shidong Hospital of Shanghai Yangpu District,Shanghai 200438,China)

机构地区：[1]上海市杨浦区市东医院医学影像科,上海200438

出　　处：《中国医学计算机成像杂志》2025年第1期8-13,共6页Chinese Computed Medical Imaging

摘　　要：目的:探讨弥散加权成像(DWI)联合磁共振三维动脉自旋标记(3D-ASL)灌注成像检测急性缺血性脑卒中(AIS)患者缺血半暗带(IP)的临床应用价值.方法:将2020年8月—2024年8月间本院收治的87例AIS患者(均完成磁共振DWI和3D-ASL灌注成像检查)纳入回顾性分析.将3D-ASL影像显示的灌注异常区面积减去DWI影像显示的异常信号区面积定义为IP区,统计两种方法结合对AIS患者IP的检出情况.比较患者脑梗死核心区、IP区与健侧镜像区表观弥散系数(ADC)与脑血流量(CBF)的差异.采用北美症状性颈动脉内膜切除试验狭窄分级法(North American Symtomatic Carotid Endarterectomy Trail,NASCET)对患者颈内动脉分支血管狭窄情况进行分级.结果:87例AIS患者中,DWI均检出脑梗死灶,3D-ASL灌注成像检出75例灌注异常,其中61例灌注异常面积>DWI显示的梗死面积(即存在IP区),两者联合对IP的检出率为70.11%(61/87).与健侧镜像区比较,IP区和梗死核心区的ADC与CBF值均降低,且梗死核心区最低(P<0.05).检测出IP区的61例AIS患者,其血管狭窄程度以0级(闭塞)、1级(局部闭塞)为主;余未检出IP区的灌注异常患者则以3级血管狭窄(狭窄<50%)为主.结论:DWI联合磁共振3D-ASL灌注成像能够帮助判断IP的存在及其位置,对指导治疗有一定参考价值.Purpose:To explore the clinical application value of diffusion-weighted imaging(DWI)combined with magnetic resonance three-dimensional arterial spin labeling(3D-ASL)perfusion imaging in detecting ischemic penumbra(IP)for patients with acute ischemic stroke(AIS).Methods:This retrospective analysis was performed on 87 AIS patients undergoing DWI and 3D-ASL perfusion imaging who were admitted to our hospital between August 2020 and August 2024.The IP zone was calculated by subtracting the area of abnormal signal displayed by DWI from the area of abnormal perfusion displayed by 3D-ASL.This study analyzed the detection of IP in AIS patients using the two methods jointly.Furthermore,this study compared the differences in apparent diffusion coefficient(ADC)and cerebral blood flow(CBF)between the core infarct area,IP area,and mirror area on the healthy side in AIS patients.In addition,the stenosis of internal carotid artery branches in patients was graded according to the North American Symptomatic Carotid Endarterectomy Trail(NASCET).Results:Among the 87 AIS patients,infarct foci were detected in all cases using DWI,and 75 cases were observed with abnormal perfusion by 3D-ASL perfusion imaging.Among them,61 cases had an area of abnormal perfusion greater than the infarct area displayed by DWI(i.e.,the presence of IP zone).The detection rate of IP by the two methods jointly was 70.11%(61/87).Compared with the mirror area on the healthy side,the ADC and CBF values both decreased in the IP zone and core infarct area,with the latter area having the lowest value(P<0.05).Among the 61 AIS patients.with the detection of the IP zone,corresponding vascular stenosis was mainly determined as grade 0(occlusion)and grade 1(local occlusion).Besides,patients with abnormal perfusion but no IP zone were mainly characterized by grade 3(vascular stenosis rate<50%).Conclusion:DWI combined with 3D-ASL perfusion imaging can facilitate the determination of the presence and location of IP,providing a potential reference for guiding treatment.

关 键 词：急性缺血性脑卒中 弥散加权成像 缺血半暗带 血管狭窄 

分 类 号：R743.3[医药卫生—神经病学与精神病学]