磁共振3D-pcASL灌注成像结合DWI鉴别超急性与急性缺血性脑梗死

摘要

Objective To explore the clinical application value of magnetic resonance 3D pseudo continuous arterial spin labeling (3D-pcASL) perfusion imaging combined with DWI in differential diagnosis of hyper-acute and acute ischemic cerebral infarction.Methods We retrospectively analyzed MRI images of 20 patients with hyper-acute ischemic cerebral infarction (group A) and 36 patients with acute ischemic cerebral infarction (group B) from the our hospital.Then,we measured the abnormal perfusion area (SCBF) on cerebral blood flow (CBF) images from 3D-pcASL and the abnormal increased signal intensity area on DWI images (SDWI) at the maximum infarction slice,calculated the theoretical ischemic penumbra (IP),compared the differences of CBF,ADC value of infarction core (IC),IP between lesion and contra and,also,analyzed the differences of the lesionscontra relative values (rCBF and rADC) between two groups.Results In IC,three cases were high perfusion (zero case in group A,3 cases in group B),nine cases were equal perfusion (1 case in group A,8 cases in group B),and forty-four cases were low perfusion (19 cases in group A,25 cases in group B).There were forty-one cases of SCBF ＞ SDWI (19 cases in group A,22 cases in group B),fifteen cases of SCBF ≈ SDWI (1 case in group A,14 cases in group B),and zero case of SCBF ＜ SDWI.The CBF and ADC value of IC were lower than contra in both two groups (P ＜ 0.05).The CBF value of theoretical IP in both two groups and the ADC value of theoretical IP in group A were lower than that of contra (P ＜ 0.05).The rADC of IC in group A was higher than that in group B.On the contrary,the rCBF and rADC of IP in group A were decreased than that in group B (P ＜ 0.05).Conclusion In clinic,the use of 3D-pcASL combined with DWI is able to make the differential diagnosis of acute cerebral infarction without clear onset time,which can benefit the timely selecting more reasonable individualized treatment project.%目的 探讨磁共振三维伪连续动脉自旋标记(3 D-pcASL)灌注成像联合DWI序列鉴别超急性与急性缺血性脑梗死的临床应用价值.方法 回顾分析我院20例超急性期(A组)和36例急性期(B组)缺血性脑梗死患者的MRI图像.在梗死最大层面测量3D-pcASL序列脑血流(CBF)的异常灌注面积(SCBF)和DWI图上异常高信号面积(SDWI),并计算理论缺血半暗带(IP).比较梗死核心(IC)、IP区CBF和ADC与对侧的差异,分析病灶-对侧相对值(rCBF、rADC)在两组间的差异.结果 IC区高灌注3例(A组0例,B组3例),IC区等灌注9例(A组1例,B组8例),IC区低灌注44例(A组19例,B组25例).SCBF＞ SDWI 41例(A组19例,B组22例),SCBF≈SDWI 15例(A组1例,B组14例).IC区的CBF和ADC值在两组中均较对侧降低(P＜0.05).两组理论IP区的CBF值和A组理论IP区的ADC值均低于对侧(P＜0.05).A组IC区的rADC高于B组,相反,A组理论IP区的rCBF、rADC低于B组(P＜0.05).结论 临床可联合应用3D-pcASL和DWI序列对发病时间不具体的急性缺血性脑梗死进行鉴别诊断,从而有助于及时合理的选择个体化治疗方案.