3DpCASL技术预测急性脑梗死后出血转化的临床价值
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摘要
目的探讨三维准连续动脉自旋标记(three dimensional pulsed continuous arterial spin labeling,3DpCASL)技术在预测急性脑梗死后出血转化(hemorrhagic transformation,HT)中的临床价值。方法收集2017年10月-2018年7月新疆医科大学第二附属医院神经内科单侧发病的急性脑梗死患者71例,分别选用标记后延迟时间(post labeling delay,PLD)1 525 ms(1.5s)、2 525ms(2.5s)的pCSAL成像,在T1WI、T2WI、SWI上将所有患者分为出血组与未出血组,测量所有患者患侧与健侧的PLD 1.5s、PLD 2.5s的脑血流量(cerebral blood flow,CBF),并进行统计学分析。结果未出血组:患侧CBF1.5s与CBF2.5s、健侧CBF1.5s与CBF2.5s、患侧CBF1.5s与健侧CBF1.5s、患侧CBF2.5s与健侧CBF2.5s,组间比较差异均有统计学意义(P <0.05)。出血组:患侧CBF1.5s与CBF2.5s、健侧CBF1.5s与CBF2.5s、患侧CBF1.5s与健侧CBF1.5s比较,差异均有统计学意义(P <0.05)。患侧CBF2.5s与健侧CBF2.5s比较,差异无统计学意义(P=0.149)。出血组与非出血组比较:早到血流%、延迟到达逆向血流%,组间比较差异均有统计学意义(P <0.05)。结论2个PLD的pCASL技术,可以评估颅内动脉侧枝循环,为预测急性脑梗塞后HT提供了可能性,具有重要的临床价值。
Objective To explore the clinical value of three dimensional pulsed continuous arterial spin labeling in predicting hemorrhagic transformation after acute cerebral infarction.Methods A total of 71 cases of acute cerebral infarction with unilateral onset in Department of Neurology of the 2nd Affiliated Hospital of Xinjiang Medical University from October 2017 to July 2018 were collected.pCSAL images of 1 525ms(1.5s)and 2 525ms(2.5s)of Post Labeling Delay(PLD)were selected,respectively.All patients were divided into hemorrhagic transformation group and non-hemorrhagic transformation group in SWI,and CBF1.5sand CBF2.5swere measured on both the lesion side and the healthy side and analyzed.Results Nohemorrhagic transformation group:CBF1.5sand CBF2.5son the lesion side,PLD CBF1.5sand CBF2.5son the healthy side,CBF1.5son the lesion side and on the healthy side,and CBF2.5son the lesion side and on the healthy side,where there were statistical significance between the groups(P <0.001).Hemorrhagic transformation group:CBF1.5sand CBF2.5son the lesion side,CBF1.5sand CBF2.5son the health side,and CBF1.5son the lesion side and on the health side,and the differences were statistically significant(P <0.001).There was no statistically significant difference between the CBF2.5son the lesion side and on the healthy side(P =0.149).Comparison between hemorrhage group and non-hemorrhage group:early arrival of blood flow percentage and delayed arrival of reverse flow percentage showed statistical significance(P <0.05).Conclusion The pCASL technique of two PLD can be used to evaluate intracranial arterial collateral circulation,which provides a possibility to predict hemorrhagic transformation after acute cerebral infarction and has important clinical value.
Objective To explore the clinical value of three dimensional pulsed continuous arterial spin labeling in predicting hemorrhagic transformation after acute cerebral infarction.Methods A total of 71 cases of acute cerebral infarction with unilateral onset in Department of Neurology of the 2nd Affiliated Hospital of Xinjiang Medical University from October 2017 to July 2018 were collected.pCSAL images of 1 525ms(1.5s)and 2 525ms(2.5s)of Post Labeling Delay(PLD)were selected,respectively.All patients were divided into hemorrhagic transformation group and non-hemorrhagic transformation group in SWI,and CBF1.5sand CBF2.5swere measured on both the lesion side and the healthy side and analyzed.Results Nohemorrhagic transformation group:CBF1.5sand CBF2.5son the lesion side,PLD CBF1.5sand CBF2.5son the healthy side,CBF1.5son the lesion side and on the healthy side,and CBF2.5son the lesion side and on the healthy side,where there were statistical significance between the groups(P <0.001).Hemorrhagic transformation group:CBF1.5sand CBF2.5son the lesion side,CBF1.5sand CBF2.5son the health side,and CBF1.5son the lesion side and on the health side,and the differences were statistically significant(P <0.001).There was no statistically significant difference between the CBF2.5son the lesion side and on the healthy side(P =0.149).Comparison between hemorrhage group and non-hemorrhage group:early arrival of blood flow percentage and delayed arrival of reverse flow percentage showed statistical significance(P <0.05).Conclusion The pCASL technique of two PLD can be used to evaluate intracranial arterial collateral circulation,which provides a possibility to predict hemorrhagic transformation after acute cerebral infarction and has important clinical value.
引文
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[8]冯馨乐,张永海.脑梗死后预测出血性转化发生的影像研究进展[J].国际医学放射学杂志,2017,40(2):137-140.
[9] ALSOP D C,DETRE J A,GOLAY X,et al.Recommendedimplementation ofarterialspin-labeledperfusionMRI forclinical applications:A consensus of the ISMRM perfusionstudy group and the European consortium for ASL in dementia[J].Magn Reson Med,2015,73(1):102-116.
[10] LOU X,MA L,LV JH,et al.The consensus of arterial spin labeled perfusion MRI for clinical applications[J].Chin J Radiol,2016,50(11):817-824.
[2] INDLEY R I,WARDLAW J M,SANDERCOCK P A,et al.Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction[J].J Stroke Cerebrovasc Dis,2004,13(6):235-246.
[3] LYU J,MA N,LIEBESKIND D S,et al.Arterial spin labeling magnetic resonance imaging estimation of antegrade and collateral flow in unilateral middle cerebral artery stenosis[J].Stroke,2016,47(2):428-433.
[4]卢瑞沾,张俊成,黄飞文,等.大脑中动脉狭窄后侧枝循环的动脉自旋标记研究[J].实用放射学杂志,2017,33(9):1344-1347.
[5] LOU X,MA X,LIEBESKIND D S,et al.Collateral perfusion using arterial spin labeling in symptomaticversus asymptomatic middlecerebral artery stenosis[J].J Cereb Blood Flow Metab,2017(1):428-433.
[6] LEE M,SAVER J I,ALGER J R,et al.Blood-brain barrier permeability derangements in posterior circulation ischemic stroke:frequency and relation to hemorrhagic transformation[J].Neurol Sci,2012,31(3):142-146.
[7] KO Y,PARK J H,YANG M H,et al.The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke[J].Stroke,2010,41(11):2512-2518.
[8]冯馨乐,张永海.脑梗死后预测出血性转化发生的影像研究进展[J].国际医学放射学杂志,2017,40(2):137-140.
[9] ALSOP D C,DETRE J A,GOLAY X,et al.Recommendedimplementation ofarterialspin-labeledperfusionMRI forclinical applications:A consensus of the ISMRM perfusionstudy group and the European consortium for ASL in dementia[J].Magn Reson Med,2015,73(1):102-116.
[10] LOU X,MA L,LV JH,et al.The consensus of arterial spin labeled perfusion MRI for clinical applications[J].Chin J Radiol,2016,50(11):817-824.