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目的探讨三维动脉自旋标记(3D-ASL)技术在短暂性脑缺发作(TIA)中的应用价值。方法选择2014年8月~2015年9月于江苏省扬州市第一人民医院就诊的TIA患者27例,于末次发作24 h内行头颅CT、常规磁共振序列、DWI、MRA及3D-ASL检查,其中5例行DSC-PWI检查者。所获得的灌注伪彩图由2名观察者独自观察,手工绘制感兴趣区(ROI)及镜像区,并定量分析相对脑血流量(r CBF)。结果头颅CT皆未显示异常。定性分析显示,27例TIA患者3D-ASL出现局灶性低灌注者23例(85.19%);定量分析显示,ROI r CBF为(28.98±8.12)m L/(100 g·min),镜像区r CBF为(40.58±9.15)m L/(100 g·min),两者间差异有统计学意义(t=9.590,P<0.05)。MRA阳性为14例(51.85%),3D-ASL皆为阳性(100.00%);MRA阴性为13例,3D-ASL阳性为9例(69.23%)。DWI阳性为10例(37.04%),3D-ASL阳性为9例(90.00%);DWI阴性为17例,3D-ASL阳性为14例(82.35%)。3例患者经治疗后复查局灶性低灌注见恢复。定性分析两种灌注成像技术检查结果显示,5例(100.00%)患者对低灌注的显示一致;定量分析显示,两种灌注成像技术的ROI与镜像区之间r CBF比值ASL为(0.52±0.17),DSC为(0.56±0.19),两者间差异无统计学意义(t=0.388,P>0.05)。结论与传统的MRA及DWI阳性率相比,3D-ASL技术对TIA局灶性低灌注的显示更敏感,而且与DSC-PWI对低灌注的显示一致,对TIA患者的诊断、疗效评估及随访具有重要价值。
Objective To investigate the value of three-dimensional arterial spin labeling (3D-ASL) in the diagnosis of transient cerebral ischemia (TIA). Methods TIA patients (27 patients) who were treated in the First People’s Hospital of Yangzhou City, Jiangsu Province from August 2014 to September 2015 were examined by CT, routine MRI, DWI, MRA and 3D-ASL within 24 hours of the last episode. Five patients underwent DSC-PWI examiner. The obtained perfusion pseudo-color image was observed by two observers alone, the ROI and the image area were hand-drawn, and the relative cerebral blood flow (r CBF) was quantitatively analyzed. Results CT showed no abnormalities. Qualitative analysis showed that 23 cases (85.19%) had focal hypoperfusion in 3D-ASL of 27 patients with TIA. Quantitative analysis showed that ROI-CBF was (28.98 ± 8.12) m L / (100 g · min) r CBF was (40.58 ± 9.15) m L / (100 g · min), the difference was statistically significant (t = 9.590, P <0.05). MRA positive in 14 cases (51.85%), 3D-ASL were positive (100.00%); MRA negative in 13 cases, 3D-ASL positive in 9 cases (69.23%). DWI positive was 10 cases (37.04%), 3D-ASL positive was 9 cases (90.00%), DWI negative was 17 cases and 3D-ASL positive was 14 cases (82.35%). Three patients were treated by review of focal hypoperfusion to restore. Qualitative analysis of the two perfusion imaging results showed that 5 patients (100.00%) showed consistent hypoperfusion. Quantitative analysis showed that the rLFF ratio between the ROI and the image area of the two perfusion techniques was (0.52 ± 0.17 ) And DSC (0.56 ± 0.19) respectively. There was no significant difference between them (t = 0.388, P> 0.05). Conclusion 3D-ASL is more sensitive to focal hypoperfusion than traditional MRA and DWI, and consistent with the demonstration of hypoperfusion by DSC-PWI. The diagnosis, efficacy and follow-up of TIA Has important value.