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目的对比研究动脉血质子自旋标记(ASL)与动态磁敏感对比(DSC)MRI 在急性脑缺血诊断中的应用价值。方法 27例发病3 d 内的急性脑卒中患者,均采用3.0 T MR 行脉冲式 ASL和 DSC MR 检查。观察2种技术的灌注表现,包括灌注不足、正常灌注、延迟灌注、过度灌注等,采用Mann-Whitney 检验做定性分析。在扩散加权成像显示的病变部位及对侧正常半球的镜像区域分别确定3个感兴趣区(ROI),测量信号强度并计算信号强度比(病侧/对照侧),并将结果做配对 t 检验。结果定性分析显示27例患者中,21例2种技术检查结果一致(灌注不足14例,正常灌注5例,过度灌注2例)。6例2种技术不一致,其中4例 ASL 显示灌注不足而 DSC 显示延迟灌注,2例 ASL 显示正常灌注而 DSC 显示延迟灌注,两者间差异无统计学意义(P>0.05)。定量分析示,2种技术的病侧与对照侧信号强度比值 ASL 为0.71±0.46,DSC 为0.73±0.42,两者间差异无统计学意义(P>0.05)。结论无创性 ASL 技术在检测灌注异常时与 DSC MRI 有相似的敏感性;ASL 可与常规MR 检查相结合,为临床诊断急性缺血性卒中提供有价值的信息。
Objective To compare the diagnostic value of arterial blood proton spin labeling (ASL) and dynamic magnetic resonance imaging (DSC) in the diagnosis of acute cerebral ischemia. Methods Twenty-seven patients with acute stroke within 3 days of onset were examined by pulsed ASL and DSC with 3.0 T MR. Perfusion performance of the two techniques was observed, including under-perfusion, normal perfusion, delayed perfusion, over-perfusion and so on. Mann-Whitney test was used for qualitative analysis. Three regions of interest (ROI) were identified in the lesion site and the normal hemisphere of the contralateral hemisphere by diffusion-weighted imaging. The signal intensity was measured and the signal intensity ratio (disease side / control side) was calculated. The results were analyzed by paired t-test . Results The qualitative analysis showed that among the 27 patients, the results of the two techniques in 21 cases were consistent (less than 14 cases of perfusion, 5 cases of normal perfusion and 2 cases of over-perfusion). The two techniques were inconsistent in 6 cases, of which 4 cases showed insufficient perfusion and DSC showed delayed perfusion, 2 ASL showed normal perfusion and DSC showed delayed perfusion, there was no significant difference between them (P> 0.05). Quantitative analysis showed that the signal intensity ratio of the two sides of the two sides of the disease and the control side ASL was 0.71 ± 0.46, DSC 0.73 ± 0.42, the difference was not statistically significant (P> 0.05). Conclusion Noninvasive ASL technique has similar sensitivity to DSC MRI in detecting perfusion abnormalities. ASL can be combined with routine MR examination to provide valuable information for clinical diagnosis of acute ischemic stroke.