动脉自旋标记技术在前循环大血管严重狭窄/闭塞患者中的应用价值

Application Value of Arterial Spin Labeling in Patients with Severe Stenosis/Occlusion of Anterior Circulation Large Vessels

摘要: 目的：前循环大血管严重狭窄/闭塞造成的脑血管病是缺血性脑血管病中的一种重要类型，并且具有较高的复发率和致残率。本研究主要探讨动脉自旋标记(ASL)技术在未接受再灌注治疗的前循环大血管严重狭窄/闭塞患者中的应用价值。方法：序贯性收集于2017年6月至2019年6月就诊于青岛大学附属医院神经内科未接受再灌注治疗的172例前循环大血管严重狭窄/闭塞患者的临床及影像学资料。入院72 h内行磁共振成像(MRI)常规扫描T1加权成像(T1WI)、T2加权成像(T2WI)、液体衰减反转恢复(FLAIR)及弥散加权成像(DWI)、磁共振血管造影(MRA)或CT血管造影(CTA)、ASL技术检查。根据检查结果评价并记录患者的基本人口学及临床资料、血管严重狭窄/闭塞位置及程度、脑血流量(CBF)。根据DWI有无显示新发梗死灶及症状持续时间分为缺血性脑卒中组和短暂性脑缺血发作(TIA)组；采用单因素、多因素Logistic回归分析前循环大血管严重狭窄/闭塞患者发生缺血性脑卒中的独立危险因素。结果：129例有症状组患者中，109例为缺血性脑卒中组，20例为TIA组。缺血性脑卒中组与TIA组患者相比，空腹血糖较高，入院舒张压较低，狭窄侧CBF (PLD = 2.5 s)较低，差异有统计学意义(P < 0.05)；多因素Logistic回归分析显示，入院舒张压(OR = 1.071, 95% CI: 1.023~1.122, P = 0.003)、狭窄侧CBF (PLD = 2.5 s) (OR = 1.035, 95% CI: 1.004~1.066, P = 0.027)是有症状的前循环大血管严重狭窄/闭塞患者发生缺血性脑卒中的独立保护因素。结论：入院舒张压、狭窄侧CBF (PLD = 2.5 s)是有症状的前循环大血管严重狭窄/闭塞患者发生缺血性脑卒中的独立保护因素。通过ASL技术测得的CBF对前循环大血管严重狭窄/闭塞患者发生缺血性脑卒中有一定的预测价值，ASL技术在前循环大血管严重狭窄/闭塞患者中有很好的应用价值。

Abstract: Objective: Cerebrovascular disease caused by severe stenosis/occlusion of anterior circulation large vessels is an important type of ischemic cerebrovascular disease, and it has a high recurrence rate and disability rate. This study mainly explored the application value of arterial spin labeling (ASL) in patients with severe stenosis/occlusion of anterior circulation large vessels without reperfusion therapy. Methods: Sequential collection of clinical and imaging data from patients with severe stenosis/occlusion of the anterior circulation large vessels who had not received reperfusion therapy in the Department of Neurology of the Affiliated Hospital of Qingdao University from June 2017 to June 2019. Within 72 hours of admission, magnetic resonance imaging (MRI) routine scanning T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), fluid attenuation inversion recovery (FLAIR) and diffusion weighted imaging (DWI), magnetic resonance angiography (MRA) or CT angiography (CTA), ASL examination were performed. The patient’s basic demographic and clinical data, the location and degree of severe stenosis or occlusion of vessels, and cerebral blood flow (CBF) are evaluated and recorded based on the examination results. According to whether DWI showed new infarct focus and the duration of symptoms, the patients were divided into cerebral infarction group and transient ischemic attack (TIA) group. Results: Of the 129 symptomatic patients, 109 were in the ischemic stroke group and 20 were in the TIA group. Compared with patients in the TIA group, the ischemic stroke group had higher fasting blood glucose, lower diastolic blood pressure at admission, and lower CBF (PLD = 2.5 s) on the stenosis side, the difference was statistically significant (P < 0.05); multivariate logistic regression analysis showed that the diastolic blood pressure at admission (OR = 1.071, 95% CI: 1.023 - 1.122, P = 0.003) and CBF at the stenosis side (PLD = 2.5s) (OR = 1.035, 95% CI: 1.004 - 1.066, P = 0.027) were independent protective factors for ischemic stroke in patients with symptomatic severe stenosis/occlusion of anterior circulation large vessels. Conclusions: The diastolic blood pressure at admission and CBF at the stenosis side (PLD = 2.5 s) were independent protective factors for ischemic stroke in patients with symptomatic severe stenosis/occlusion of anterior circulation large vessels. The CBF measured by the ASL has certain predictive value for the occurrence of ischemic stroke in patients with severe stenosis/occlusion of anterior circulation large vessels; the ASL has good application value in patients with severe stenosis/occlusion of anterior circulation large vessels.