| ObjectiveThe assessment of collateral circulation has important guiding significance in clinic.The mTI-ASL obtains not only multiple quantitative hemodynamic parameters but also dPWI with temporal characteristics.In this study,the collateral circulation state of patients with large vessel occlusion assessed by DSA was used as the gold standard,and the application of 3DmTI-ASL in noninvasive evaluation of collateral circulation was explored.From a quantitative perspective,we analyzed the ability of multiple parameters to distinguish collateral state.From the qualitative point of view,we compared a novel dCFM based on ASL-dPWI with DSA for determining collateral circulation.Subjects and MethodsEnrolled patients with unilateral internal carotid artery occlusion or middle cerebral artery occlusion diagnosed by DSA in Tianjin Huanhu Hospital from December 2017 to February 2019.A total of 28 cases,female patients 6 cases,22 cases of male patients,mean aged 58±11 years old.Select the middle cerebral artery blood supply area as the region of interest(ROI).The differences of CBF and BAT of the ipsilateral and healthy were compared respectively within the two groups;The differences of CBF,BAT,rCBF and rBAT were compared between the two groups;Analyzed the efficacy of the quantitative parameters to distinguish the two groups.dCFM with high signal to noise ratio and spatial resolution derived from dPWI.Collateral grading based on the 3DmTI-ASL was performed and compared with DSA.Results1.The number of patients with collateral grade 0-4 evaluated by DSA was 0,6,7,8 and 7,respectively.Good grade(grade3-4)were 15 patients: the ipsilateral CBF(66.84±17.90ml/100g/min)was higher than(t=2.235,P=0.042)the healthy side(CBF=59.08±18.55ml/100g/min).The ipsilateral BAT(1000.28±139.02ms)was higher than the healthy side(BAT=816.31±122.63ms)(t=7.582,P=0.000).Poor grade(grade0-2)were 13 patients: the ipsilateral CBF(47.47±15.64ml/100g/min)was lower than(t=-2.694,P=0.020)the healthy side(CBF=51.21±20.06ml/100g/min).The ipsilateral BAT(925.93±115.92ms)was higher than the healthy side(BAT=737.28±100.05ms)(t=11.319,P=0.000).2.The ipsilateral CBF value(66.84±17.90 ml/100g/min)of the good collateral group was higher than(t=3.025,P=0.006)that of the poor collateral group(47.47±15.640ml/100g/min).The rCBF(1.16±0.23)of the good collateral group was higher than(t=3.189,P=0.005)that of the poor collateral group(0.95±0.09).There was no significant difference in BAT and rBAT between the two groups.3.The efficacy of using the values of CBF and rCBF on the affected side to distinguish the two groups was 77.8%,and the efficacy of using the multiple parameters of CBF,rCBF,BAT and rBAT to distinguish the two groups was 81.5%.4.The number of patients with collateral grade 0-4 evaluated by 3DmTI-ASL was 0,7,3,11 and 7,respectively.The к value for inter-modality agreement of collateral grade was 0.576.Eighteen patients in the good collateral group(grade 3-4)and 10 patients in the bad collateral group(grade 0-2)were evaluated by 3DmTI-ASL,and The к value for inter-modality agreement of collateral grade was 0.781.ConclusionsQuantitative parameter of 3DmTI-ASL can distinguish between good and bad collateral circulation.The efficiency of distinguishing collateral status with multiple parameters of CBF,rCBF,BAT and rBAT is relatively high.dCFM based on ASL-dPWI was able to effectively assess collateral circulation grade;it was in good consistency with DSA rating.In general,3DmTI-ASL can reflect the collateral circulation status sensitively and effectively and be used as an alternative to DSA for the evaluation of collateral circulation status. |
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