| Background:Acute ischemic stroke(AIS)has become one of the leading causes of death worldwide.Although the treatment technology has made great progress in recent years,the disability rate is still as high as 67%.Early prognostic evaluation is helpful to adopt reasonable treatment plan,improve patient survival rate and reduce disability rate.So,how can we accurately evaluate the prognosis in the early stage? Currently,the National Institutes of Health Stroke Scale(NIHSS)or modified Rankin Scale(m RS)are mainly used to evaluate the prognosis of acute cerebral infarction,and the prognosis of clinical neurological function and infarction volume can be predicted according to the imaging trend of the lesion.However,NIHSS scores need to be evaluated every 3 or 6 hours.It is difficult to achieve in practice.However,clinical scores such as NIHSS and m RS can only reflect the information of neurological function,and can not visually display the pathological changes of cerebral infarction in morphology,blood flow and metabolism.However,imaging examination has a unique advantage in evaluating the prognosis of cerebral infarction,because it can provide information on the shape,function and blood perfusion of cerebral infarction lesions.Diffusion-weighted imaging(DWI)and perfusion-weighted imaging(PWI)have been the most commonly used in the past,but PWI requires injection of contrast agents.For patients with contraindications of contrast agents(such as allergy or renal failure)Or the use of emergency patients is limited,and the operation is time-consuming,complex,and equipment requirements are high.Non-contrast agent MR functional imaging of arterial spin labeling(ASL)imaging is more suitable for prognostic evaluation of patients with acute cerebral infarction because of its visual,easy to distinguish,no need for contrast agent injection and good repeatability.Objective:For the treatment of acute cerebral infarction patients at home and abroad,early diagnosis and vascular opening are emphasized in order to reduce the probability of major adverse prognosis events.It is well known that brain tissue is very sensitive to ischemic and hypoxic damage.If the whole brain blood supply is completely interrupted for 6seconds,the patient will lose consciousness,spontaneous brain electrical activity disappears in 10 seconds,irreversible damage occurs in the most vulnerable specific neurons in 5 minutes,and extensive selective neuronal necrosis occurs in the cerebral cortex in 10-20 minutes.Therefore,once a serious acute cerebral infarction occurs,it is impossible to open the responsible blood vessels in time before the brain neurons are destroyed at the current level of treatment.Therefore,for patients with acute cerebral infarction,we have to mention the treatment effect and prognosis.Since the establishment of stroke center,our hospital has treated a large number of patients with acute cerebral infarction and accumulated valuable clinical experience.Through this experiment,we observed the value of ASL imaging technology in evaluating the prognosis of patients with acute cerebral infarction,and discussed the advantages and disadvantages of traditional methods to evaluate the prognosis by NIHSS score and ASL perfusion image after operation.Method:A retrospective analysis was made of 60 patients with acute cerebral infarction treated by interventional thrombectomy from December 2016 to December 2018 in neurosurgery department of Jinan Central Hospital affiliated to Shandong University.The prognosis of all patients was judged by two methods after admission to hospital,namely,NIHSS score and ASL image acquisition.The patients were compared by themselves.The accuracy of different methods in judging short-term therapeutic effect and long-term prognosis of patients.Result:Sixty patients underwent magnetic resonance ASL image acquisition.After software processing,the images showed that there was no obvious decrease of cerebral perfusion in infarct side of some patients compared with the healthy side,and the perfusion signals in some local areas were even enhanced compared with the healthy side.The ASL images of patients with higher NIHSS score after operation do not necessarily show poor perfusion,and their recovery speed and prognosis often exceed the prognosis level reflected by NIHSS score.The accuracy and reliability of ASL in evaluating the prognosis of patients were higher than that of NIHSS in evaluating the prognosis of the same patients,and the difference was statistically significant.Conclusion:All the patients were treated by interventional therapy in the acute stage.A retrospective evaluation of the therapeutic effect and prognosis of the operation showed that ASL could visually show the opening effect of the operation on the responsible vessels.At the same time,ASL could more directly and accurately reflect the cerebral perfusion in patients with cerebral infarction after operation,and its accuracy in evaluating the prognosis of patients was significantly better than NIHSS score. |
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