Application Of 3D-ASL Cerebral Blood Perfusion Parameters In The Diagnosis And Treatment Of Acute Cerebral Infarction

Objective:To investigate the application value of cerebral blood perfusion parameters provided by three dimensional arterial spin labeling（3D-ASL）in the diagnosis and treatment of acute cerebral infarction.Methods:A total of 78 patients diagnosed with acute cerebral infarction between August 2017 to December 2019 who had undergone brain MRI assessment in neurology department of the fourth affiliated hospital of Guangxi Medical University were retrospectively analyzed.The patients were clinically scored using the National Institutes of Health Stroke Scale（NIHSS）tools.Clinical data were recorded,such as gender,age,underlying diseases and treatment protocol,etc.The examinations of pre-and post-treatment included3D-ASL.In addition,the diagnostic performances obtained from imaging data including types of cerebral infarction and offending vessels were recorded.The region of interest（ROI）was drawn on 3D-ASL perfusion map base on hypo-perfusion zone,and the cerebral blood flow（CBF）was obtained.The CBF in normal area of the same layer was measured,the relative cerebral blood flow（r CBF）was obtained by calculating the ratio of CBF between lesion and normal area.Wilcoxon signed rank sum test was used to compare the CBF,r CBF and NIHSS score of pre-and post-treatment.Spearman test was applied to evaluate the correlation between CBF and r CBF with NIHSS score.The correlation between the CBF and r CBF change of post-treatment with NIHSS score change of post-treatment were analyzed.Multiple linear regression analysis was conducted on NIHSS score with gender,age,number of underlying diseases,type of cerebral infarction,offending vessels and CBF.Multiple linear regression analysis also was conducted on NIHSS score change of post-treatment with gender,age,number of underlying diseases,type of cerebral infarction,offending vessels,CBF change of post-treatment and treatment protocol.Results:There were significant differences in CBF,r CBF and NIHSS score of pre-and post-treatment（Z=-5.140,P=0.000;Z=-5.591,P=0.000;Z=-5.560,P=0.000）.CBF and r CBF were moderately negative correlated with NIHSS score before treatment（r=-0.357,P=0.001 and r=-0.345,P=0.002,respectively）,while CBF and r CBF have no significant correlation with NIHSS score after treatment（r=-0.166,P=0.146 and r=-0.157,P=0.171,respectively）.The CBF and r CBF change of post-treatment were moderately negative correlated with NIHSS score change of post-treatment（r=-0.430,P=0.000 and r=-0.327,P=0.003,respectively）.The linear regression equation of NIHSS score was Y=8.671-1.852X₁+2.519X₂-0.132X₃before treatment,X₁was number of underlying diseases（0≤X₁≤4,X₁was integer）（t=-3.684,P=0.000）,X₂was type of cerebral infarction（X₂=1 means lacunar cerebral infarction,X₂=2 means small cerebral infarction,X₂=3 means large cerebral infarction）（t=3.107,P=0.003）,and X₃was CBF（t=-2.824,P=0.006）.The multiple linear regression analysis which was conducted on NIHSS score with gender,age,number of underlying diseases,type of cerebral infarction,offending vessels,and CBF have no statistical significance after treatment（F=1.419,P=0.219）.The linear regression equation of NIHSS score change of post-treatment was Y=0.964+0.793X₁-1.391X₂-0.128X₃,X₁was number of underlying diseases（0≤X₁≤4,X₁was integer）（t=2.282,P=0.026）,X₂was type of cerebral infarction（X₂=1 means lacunar cerebral infarction,X₂=2means small cerebral infarction,X₂=3 means large cerebral infarction）（t=-2.433,P=0.018）,and X₃was CBF change of post-treatment（t=-3.337,P=0.001）.Conclusion:1.The cerebral blood perfusion parameters of3D-ASL have certain reference value for the evaluation of the situation and curative effect of acute cerebral infarction.2.The cerebral blood perfusion parameters of 3D-ASL are not the only influencing factor for the situation of cerebral infarction,and it should be noted that there are other factors which could influence the situation of patients.3.3D-ASL is an important imaging examination for acute cerebral infarction,because it can provide quantitative reference indexes for evaluation of acute cerebral infarction,and its examination process has the advantage of no contrast agent.