| Objective: This study aims to analyze the clinical significance of dual-TI Three-dimentional arterial spin labeling(3D-ASL)in assessing the establishment of collateral circulation in patients with acute cerebral infarction and predicting the prognosis.Materials and methods: A total of 98 hospitalized patients with acute ischemic cerebral infarction whose responsible blood vessels of the infarct lesions were all the unilateral middle cerebral artery or the intracranial segment of the internal carotid artery were recruited.They were examined by cranial magnetic resonance imaging,including the following examinations:Conventional magnetic resonance imaging(MRI),diffusion-weighted imaging(DWI),Three-dimentional time-of-flight MR angiography(3D-TOF MRA)and dual-TI 3D-ASL(TI=1500 ms,2480 ms).Among them,53 patients underwent the whole-brain digital subtraction angiography(DSA),and their responsible vessels were the intracranial segment of unilateral middle cerebral artery or the internal carotid artery with severe stenosis or occlusion.According to the pseudo color images of ASL TI 1500 ms、2480 ms,98 patients were divided into normal perfusion group,delayed perfusion group,low perfusion group,and high perfusion group.In addition,according to the results of DSA examination,53 patients underwent the whole-brain DSA were divided into collateral circulation group and non-collateral circulation group.Differences in the baseline characteristics and imaging data between groups were analyzed using the SPSS25.0 software.By analyzing baseline characteristics(gender,age,hypertension,diabetes,hyperlipidemia,smoking history,drinking history,therapeutic methods)and imaging data(the largest area of cerebral infarction,the degree of cerebral artery stenosis,cerebral blood flow perfusion,ischemic penumbra),multivariate logistics regression model was introduced to determine risk factors for the prognosis of acute cerebral infarction.Considering the whole-brain DSA results as the gold standard,ROC curves were depicted to measure the sensitivity,specificity,positive predictive value,and negative predictive value of dual-TI3D-ASL in diagnosing collateral circulation in patients with acute cerebral infarction,and meanwhile,the consistency was calculated by the Kappa test.P<0.05 was considered as statistically significant.Results:(1)DSA showed that there were significant differences in NIHSS score,cerebral infarction maximum area,cerebral blood flow perfusion and ischemic penumbra between the group with collateral circulation and the group without collateral circulation(P<0.05),but there were no significant differences in gender,age,hypertension,diabetes,smoking and drinking history and cerebral artery stenosis(P>0.05).The NIHSS scores of patients with collateral circulation were lower than those without collateral circulation.The basic conditions of cerebral infarction in the group with collateral circulation,such as infarct size and ischemic penumbra,were better than those in the group without collateral circulation.In cerebral blood flow perfusion,delayed perfusion is more common in the group with collateral circulation,while low perfusion is more common in the group without collateral circulation.(2)With DSA as the gold standard,the accuracy of double TI 3D-ASL method in diagnosing the establishment of collateral circulation in acute cerebral infarction was calculated as follows: sensitivity 84.2%,specificity 73.3%,positive predictive value 88.9%,negative predictive value 64.7%;Kappa index was 0.553,P=0.000,with moderate consistency.(3)There was no significant difference in gender,age,hypertension,diabetes,hyperlipidemia,smoking history and drinking history among different cerebral blood flow perfusion groups(normal perfusion group,delayed perfusion group,low perfusion group and high perfusion group)(P>0.05).The maximum cerebral infarction area and cerebral artery stenosis of patients with acute cerebral infarction were statistically significant among different cerebral blood flow perfusion groups(P<0.05).The maximum area of cerebral infarction in low perfusion group was significantly larger than that in normal perfusion,delayed perfusion and high perfusion.Mild and moderate cerebral artery stenosis is more common with normal perfusion,and cerebral artery occlusion is more common with delayed perfusion and low perfusion.(4)NIHSS scores of low perfusion group were higher than those of normal perfusion group,delayed perfusion group and high perfusion group(P<0.05).The NIHSS scores of normal perfusion group were lower than those of high perfusion group,delayed perfusion group and low perfusion group(P<0.05).There was no significant difference in NIHSS scores between delayed perfusion group and high perfusion group(P>0.05).In clinical prognosis,delayed perfusion was the most common prognosis,and low perfusion was the most common prognosis(P < 0.05).(5)Multivariate ordered logistics regression analysis of clinical baseline data and imaging baseline data of patients with acute cerebral infarction showed that hypertension,cerebral infarction maximum area and hypoperfusion(OR=1.774,95%CI: 0.124 ～ 3.423;OR=1.157,95%CI: 0.068 ～ 0.247;OR=3.248,95%CI: 1.562～5.434)is a risk factor affecting clinical prognosis.Conclusion:(1)Dual TI 3D-ASL imaging technology can effectively evaluate the basic situation of blood perfusion in patients with acute cerebral infarction.ASL pseudo-color images show that patients with delayed perfusion suggest the formation of collateral circulation in infarction area.(2)Dual TI 3D-ASL imaging technology can be an important imaging method to evaluate the establishment of collateral circulation in patients with acute cerebral infarction,and can provide some help for clinical individualized treatment.(3)Dual TI 3D-ASL imaging technology can effectively predict the clinical prognosis of patients,and can provide a certain imaging basis for the evaluation of clinical prognosis of patients. |
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