The Clinical Application Value Of Magnetic Resonance 3D Arterial Spin Labeling Perfusion Imaging In Ischemic Leukoaraiosis

Objective : The aim of the present study was to find out the related factors influencing the occurrence and development of ischemic leukoaraiosis(ILA),explore the relationship between the change of cerebral blood flow(CBF)in different parts and the severity of ILA and ILA-related cognitive impairment by applying magnetic resonance(MR)3D arterial spin labeling(3D-ASL)perfusion imaging technology and investigate the clinical value of 3D-ASL in ILA.Method:According the inclusion and exclusion criteria,a total of 139 including ILA patients and health examination who were hospitalized at the Department of Neurology in the First Hospital of Dalian Medical University from 2016 August to 2017 October were enrolled.101 cases of ILA group,52 males and 49 females,The ages ranged from 39 to88 years(mean 67.24±10.91 years);38 cases of normal control group,14 males and 24 females,The ages ranged from 20 to 59 years(mean 45.76±9.74 years).All selectors scanned 3D-ASL,The Fazecas Score Criteria was used to score the mark of periventricular lesions(PVL)and deep white matter lesions(DWML).The sum of two score graded ILA seve-rity,No lesions,0 points;mild lesions,1 to 2 points;severe lesions 3to 6 points.CBF parameters were obtained using 3D-ASL technique,Manual drawing method measures periventricular(PV),deep white matter(DWM)and whole-brain average CBF.Using neck artery ultrasound checked carotid atherosclerotic plaque and scored,Using 3 dimension-time of flight magnetic resonance angiography(3D TOFMRA)checked Intracranial atherosclerosis and scored.The cognitive function was scored and graded by Montreal Cognitive Assessment(MoCA),normal,26 to 30 points,mild cognitive impairment(MCI),15 to 25 points;Dementia,0 to 14 points.All enrolled objects were recorded Gender,age,history of hypertension,history of stroke,history of coronary heart disease,history of diabetes,history of smoking and drinking,fasting blood glucose(FBG),total cholesterol(TC),triacylglycerol(TG),Low-density lipoprotein-cholesterol(LDL-ch),high-density lipoprotein-cholesterol(HDL-ch),homocysteine(Hcy),Foli-cacid(Fol),C-reactive protein(CRP),Fibrinogen(Fib),Plasma viscosity etc.Data were analyzed with the Statistical Package for Social Sciences for Windows software(version 21.0 SPSS).The signifycance level for bilateral test was less than 0.05(P<0.05).Result:1.There were statistically different in age,hypertension,hyperlipidemia,carotid arteriosclerosis,intracranial arteriosclerosis,blood Fol,CRP,Hcy,Fib levels,plasma viscosity,mean CBF between the normal control group and ILA group,PVL score group and DWML score group(P<0.05).There were no significant differences in gender,drinking and smoking cases.Spearman correlation analysis showed that age,blood Hcy,CRP,Fib levels,carotid atherosclerosis,intracranial arteriosclerosis,plasma viscosity and PVL,DWML score was significantly positive correlation(P?0.001).Blood Fol level and PVL,DWML score was significantly negative correlation(P <0.05).Binary logistic analysis showed that hypertension was independently associated with the severity of ILA(OR = 0.032,P = 0.008).Spearsman correlation analysis found that age and DWML,PVL score was significantly positive correlated(P <0.001).Ordered logistic regression analysis showed that age was an independent related factor of DWML and PVL score(OR = 0.816,P = 0.025)(OR = 0.860,P = 0.016).2.Binary logistic regression analysis found that the mean CBF was independently associated with the severity of ILA(OR = 0.364,P = 0.019).Spearman correlation analysis showed PV CBF and PVL score was significantly negatively correlated(P <0.001)and DWM CBF and DWML score was significantly negatively correlated(P <0.001).Ordered logistic regression analysis showed that PV CBF was independently associated with PVL score(OR = 0.108,P <0.001).DWM CBF was independently associated with DWML score(OR = 0.067,P <0.001).Spearman correlation analysis showed that mean CBF,DWM CBF,PV CBF,blood Fol level and MoCA score was significant positive correlation(P <0.05).Blood CRP,Hcy level,ILA grade,carotid atherosclerosis,intracranial arteriosclerosis score and MoCA score was significantly negative correlation(P<0.001).Logistic regression analysis showed that PV CBF(OR = 0.503,P = 0.029),DWM CBF(OR = 0.327,P = 0.002)and age(OR = 1.256,P = 0.019)were independently associated with ILA-related cognitive impairment.Conclusion:1.Age,hypertension,hyperlipidemia,blood Fol,CRP,HCY,Fib level,plasma viscosity,carotid atherosclerosis and intracranial atherosclerosis are important related factors of ILA.Hypertension is an independent risk factor of ILA severity,and age is an independent factor of DWL and PVL score.2.The mean CBF reduction is an independent risk factor for the severity of ILA.PV CBF was independently associated with PVL score,and DWM CBF was independently correlated with DWML score.3.PV CBF,DWM CBF,and age were independently associated with ILA-related cognitive impairment.4.3D-ASL can accurately reflect the state of blood perfusion of ILA,help to guide the clinical treatment and determine the severity and prognosis of the disease,which has important clinical value.