Evaluation Of Acute Cerebral Infarction With 3D-ASL Combined With DWI And MRA Ischemic Penumbra

Objective: To evaluate the clinical application value of Three-dimensional arterial spin labeling(3D-ASL)combined with diffusion weighted imaging(Diffuse weighted imaging,DWI)and magnetic resonance angiography(Magnetic resonance angiography)to evaluate the ischemic penumbra of acute cerebral infarction.Methods: 36 cases of acute cerebral infarction were selected from October 2016 to December 2017 in our hospital,including 22 males and 14 females,aged 49-75 years,with an average of(64.35 + 6.25)years of age.3D-ASL,DWI and MRA scans were performed on the patients after admission.According to the mismatch principle of3D-ASL-DWI,the infarct core area and the ischemic penumbra zone(ischemic penumbra,IP)were determined,and the cerebral blood flow(cerebral blood flow,CBF)value and apparent diffusion coefficient were recorded respectively in the infarct core area and IP.T,ADC).According to the area of 3D-ASL perfusion abnormal area and the area of DWI signal abnormal area,it was divided into ASL > DWI group,ASL DWI group,ASL < DWI group.Classification according to the degree of MRA vascular stenosis: level 0,indicating occlusion,distal blood vessels without development;L level,indicating the loss of local vascular signals,and incomplete distal vascular development;Level 2,indicating the degree of stenosis >50%,and the complete development of the distal blood vessels;3,indicating the stenosis < 50%,and the distal vascular complete development: 4 levels,expressed Normal.The value of the infarct core area and the image area of the healthy side,the ADC and CBF of IP were compared and compared,and the vascular stenosis in the ASL > DWI,ASL DWI,ASL < DWI group was further studied.SPSS 21 software was used to analyze all data.Bilateral test P < 0.05 was statistically significant.Result:(1)the ADC and CBF values of the infarct core area were significantly lower than those of the uninjured side.There was statistical significance between the two groups(T=15.053,26.676,P < 0.05).(2)the ADC value and CBF value of the healthy side mirror area were significantly higher than those of IP.The difference between the two groups was statistically significant(T=4.694,13.489,P < 0.05).(3)comparing and analyzing the CBF and ADC images of the patients with cerebral infarction,it was found that the whole brain of 1 patients with large area acute cerebral infarction showed significant low perfusion and a large range,and the low perfusion area of 35 cases of CBF was greater than that of ADC,and the mismatched area was >20%.Infarct core area and IP ADC value and CBF value,infarct core area were lower than IP,the difference was statistically significant(T=14.847,12.411,P < 0.05).(4)23 cases in group ASL>DWI,the degree of vascular stenosis was mainly in grade 0and 1,and 3 cases in group ASL DWI,1 cases were vascular occlusion(0),2 cases were mild stenosis(3 grade);5 patients in group ASL<DWI,2 cases with severe stenosis(1),and 3 cases for mild stenosis(3).The remaining 5 cases of ASL showed no abnormalities,of which MRA showed 1 cases of grade 3 stenosis and 4 cases of normal ones.Conclusion:3D-ASL is a noninvasive technique that can objectively reflect the blood flow perfusion in the acute cerebral infarction area.The combination of DWI and MRA scan can accurately determine the existence and definition of the ischemic penumbra.