【摘要】 目的 探讨双延迟三维动脉自旋标记(3D ASL)在评估单侧大脑中动脉(MCA)闭塞患者侧支循环状态及临床转归中的应用价值。方法 回顾性分析2019年1月至2021年12月经MRA证实的单侧MCA闭塞的患者134例，所有患者治疗前行T2-FLAIR、DWI、MRA及双延迟3D-ASL检查，入院当日和入院15日美国国立卫生研究院卒中量表(NIHSS)评分完整。测量患侧及镜像侧脑血流量(CBF)值，并计算相对脑血流量(rCBF)(rCBF=患侧CBF/健侧CBF);依据CBF伪彩图梗死核心周围低灌注区皮层及皮层下是否出现动脉穿行伪影(ATA)征象，将患者分为ATA(+)组和ATA(-)组；依据T2-FLAIR序列中高信号血管征(HVS),对所有患者进行侧支循环等级分组。结果 (1)ATA(-)组28例，ATA(+)组106例，两组患者在侧支循环等级分组、PLD=1.5 s rCBF值、入院15 d NIHSS评分及入院15 d NIHSS评分降度差异均有统计学意义(P<0.001),其中ATA(+)组PLD=1.5s rCBF明显低于ATA(-)组、入院15 d NIHSS评分降度明显高于ATA(-)组；(2)侧支循环等级分组：0级28例，1级25例，2级33例，3级48例，各组间PLD=1.5 s rCBF、入院15 d NIHSS评分及入院15 d NIHSS评分降度差异均有统计学意义(P<0.001),侧支循环等级越高，rCBF(PLD=1.5 s)越低、入院15 d NIHSS评分降度越大；(3)侧支循环评分与入院15 d NIHSS评分降度呈明显正相关(t=10.241,B=0.096,95%CI0.077～0.114,P<0.001)。结论 双延迟3D-ASL可以无创、直观地判断单侧大脑中动脉闭塞患者是否存在侧支循环，与T2-FLAIR联合可进一步评估侧支循环的状态，为临床评价预后提供客观依据。更多还原

【Abstract】 Objective To investigate the value of double delayed three-dimensional arterial spin labeling(3D ASL) in evaluating the collateral circulation status and clinical outcome of patients with unilateral middle cerebral artery(MCA) occlusion.Methods A retrospective analysis was performed on 134 patients with unilateral MCA occlusion confirmed by MRA at our hospital from Jan 2019 to Dec 2021.All patients underwent T2-FLAIR,DWI,MRA and 3D-ASL exams.The scores of the National Institutes of Health Stroke Scale(NIHSS) were complete on the day and 15 days after admission.Measure the cerebral blood flow(CBF) on the affected side and the mirror side, and calculate the ratio(affected side/healthy side) to get the relative cerebral blood flow(rCBF);Patients were divided into ATA(+) and ATA(-) groups depending on whether there were ATA signs around the central area of the infarction in the pseudo color CBF image.All patients were classified into collateral circulation hierarchically according to the hyperintense vascular sign(HVS) in the T2-FLAIR sequences.Results(1) 28 cases in ATA(-) group, 106 cases in ATA(+) group, there were statistically significant differences in the grade of collateral circulation, PLD=1.5s rCBF value, NIHSS score 15 days after admission and NIHSS score decreased of 15 days after admission between the two groups(P<0.001),PLD=1.5s rCBF of ATA(+) group was significantly lower than ATA(-) group, and NIHSS score decreased of 15 days after admission significantly higher than ATA(-) group.(2) Classification of collateral circulation: 28 cases in grade 0,25 cases in grade 1,33 cases in grade 2,and 48 cases in grade 3,there were statistically significant differences in PLD=1.5 s rCBF,NIHSS score at 15 days after admission, and NIHSS score decreased of 15 days after admission in each group(P<0.001),the higher the grade of collateral circulation, the lower rCBF(PLD=1.5s) and the greater the NIHSS score decreased of 15 days after admission.(3)There was a positive correlation between collateral circulation score and NIHSS score decreased of 15 days after admission(t=10.241,B=0.096,95%CI 0.077～0.114,P<0.001).Conclusion Dual-delay 3D-ASL can determine collateral circulation noninvasively and intuitively in patients with unilateral middle cerebral artery occlusion, combining with T2-FLAIR may further evaluate the condition of collateral circulation, providing an objective basis for clinical assessment of prognosis.更多还原