Application Value of Magnetic Resonance Diffusion-Weighted Imaging and Arterial Spin Markers in the Diagnosis of Acute Cerebrovascular Disease
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摘要:
目的 探讨急性脑血管病诊断中磁共振扩散加权成像（magnetic resonance diffusion-weighted imaging，DWI）与动脉自旋标记（arterial spin labeling，ASL）的应用价值。 方法 选取云南中医药大学第二附属医院医学影像科2019年7月至2020年8月收治的疑似急性脑血管病患者82例，均给予ASL和DWI。分析同时间段病灶中心与健侧相应部位表观扩散系数（ADC）值、病变信号特征变化、ASL和DWI的灵敏度和特异度。 结果 82例患者中，患侧6 h内、6～24 h、24～48 h及平均值ADC值均低于健侧，差异有统计学意义（P < 0.05）；健侧与患侧6 h、6～24 h、24～48 h及平均值ADC值，差异无统计意义（P > 0.05）；所有患者中CASL-PWI低灌注区比DWI的异常信号区大的患者共有47例，而CASL-PWI低灌注区比DWI的异常信号区小的患者共有32例，2种变化信号相等患者6例；DWI < PWI患者中DWI、PWI病变面积均高于DWI = PWI和DWI > PWI，差异有统计学意义（P < 0.05）；DWI = PWI患者中DWI、PWI病变面积均大于DWI > PWI，差异有统计学意义（P < 0.05）；联合检查灵敏度与特异度高于单纯使用磁共振扩散加权成像与动脉自旋标记检查，差异有统计学意义（P < 0.05）。 结论 急性脑血管病诊断中，磁共振扩散加权成像与动脉自旋标记检查均有较好的效果，但是联合使用效果更好。 Abstract:Objective To explore the value of magnetic resonance diffusion-weighted imaging （DWI） and Arterial Spin labeling （ASL） in the diagnosis of acute cerebrovascular diseases. Methods A total of 82 patients with suspected acute cerebrovascular disease admitted to the Medical Imaging Department of the Second Affiliated Hospital of Yunnan University of Traditional Chinese Medicine from July 2019 to August 2020 were selected and imaging was conducted using ASL and DWI. The apparent diffusion coefficient （ADC） values, changes of lesion signal characteristics, sensitivity and specificity of ASL and DWI were analyzed at different time points. Results In all patients, ADC values within 6 h, 6～24 h, 24～48 h and average values of the affected side were lower than those of the unaffected side, and the differences were statistically significant （P < 0.05）. There was no statistical significance in ADC values at 6 h, 6～24 h, 24～48 h in unaffected and affected sides （P > 0.05）. There were no statistically significant differences between unaffected side and affected side in 6 h, 6～24 h, 24～48 h and average ADC values （P > 0.05）. Among all patients, there were 47 patients whose CASL-PWI hypoperfusion area was larger than DWI abnormal signal area, and 32 patients whose CASL-PWI hypoperfusion area was smaller than DWI abnormal signal area, and 6 patients whose two signal changes were equal. The lesion area of DWI and PWI in patients with DWI < PWI was higher than that of DWI = PWI and DWI > PWI, and the difference was statistically significant （P < 0.05）. DWI = PWI patients’ lesion area of DWI and PWI was larger than that of DWI > PWI, and the difference was statistically significant （P < 0.05）. The sensitivity and specificity of combined examination were higher than those of DWI and spin marking alone, and the difference was statistically significant （P < 0.05）. Conclusion In the diagnosis of acute cerebrovascular disease, both diffusion weighted magnetic resonance imaging （DWI） and arterial spin labeling are effective, but it is more valuable if combined. -
表 1 同时间段病灶中心与健侧相应部位表观扩散系数(ADC)值分析（×10−3 mm2/s，
$\bar{{x}} \pm s$ ）Table 1. Analysis of apparent diffusion coefficient (ADC) values at the center of focus and corresponding parts on the healthy side at the same time （×10−3 mm2/s，
$\bar{{x}} \pm s$ ）项目 n 6 h内 6～24 h 24～48 h 平均值 F P 健侧 82 0.8 ± 0.1 0.9 ± 0.2 0.9 ± 0.2 0.8 ± 0.1 / / 患侧 82 0.4 ± 0.1 0.4 ± 0.1 0.3 ± 0.1 0.4 ± 0.1 / / 差值 82 0.4 ± 0.1 0.5 ± 0.1 0.6 ± 0.1 0.4 ± 0.1 75.167 0.001* *P < 0.05。 
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表 2 病变信号特征变化分析（
$\bar{{x}} \pm s$ ）Table 2. Analysis of changes in lesion signal characteristics（
$\bar{{x}} \pm s$ ）面积比较 n DWI病变面积（cm2） PWI病变面积（cm2） DWI > PWI 32 2.4 ± 0.33 2.0 ± 0.22 DWI = PWI 6 2.77 ± 0.68* 2.77 ± 0.68* DWI < PWI 47 6.4 ± 1.23#* 7.8 ± 2.4#* F / 178.164 103.809 P / 0.001 0.001 与DWI > PWI比较，#P < 0.05；与DWI = PWI比较，*P < 0.05。
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表 3 磁共振扩散加权成像与动脉自旋标记检查灵敏度和特异度比较[n（%）]
Table 3. Comparison of sensitivity and specificity between diffusion-weighted Mr Imaging and arterial spin labeling [n（%）]
方法 n 灵敏度 特异度 磁共振扩散加权成像 82 94.37（67/71） 54.55（6/11） 动脉自旋标记 82 95.89（70/73） 55.56（5/9） 联合 82 98.73（78/79） 66.67（2/3） χ2 3.401 5.209 P 0.046* 0.041* 灵敏度 = 真阳/（真阳 + 假阴）；特异度 = 真阴/（真阴 + 假阳）。*P < 0.05。
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[1] 梅茸,陈文利,张凤丽,等. 脑CT灌注成像在血管性认知功能障碍早期诊断中的应用[J]. 昆明医科大学学报,2017,38(3):64-70. doi: 10.3969/j.issn.1003-4706.2017.03.015 [2] 庞坚信,季文斌,杨艳,等. 三维动脉自旋标记成像联合DWI在急性脑缺血病变中的应用[J]. 心脑血管病防治,2019,19(2):127-129. doi: 10.3969/j.issn.1009-816x.2019.02.006 [3] 戴真煜,陈飞,姚立正,等. 磁共振扩散张量成像和三维伪连续动脉自旋标记在鉴别超急性与急性缺血性脑梗死中的联合应用[J]. 中华医学杂志,2018,98(17):1327-1332. doi: 10.3760/cma.j.issn.0376-2491.2018.17.009 [4] 崔勇,郑智艳,黄玲,等. 磁共振弥散加权成像和三维时间飞跃法血管成像及三维动脉自旋标记在老年人缺血性脑血管病中的应用[J]. 中华老年医学杂志,2018,37(8):847-850. doi: 10.3760/cma.j.issn.0254-9026.2018.08.003 [5] 高原,刘晓凡,牛朋影,等. 全脑三维动脉自旋标记灌注成像技术在缺血性脑血管病中的临床应用[J]. 宁夏医学杂志,2018,40(7):614-616. [6] 张博伦,梁晓芸,韩璐,等. 三维动脉自旋标记联合扩散加权成像、磁共振血管成像在急性腔隙性脑梗死中的应用价值[J]. 实用放射学杂志,2020,36(12):1898-1901. doi: 10.3969/j.issn.1002-1671.2020.12.003 [7] 杨民,李海歌,吴亚红,等. 联合磁共振弥散加权成像和三维伪连续动脉自旋标记对急性缺血性脑卒中的研究[J]. 医学影像学杂志,2017,27(8):1428-1431,1436. [8] 阎晓宇,王培培,吉祥. 动脉自旋标记灌注成像联合磁敏感加权血管成像在急性脑梗死患者诊断中的应用价值[J]. 实用医学影像杂志,2019,20(4):408-410. [9] 蒋代彬,杨清,张国靖,等. 磁共振3D-pCASL成像技术在急性缺血性脑卒中临床诊断中的应用价值[J]. 川北医学院学报,2019,34(4):437-440. doi: 10.3969/j.issn.1005-3697.2019.04.31 [10] 边祥兵,张德康,吕晋浩,等. 多模式MRI技术在急性缺血性脑卒中的临床应用价值[J]. 中国医学装备,2020,17(3):57-61. doi: 10.3969/J.ISSN.1672-8270.2020.03.015 [11] 刘佩. 磁共振血管成像联合三维动脉自旋标记技术检查在缺血性脑血管疾病患者诊断中的应用[J]. 实用中西医结合临床,2019,19(10):129-130,141. [12] Mesguich C,Hulin C,V Latrabe,et al. Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma[J]. Annals of Hematology,2020,99(12):2869-2880. doi: 10.1007/s00277-020-04265-2 [13] 赵文超,宋雨,唐晨虎,等. 磁共振三维准连续式动脉自旋标记成像在急性脑梗死患者中的应用[J]. 磁共振成像,2020,11(12):1156-1158,1166. doi: 10.12015/issn.1674-8034.2020.12.016 [14] 孟云,符大勇,周建国,等. 磁敏感加权成像在急性缺血性脑卒中方面的临床应用价值[J]. 中风与神经疾病杂志,2019,36(2):143-146. [15] 钟柱,蔡少训,林海韬. MRA联合3D-ASL检查在缺血性脑血管疾病诊断中的价值[J]. 广州医科大学学报,2020,48(1):10-12. doi: 10.3969/j.issn.2095-9664.2020.01.03 [16] Pirasteh A,Johnson B,Dimitrov I E,et al. Turbo spin-echo diffusion-weighted imaging in prostate magnetic resonance imaging of men with pelvic hardware[J]. Journal of Computer Assisted Tomography,2020,44(4):519-526. doi: 10.1097/RCT.0000000000001067 [17] 温宏峰,王瑞彤,李继来,等. 磁共振双不匹配技术指导不明时间窗急性前循环大血管闭塞伴脑梗死患者的血管内治疗[J]. 中华老年心脑血管病杂志,2019,21(6):568-571. doi: 10.3969/j.issn.1009-0126.2019.06.003 [18] 王盛磊,朱幼玲,唐敏. MR灌注加权成像在急性脑梗死患者临床诊治中的应用研究[J]. 中国脑血管病杂志,2019,16(5):274-277. doi: 10.3969/j.issn.1672-5921.2019.05.011 -
