1、DOI:10 3969/j issn 1671 4695 2023 07 022文章编号:1671 4695(2023)07 0754 04DWI、DTI 及 3D ASL 定量参数在 AIS 预后判断中的应用价值陈玉昆滕佳歧王娟秦丹郭玥李优伟*(首都医科大学附属北京康复医院放射科北京100144)【摘要】目的探讨扩散加权成像(DWI)、弥散张量成像(DTI)及三维动脉自旋标记(3D ASL)定量参数在急性缺血性脑卒中(AIS)预后判断中的应用价值。方法回顾性选取 2020 年 1 月至 2022 年 1 月在首都医科大学附属北京康复医院接受治疗的 AIS 患者 110 例作为研究对象，根据改
2、良 ankin 量表(mS)分为预后良好组 59 例，预后不良组患者 51 例。比较预后良好组和预后不良组患者的临床资料、DWI、DTI 和 3D ASL 定量参数差异。分析 DWI、DTI 及 3D ASL 定量参数与梗死面积、NIHSS 评分的相关性，并分析 DWI、DTI 及 3D ASL 定量参数预测预后不良的价值。结果预后不良组患者梗死面积和入院时美国国立卫生研究院卒中量表(NIHSS)评分分别为(13 22 1 19)cm2和(10 841 21)分，明显高于预后良好组患者，差异均有统计学意义(P 0 05)。预后不良组患者病灶表观弥散系数(ADC)值、相对表观弥散系数(rADC)
3、值、各项异性指数(FA)值、相对各项异性指数(rFA)值、脑血流量(CBF)和相对血流量(rCBF)分别为(0 30 0 09)103mm2/s、0 46 0 10、0 23 0 06、0 55 0 12、(22 10 9 92)mL100 g1min1和 0 44 0 14，均明显低于预后良好组患者，差异均有统计学意义(P 0 05);预后不良组和预后良好组患者平均弥散吸收(Dcavg)值和相对弥散吸收(rDCavg)值比较，差异均无统计学意义(P 0 05)。ADC 值、rADC 值与梗死面积呈负相关(P 0 05)，ADC 值、rADC 值、FA 值、rFA 值、CBF 值和 rCBF
4、值与 NIHSS 评分呈负相关(P 0 05)。ADC 值、rADC值、FA 值、rFA 值、CBF 值和 rCBF 值预测预后不良的受试者工作特征曲线下面积分别为 0 673、0 769、0 824、0 793、0 830和 0 900，其中 ADC 值预测价值较低，rCBF 值预测价值较高。结论DWI、DTI 及 3D ASL 定量参数与 AIS 患者梗死面积、病情严重程度存在相关性，同时在预测 AIS 患者预后方面有一定应用价值。【关键词】扩散加权成像弥散张量成像三维动脉自旋标记定量参数急性缺血性脑卒中预后预测价值Application value of DWI，DTI and 3D A
5、SL quantitative parameters in the prognosis of AIS CHEN Yu kun，TENG Jia qi，WANGJuan，et al Department of adiology，Beijing ehabilitation Hospital，Capital Medical University，Beijing 100144，China【Abstract】ObjectiveTo explore the value of diffusion weighted imaging(DWI)，diffusion tensor imaging(DTI)and t
6、hree dimen-sional arterial spin labeling(3D ASL)quantitative parameters in predicting the prognosis of acute ischemic stroke(AIS)MethodsA total of110 patients with AIS who were treated in Beijing ehabilitation Hospital，Capital Medical University from January 2020 to January 2022 were se-lected and d
7、ivided into 59 patients in good prognosis and 51 patients in poor prognosis patients according to the modified ankin scale(mS)Clinical data，DWI，DTI and 3D ASL quantitative parameters of patients with good and poor prognosis were compared The correlation betweenDWI，DTI and 3D ASL quantitative paramet
8、ers and infarct size and NIHSS score were analyzed，and the value of DWI，DTI and 3D ASL quan-titative parameters in predicting poor prognosis were analyzed esultsThe infarct size and the National Institutes of Health Stroke Scale(NIH-SS)score on admission of patients with poor prognosis group were(13
9、22 119)cm2and(10 84 1 21)，respectively，which were signifi-cantly higher than those of patients with good prognosis group，the differences were statistically significant(P 0 05)The apparent diffusion co-efficient(ADC)，relative apparent diffusion coefficient(rADC)，fractional anisotropy index(FA)，relati
10、ve fractional anisotropy index(rFA)，cerebral blood flow(CBF)and relative blood flow(rCBF)of patients with poor prognosis group were(0 30 0 09)103mm2/s，0 46 0 10，0 23 0 06，0 55 0 12，(22 10 9 92)mL100 g1min1and 0 44 0 14，which were significantly lower than those of pa-tients in good prognosis group，th
11、e differences were statistically significant(P 005)There was no statistically significant difference in averagediffusion coefficient(Dcavg)and relative average diffusion coefficient(rDCavg)between poor and good prognosis patients(P 005)ADC valueand rADC value were negatively correlated with infarct
12、size(P 005)ADC value，rADC value，FA value，rFA value，CBF value and rCBFvalue were negatively correlated with NIHSS score(P 005)The area under the receiver operating characteristic curve of ADC value，rADCvalue，FA value，rFA value，CBF value and rCBF value for predicting poor prognosis were 0673，0769，0 82
13、4，0793，0830 and 0900，P0 05，respectively ADC value had lower predictive value，while rCBF value had higher predictive value ConclusionThe quantitative pa-rameters of DWI，DTI and 3D ASL are correlated with the infarct size and severity of AIS patients，and have certain application value in predic-ting t
14、he prognosis of AIS patients【Key words】Diffusion weighted imaging;Diffusion tensor imaging;Three dimensional arterial spin labeling;Quantitative parameters;Acute ischemic stroke;Prognosis;Predictive value基金课题:北京市科技支撑重点项目(编号:Z101107052210002)*通讯作者:李优伟，E mail:13911482788163 com急性缺血性脑梗死(acute ischemic
15、stroke，AIS)是各种脑血管病变导致脑组织血液供应障碍，引发局部脑组织坏死的病变，临床常表现为感觉、运动及吞咽障碍等，严重者可出现意识障碍1 2。AIS 的治疗以扩容补液改善脑循环为主，但不同的患者预后差异较大，因此需探究有效的预后预测方法3。扩散加权成像(diffusionweighted imaging，DWI)为早期评估 AIS 较为精确的方法，其可对组织扩散程度进行量化，但其中 b 值位置的选取复杂4。扩散张量成像(diffusion tensor imaging，457Journal of Clinical and Experimental Medicine Vol22，No7
16、Apr2023DTI)是一种无创检查技术，可对组织进行针对性检查，对微结构损伤的敏感度较高，但其无法对图像进行三维成像5。三维动脉自旋标记(3D arterial spin labeling，3D ASL)脑灌注成像是评估脑血管病较为先进的影像学手段，其也可对组织血流灌注进行检查6。本研究探讨 DWI、DTI 及3D ASL 定量参数在 AIS 预后判断中的应用价值。现将结果报道如下。1资料与方法1 1一般资料回顾性选取 2020 年 1 月至 2022 年 1月在首都医科大学附属北京康复医院接受治疗的 AIS患者 110 例作为研究对象，其中男性 64 例，女性 46 例;年龄 52 81 岁，平均年龄(64 50 8 92)岁;病灶位置:左侧 71 例，右侧 39 例;病变部位:额叶 39 例，颞叶 36例，顶叶 20 例，其他 15 例。本研究获首都医科大学附属北京康复医院伦理学会批准(批号:2020 KF012)。1 2纳入与排除标准纳入标准:(1)AIS 诊断符合中国急性缺血性脑卒中诊治指南7 中的标准;(2)发病至入院 MI 检查不超过 72 h;(3)单侧病灶;(4)依从