<sup>1</sup>H-磁共振波普成像联合弥散加权成像、3D-动脉内源性标记对急性脑梗死缺血半暗带的评估价值

doi:10.3877/cma.j.issn.1674-0785.2019.08.007

目的

探讨¹H-磁共振波谱成像（MRS）联合弥散加权成像（DWI）、3D-动脉内源性标记（ASL）的磁共振成像方法，对评估急性脑梗死患者缺血半暗带的应用价值。

方法

收集绵阳市第三人民医院2016年10月至2018年3月诊断为急性脑梗死且还未进行临床干预的患者，入组的31例急性脑梗死患者，在症状出现后最短时间内接受DWI、T1加权成像（T1WI）、T2加权成像（T2WI）、磁共振成像液体衰减反转恢复序列（FLAIR）、3D-ASL及¹H-MRS序列扫描，通过ASL-DWI不匹配区来判断患者脑梗死病灶周围的缺血半暗带的范围，再利用¹H-MRS对梗死灶中心区、缺血半暗带及梗死周围正常区的代谢产物浓度［乳酸（Lac）、N-2酰-天门冬氨酸（NAA）、胆碱（Cho）及肌酸（Cr）］进行分析，采用配对样本t检验比较不同区域的Lac、NAA、Cho及Cr的代谢物浓度差异。

结果

本研究的31例急性脑梗死患者中，有26例患者ASL低灌注面积大于DWI信号异常区面积，5例患者ASL低灌注面积约等于DWI信号异常区面积。脑梗死中心区的Lac、NAA、Cho及Cr峰值分别为44.79±16.90、25.34±12.12、34.44±8.24、27.91±7.83；缺血半暗带的Lac、NAA、Cho及Cr峰值分别为22.57±8.57、46.64±10.41、51.37±10.86、36.86±6.00；脑梗死周围正常区的Lac、NAA、Cho及Cr峰值分别为6.54±3.34、58.78±9.01、48.02±7.93、39.02±4.74。脑梗死中心区的Lac、NAA、Cho及Cr峰值明显低于缺血半暗带，差异均具有统计学意义（P<0.05）。脑梗死周围正常区与缺血半暗带相比，Lac峰值较高，NAA峰值较低，差异均具有统计学意义（P<0.05）；而Cho及Cr峰值2者差异无统计学意义（P均>0.05）。

结论

¹H-MRS联合DWI、3D-ASL可以更准确的评估急性脑梗死患者缺血半暗带的存在及其物质代谢变化，为急性脑梗死患者的临床治疗方式的选择提供了更好的影像学依据。

关键词: 磁共振波谱学, 弥散加权成像, 动脉自旋标记, 脑梗死, 缺血半暗带

Objective

To assess the value of proton magnetic resonance spectroscopy (¹H-MRS) combined with diffusion-weighted imaging (DWI) and three-dimensional arterial spin labeling (3D-ASL) magnetic resonance imaging in the evaluation of ischemic penumbra in patients with acute cerebral infarction.

Methods

This study included 31 patients with acute infarction. DWI, T1WI, T2WI, FLAIR, 3D-ASL, and ¹H-MRS sequence scans were performed within the shortest time after symptoms appeared. The extent of the ischemic penumbra around the patient's infarcted lesion was determined by the ASL-DWI mismatch zone. ¹H-MRS was used to analyze the metabolite concentrations (lactic acid [Lac], acetyl aspartate [NAA], choline [Cho], and creatine [Cr]) in the central region of the infarct, the ischemic penumbra, and the normal area around the infarct. The concentrations of Lac, NAA, Cho, and Cr in different regions were compared by the paired sample t-test.

Results

Of the 31 patients with acute cerebral infarction in this study, 26 patients had an ASL low perfusion area that was larger than the DWI signal abnormal area, and 5 patients had an ASL low perfusion area that was approximately equal to the DWI signal abnormal area. The peaks of Lac, NAA, Cho, and Cr in the central region of cerebral infarction were 44.79±16.90, 25.34±12.12, 34.44±8.24, and 27.91±7.83, respectively, and the corresponding values in the ischemic penumbra and the normal area around the infarction were 22.57±8.57, 46.64±10.41, 51.37±10.86, and 36.86±6.00, and 6.54±3.34, 58.78±9.01, 48.02±7.93, and 39.02±4.74. The peaks of Lac, NAA, Cho, and Cr in the central area of cerebral infarction were significantly lower than those in the ischemic penumbra (P<0.05). Compared with the ischemic penumbra, the normal area around the infarction had a significantly higher Lac peak and significantly lower NAA peak (P<0.05), although there was no statistical difference in Cho and Cr peaks.

Conclusion

¹H-MRS combined with DWI and 3D-ASL can more accurately assess the presence of ischemic penumbra and its metabolic changes in patients with acute cerebral infarction, providing a better imaging basis for selecting optimal clinical treatment for patients with acute cerebral infarction.

Key words: Magnetic resonance spectroscopy, Diffusion-weighted imaging, Arterial spin labeling, Cerebral infarction, Ischemic penumbra

图1 左侧半卵圆中心区急性期脑梗死患者影像诊断图　患者男，45岁，以右侧肢体肌力减退、吐词不清3 h入院，本次磁共振检查距患者发病10 h余，图a为DWI图，图b为ASL血流量图，图c为梗死中心区¹H-MRS波普曲线图，图d为缺血半暗带¹H-MRS波普曲线图，图e为梗死灶周围正常区¹H-MRS波普曲线图

图2 右侧额顶叶急性期脑梗死患者影像诊断图　患者男性，65岁，以左侧肢体无力2 h入院，本次磁共振检查距患者发病8 h余，图a为DWI图，图b为ASL血流量图，图c为梗死中心区¹H-MRS波普曲线图，图d为缺血半暗带¹H-MRS波普曲线图，图e为梗死灶周围正常区¹H-MRS波普曲线图

表1 缺血半暗带分别与梗死中心区及周围正常区代谢物浓度比较（±s）

组别	Lac	NAA	Cho	Cr
缺血半暗带	22.57±8.57	46.64±10.41	51.37±10.86	36.86±6.00
梗死中心区	44.79±16.90	25.34±12.12	34.44±8.24	27.91±7.83
梗死灶周围正常区	6.54±3.34	58.78±9.01	48.02±7.93	39.02±4.74
^at值	9.78	-11.11	-8.25	-8.84
^aP值	<0.001	<0.001	<0.001	<0.001
^bt值	-10.49	5.32	-1.57	1.72
^bP值	<0.001	<0.001	0.126	0.095

表1 缺血半暗带分别与梗死中心区及周围正常区代谢物浓度比较（±s）

组别	Lac	NAA	Cho	Cr
缺血半暗带	22.57±8.57	46.64±10.41	51.37±10.86	36.86±6.00
梗死中心区	44.79±16.90	25.34±12.12	34.44±8.24	27.91±7.83
梗死灶周围正常区	6.54±3.34	58.78±9.01	48.02±7.93	39.02±4.74
^at值	9.78	-11.11	-8.25	-8.84
^aP值	<0.001	<0.001	<0.001	<0.001
^bt值	-10.49	5.32	-1.57	1.72
^bP值	<0.001	<0.001	0.126	0.095

1	Liu D, Sun W, Scalzo F, et al. Early Magnetic Resonance Imaging Predicts Early Neurological Deterioration in Acute Middle Cerebral Artery Minor Stroke[J]. J Stroke Cerebrovasc, 2016, 25(2): 469-474.
2	Vicente J, Fuster-Garcia E, Tortajada S, et al. Accurate classification of childhood brain tumours by in vivo ¹H MRS-a multi-centre study[J]. Eur J Cancer, 2013, 49(3): 658-667.
3	Vilela P, Rowley HA. Brain Ischemia: CT and MRI Techniques in Acute Ischemic Stroke[J]. Eur J Cancer, 2017, 96(3): 162-172.
4	Luo S, Yang L, Wang L. Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke[J]. J Neuroradiol, 2015, 42(5): 255-260.
5	Bushnell C, Howard VJ, Lisabeth L, et al. Sex differences in the evaluation and treatment of acute ischaemic stroke[J]. Lancet Neurol, 2018, 17(7): 641-650.
6	Goyal MS, Hoff BG, Williams J, et al. Streamlined hyperacute magnetic resonance imaging protocol identifies tissue-type plasminogen activator-eligible stroke patients when clinical impression is stroke mimic[J]. Stroke, 2016, 47(4): 1012-1017.
7	Hansen CK, Christensen A, Rodgers H, et al. Does the Primary Imaging Modality-Computed Tomography or Magnetic Resonance Imaging-Influence Stroke Physicians′ Certainty on Whether or Not to Give Thrombolysis to Randomized Acute Stroke Patients?[J]. J Stroke Cerebrovasc, 2018, 27(4): 926-935.
8	Warach SJ, Luby M, Albers GW, et al. Acute Stroke Imaging Research Roadmap III Imaging Selection and Outcomes in Acute Stroke Reperfusion Clinical Trials[J]. Stroke, 2016, 47(5): 1389-1398.
9	Lin L, Bivard A, Levi CR, et al. Comparison of Computed Tomographic and Magnetic Resonance Perfusion Measurements in Acute Ischemic Stroke[J]. Stroke, 2014, 45(6): 1727-1732.
10	Bivard A, Krishnamurthy V, Stanwell P, et al. Arterial Spin Labeling Versus Bolus-Tracking Perfusion in Hyperacute Stroke[J]. Stroke, 2013, 45(1): 127-133.
11	李忠维，张国伟，梁辉, 等. 动脉自旋标记技术联合扩散加权成像在脑梗死诊治中的应用价值[J]. 中华老年心脑血管病杂志, 2016, 18(10): 1020-1022.
12	纪宇，邵广瑞，马帅. 磁共振3D-ASL与DWI在脑血管闭塞疾病中的临床应用价值[J]. 医学影像学杂志, 2016, 26(7): 1164-1166.
13	尚文文，殷信道，周俊山, 等. 多体素氢质子磁共振波谱成像(~1H-MRS)在急性脑梗死中的应用研究[J].中国CT和MRI杂志, 2017, 15(5): 5-7.
14	Kaplan B, Brint S, Tanabe J, et al. Temporal thresholds for neocortical infarction in rats subjected to reversible focal cerebral ischemia[J]. Stroke, 1991, 22(8): 1032-1039.
15	McCabe C, Arroja MM, Reid E, et al. Animal models of ischaemic stroke and characterisation of the ischaemic penumbra[J]. Neuropharmacology, 2018, 134(15): 169-177.
16	曲鑫鑫，孙洪赞，朱文珍, 等. DWI联合动脉自旋标记及MRA评价脑梗死缺血半暗带[J]. 中国医学影像技术, 2014, 30(1): 11-15.
17	Pigula FA, Siewers RD, Nemoto EM. Hypothermic cardiopulmonary bypass alters oxygen/glucose uptake in the pediatric brain[J]. J Thorac Cardiov Surg, 2001, 121(2): 366-373.
18	William M, Holmes MR, Lopez-Gonzalez LG, et al. Novel MRI detection of the ischemic penumbra: direct assessment of metabolic integrity[J]. Nmr Biomed, 2012, 25(2): 295-304.
19	Saresa DP, Law M. Magnetic resonance spectroscopy of the brain: review of metabolites and clinical applications[J]. Clin Radiol, 2009, 64(1): 12-21.
20	Bivard A, Krishnamurthy V, Stanwell P, et al. Spectroscopy of Reperfused Tissue after Stroke Reveals Heightened Metabolism in Patients with Good Clinical Outcomes[J]. J Cerebr Blood Flow Met, 2014, 34(12): 1944-1950.
21	Kim DH, Kim S, Jung WY, et al. The neuroprotective effects of the seeds of Cassia obtusifolia on transient cerebral global ischemia in mice[J]. Food Chem Toxicol, 2009, 47(7): 1473-1479.
22	Singhal AB, Ratai E, Benner T, et al. Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke[J]. Stroke, 2007, 38(10): 2851-2854.
23	Muñoz MS, Cvoro V, Chappell FM, et al. Changes in NAA and lactate following ischemic stroke A serial MR spectroscopic imaging study[J]. Neurology, 2008, 71(24): 1993-1999.
24	Saunders DE, Howe FA, van den Boogaart A, et al. Continuing Ischemic Damage After Acute Middle Cerebral Artery Infarction in Humans Demonstrated by Short-Echo Proton Spectroscopy[J]. Stroke, 1995, 26(6): 1007-1013.
25	尚文文，薛莲，张慧丽, 等. ¹H-MRS采用短回波扫描在超急性脑梗死治疗中的应用价值[J]. 磁共振成像, 2018, 9(4): 246-252.
26	Mathews VP, Barker PB, Blackband SJ, et al. Cerebral metabolites in patients with acute and subacute strokes: concentrations determined by quantitative proton MR spectroscopy[J]. Am J Roentgenol, 1995, 165(3): 633-638.

[1]	刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2]	李全喜, 唐辉军, 张健生, 杨飞. 基于MUSE-DWI与SS-DWI技术在前列腺癌图像中的对比研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 553-557.
[3]	王静, 何彬. 经颅彩色多普勒超声联合血sCD40L、Fib、PAF对短暂性脑缺血发作后脑梗死的预测效果[J]. 中华神经创伤外科电子杂志, 2023, 09(04): 222-227.
[4]	刘宏达, 邵祥忠, 李林, 许小伟. 海安地区动脉粥样硬化性脑梗死患者CYP2C19基因多态性及与氯吡格雷抵抗的关系[J]. 中华神经创伤外科电子杂志, 2023, 09(04): 234-240.
[5]	马丽. CT灌注联合血管成像预测急性脑梗死患者近期神经功能预后的价值分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 229-234.
[6]	许秀兰, 朱建建. 血压变异性与伴H型高血压的急性脑梗死患者预后不良的临床关系分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(04): 199-204.
[7]	王姗姗, 徐小汝, 史振仙, 张德杰. 丹参多酚酸联合尤瑞克林治疗急性分水岭脑梗死的疗效及对认知功能、脑血流动力学和血清LPA、ox-LDL、MMP-9水平的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(03): 142-149.
[8]	胡宝茹, 尚乃舰, 高迪. 中晚期肝细胞癌的DCE-MRI及DWI表现与免疫治疗预后的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 399-403.
[9]	冯海涛, 徐涛, 刘文阳, 孙晨, 曹尚超. 三维动脉自旋标记联合动态对比增强MRI对脑胶质瘤术后复发及放射性脑坏死诊断的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 262-265.
[10]	丁晶, 李培雯, 许迎春. 醒脑开窍针刺法在神经急重症中的应用[J]. 中华针灸电子杂志, 2023, 12(04): 161-164.
[11]	宁丽娜, 熊杰. 醒脑开窍针刺法结合舌部针刺治疗脑梗死后构音障碍的疗效观察[J]. 中华针灸电子杂志, 2023, 12(04): 146-150.
[12]	邱甜, 杨苗娟, 胡波, 郭毅, 何奕涛. 亚低温治疗脑梗死机制的研究进展[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 518-521.
[13]	李秦鹏, 王其涛, 朱媛媛, 周琦, 刘笑言, 许勇. 颈动脉彩色多普勒超声、颈部CT血管成像及脑部CT灌注成像在脑梗死并发颈动脉狭窄患者中的应用研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 482-488.
[14]	朱敏, 李法强. 血清GFAP、UCH-L1联合VILIP-1水平对急性脑梗死神经功能预后不良的预测研究[J]. 中华脑血管病杂志(电子版), 2023, 17(05): 452-457.
[15]	李安, 张秀萍, 白波, 赵阳, 薛国芳, 李东芳. 主动脉夹层术后并发神经系统并发症二例及文献复习[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 373-378.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

¹H-MRS combined with DWI and 3D-ASL for evaluation of ischemic penumbra of acute cerebral infarction

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

1H-MRS combined with DWI and 3D-ASL for evaluation of ischemic penumbra of acute cerebral infarction

¹H-MRS combined with DWI and 3D-ASL for evaluation of ischemic penumbra of acute cerebral infarction