多延迟动脉自旋标记成像在急性缺血性脑卒中灌注评估中的研究进展与临床应用

doi:10.3877/cma.j.issn.1674-0785.2025.06.009

急性缺血性脑卒中的迅速且精确的灌注评估，于患者的治疗指导和预后评估而言至关重要，随着影像学技术的不断进步，多延迟动脉自旋标记成像（md-ASL）作为一项非侵入性且无辐射的灌注成像技术，渐受关注，此技术可供给脑部血流（CBF）及动脉输运时间（ATT）等核心指标，辅助识别缺血半暗区并预测病灶演变。然而，尽管多项研究已探讨md-ASL在AIS中的应用，参数标准化不足且临床适用性受限等问题依旧存在，因此，本文旨在总结md-ASL在急性缺血性脑卒中灌注评估领域的最新研究成果，深入分析CBF与ATT参数与缺血区核心及半暗带范围及临床结果间的联系，同步研究其在各种再通状态下的临床应用价值及未来发展趋势。

关键词: 多延迟动脉自旋标记, 急性缺血性脑卒中, 灌注成像, 延迟时间, 缺血半暗带

The rapid and precise perfusion assessment of acute ischemic stroke is of paramount significance for treatment guidance and prognosis evaluation. With the continuous progress of imaging technologies, multi-delay pseudocontinuous arterial spin labeling (md-ASL), a non-invasive and radiation-free perfusion imaging technique, has increasingly drawn attention. This technique can provide key parameters such as cerebral blood flow (CBF) and arterial transit time (ATT), which helps to identify the ischemic penumbra and predict the evolution of lesions. However, although numerous studies have investigated the application of md-ASL in acute ischemic stroke (AIS), problems such as insufficient parameter standardization and limited clinical applicability still remain. Therefore, this paper aims to comprehensively summarize the latest research findings on md-ASL in the field of perfusion assessment for acute ischemic stroke, and conduct an in-depth analysis of the relationships between CBF and ATT parameters, the core and penumbra regions of the ischemic area, and clinical outcomes. Meanwhile, the paper explores the clinical application value of md-ASL under various recanalization conditions and its future development trends.

Key words: Multi-delay arterial spin labeling, Acute ischemic stroke, Perfusion imaging, Delay time, Ischemic penumbra

表1 md-ASL与传统灌注技术在识别缺血半暗带中的性能对比^[16,39]

技术方法	敏感度	特异度	一致性
md-ASL（rCBF<40%）	91.5%	80.5%	0.91
md-ASL（cCBF<20）	87.2%	76.4%	0.73
CTP（CBF/MTT/Tmax）	80–85%	68–72%	0.64

表1 md-ASL与传统灌注技术在识别缺血半暗带中的性能对比^[16,39]

技术方法	敏感度	特异度	一致性
md-ASL（rCBF<40%）	91.5%	80.5%	0.91
md-ASL（cCBF<20）	87.2%	76.4%	0.73
CTP（CBF/MTT/Tmax）	80–85%	68–72%	0.64

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