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.

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.

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.

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.