Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke.
Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke.
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急性中风患者的全脑动脉自旋标记灌注MRI。
DOI：
10.1161/strokeaha.110.589234
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发表时间：
2012-05
期刊：
影响因子：
8.3
通讯作者：
National Institutes of Health Stroke Natural History Investigators
中科院分区：
文献类型：
--
作者：
Bokkers RP;Hernandez DA;Merino JG;Mirasol RV;van Osch MJ;Hendrikse J;Warach S;Latour LL;National Institutes of Health Stroke Natural History Investigators
核磁共振灌注成像可用于确定急性缺血性卒中患者可能受益于再灌注治疗。然而，肾源性系统性纤维化的风险限制了造影剂的使用。我们的目的是评估动脉自旋标记(ASL)，一种替代的非侵入性灌注技术，与动态磁化率对比(DSC)灌注成像检测灌注缺陷的能力。对7个月内因疑似急性卒中进行紧急评估的连续患者同时进行ASL和DSC灌注磁共振成像。图像由两位专家以随机顺序进行解释，他们对图像质量、是否存在灌注缺陷和扩散-灌注不匹配的临床信息视而不见。156例患者接受了扫描，距离最后一次正常扫描的中位时间为5.6(3.0-17.7)小时。78例患者经临床确诊为中风。这些患者中的均有ASL和DSC影像。在这些患者中，39例DSC检测到了灌注缺陷；ASL检测到了32个这些指标的灌注缺陷，缺失了7个病变。在ASL评估为正常的患者中，DSC测定的灌注缺损量的中位数小于缺陷者(中位数，四分位数范围：56(10-116)ml对114(41-225)ml，p=0.01)。与DSC相对应，ASL可显示较大的灌注缺陷和灌注/弥散失配。我们的研究结果表明，快速2.5分钟的ASL血流灌注扫描可能足以筛查急性卒中患者，这些患者禁忌症是基于Gd的造影剂。
Perfusion MRI can be used to identify patients with acute ischemic stroke that may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative non-invasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging. Consecutive patients referred for emergency assessment of suspected acute stroke within a seven-month period were imaged with both ASL and DSC perfusion MRI. Images were interpreted in a random order by two experts blinded to clinical information for image quality, presence of perfusion deficits and diffusion-perfusion mismatches. 156 patients were scanned with a median time of 5.6 (3.0–17.7) hours from last seen normal. Stroke diagnosis was clinically confirmed in 78 patients. ASL and DSC imaging were available in 64 of these patients. A perfusion deficit was detected with DSC in 39 of these patients; ASL detected 32 of these index perfusion deficits, missing 7 lesions. The median volume of the perfusion deficits as determined with DSC was smaller in patients which were evaluated as normal with ASL than in those with a deficit (median, interquartile range; 56 (10–116) vs. 114 (41–225) ml, p=0.01). ASL can depict large perfusion deficits and perfusion/diffusion mismatches in correspondence with DSC. Our findings show that a fast 2½ minute ASL perfusion scan may be adequate for screening acute stroke patients with contraindications to gadolinium-based contrast agents.