The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
The D. Samuel Gottesman Library, Albert Einstein College of Medicine, Bronx, New York, USA.
J Neuroimaging. 2021 Nov;31(6):1067-1076. doi: 10.1111/jon.12913. Epub 2021 Aug 13.
Dynamic susceptibility contrast (DSC) MR imaging is commonly used to estimate penumbra size in acute ischemic stroke; this technique relies on the administration of gadolinium contrast, which has limited use in certain populations, such as those with impaired renal function or allergies. Arterial spin labeling (ASL) is a relatively new technique that can provide information on cerebral perfusion without need for exogenous contrast agents. This systematic review examines published studies that specifically compared ASL to DSC for assessment of ischemic penumbra.
We searched PubMed, Embase, Web of Science, and the Cochrane Library for papers which compared ASL with DSC for assessment of ischemic penumbra in acute ischemic stroke among adult human populations. Two independent reviewers screened studies using predefined inclusion and exclusion criteria. Study characteristics and findings regarding the utility of ASL compared to DSC for identification of penumbra were then extracted and anlyzed for results and risk of bias.
Seventeen articles met inclusion and exclusion criteria. Studies compared ASL with DSC on a range of metrics (hypoperfusion, hyperperfusion, mismatch, and reperfusion). Most studies concluded that agreement of ASL with DSC was moderate to very high. A small subset of studies found discrepancy in agreement of ASL with DSC for size or location of perfusion abnormalities. A heterogeneity of perfusion parameters studied for DSC was noted, along with the need for more standardization of research methods.
ASL shows moderate to high agreement with DSC for detection of penumbra among ischemic stroke patients.
动态磁敏感对比（DSC）磁共振成像常用于评估急性缺血性卒中的半暗带大小；该技术依赖于钆造影剂的给药，但在某些人群中，如肾功能受损或过敏人群，其使用受限。动脉自旋标记（ASL）是一种相对较新的技术，无需使用外源性对比剂即可提供脑灌注信息。本系统评价检查了专门比较 ASL 和 DSC 评估缺血半暗带的已发表研究。
我们在 PubMed、Embase、Web of Science 和 Cochrane Library 中搜索了比较成人急性缺血性卒中患者的 ASL 和 DSC 评估缺血半暗带的研究。两名独立审查员使用预定义的纳入和排除标准筛选研究。然后提取并分析研究特征和关于 ASL 用于识别半暗带的与 DSC 相比的实用性的发现，以进行结果和偏倚风险评估。
有 17 篇文章符合纳入和排除标准。研究比较了 ASL 与 DSC 在各种指标（低灌注、高灌注、不匹配和再灌注）上的差异。大多数研究得出结论，ASL 与 DSC 的一致性为中度至高度。一小部分研究发现 ASL 与 DSC 对灌注异常的大小或位置的一致性存在差异。DSC 研究的灌注参数存在异质性，需要对研究方法进行更多的标准化。
ASL 对半暗带的检测与 DSC 具有中度至高度的一致性。
