School of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China.
Department of Medical Imaging, Weifang Sunshine Union Hospital, Weifang, China.
Ann Palliat Med. 2022 Apr;11(4):1351-1359. doi: 10.21037/apm-21-3589.
Perfusion-weighted magnetic resonance imaging (MRI) can evaluate collateral circulation in patients with acute cerebral infarction by reflecting hemodynamic signals in the brain. The purpose of this study was to evaluate the collateral circulation and short-term prognosis of patients with acute cerebral infarction, using perfusion-weighted MRI.
The study enrolled 206 patients with acute cerebral infarction due to unilateral cerebral artery occlusion diagnosed by digital subtraction angiography (DSA) and computed tomography angiography (CTA). The relative cerebral blood volume (rCBV), relative cerebral blood flow map (rCBF), relative peak time (rTTP), and relative mean transit time (rMTT) were calculated based on the ratio of the perfusion-weighted MRI reference values of the infarcted side and the control side of the patient. According to the results of perfusion-weighted MRI, patients were divided into a high perfusion group (n=121) and a low perfusion group (n=85). The Thrombolysis in Cerebral Infarction scale proposed by Higashida et al. in 2003 (Higashida scale) was used to evaluate the establishment of collateral circulation on the day of admission and 15 days after admission. The National Institutes of Health Stroke Scale (NIHSS) score and the modified Rankin scale assessed the short-term prognosis of patients with cerebral infarction. The Spearman correlation analysis examined the correlation between the rCBV, rCBF, and NIHSS scores, and the modified Rankin scale (mRS).
Compared with the patients in the low perfusion group, the rCBV and rCBF in the infarcted area of the patients in the high perfusion group were significantly increased and the rTTP and rMTT were significantly decreased. On day 15 after admission, the collateral circulation rate of the high perfusion group was significantly higher than that of the low perfusion group, and the NIHSS score and the mRS score were significantly lower than those scores of the low perfusion group. Perfusion-weighted MRI indexes, rCBV, and rCBF were negatively correlated with the NIHSS score and Rankin scale.
Perfusion-weighted MRI can effectively evaluate the compensatory ability of collateral circulation and the prognosis of patients with acute cerebral infarction.
灌注加权磁共振成像（MRI）可以通过反映大脑中的血流动力学信号来评估急性脑梗死患者的侧支循环。本研究旨在通过灌注加权 MRI 评估急性脑梗死患者的侧支循环和短期预后。
本研究纳入了 206 例经数字减影血管造影（DSA）和计算机断层血管造影（CTA）诊断为单侧大脑动脉闭塞的急性脑梗死患者。根据患者患侧和健侧灌注加权 MRI 参考值的比值计算相对脑血容量（rCBV）、相对脑血流图（rCBF）、相对峰值时间（rTTP）和相对平均通过时间（rMTT）。根据灌注加权 MRI 的结果，将患者分为高灌注组（n=121）和低灌注组（n=85）。采用 Higashida 等 2003 年提出的溶栓治疗脑梗死量表（Higashida 量表）于入院当天和入院后 15 天评估侧支循环的建立情况。采用国立卫生研究院卒中量表（NIHSS）评分和改良 Rankin 量表（mRS）评估脑梗死患者的短期预后。Spearman 相关分析检验 rCBV、rCBF 与 NIHSS 评分和 mRS 的相关性。
与低灌注组患者相比，高灌注组患者梗死区 rCBV 和 rCBF 明显升高，rTTP 和 rMTT 明显降低。入院后第 15 天，高灌注组侧支循环率明显高于低灌注组，NIHSS 评分和 mRS 评分明显低于低灌注组。灌注加权 MRI 指标 rCBV 和 rCBF 与 NIHSS 评分和 Rankin 量表呈负相关。
灌注加权 MRI 能有效评估急性脑梗死患者侧支循环代偿能力和预后。
