Lyu Jinhao, Duan Qi, Xiao Sa, Meng Zhihua, Wu Xiaoyan, Chen Wen, Wang Guohua, Niu Qingliang, Li Xin, Bian Yitong, Han Dan, Guo Weiting, Yang Shuai, Bian Xiangbing, Lan Yina, Wang Liuxian, Zhang Tingyang, Duan Caohui, Zhang Dekang, Wang Xueyang, Chen Ling, Tian Chenglin, Zhou Xin, Lou Xin
Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China.
Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.
J Magn Reson Imaging. 2023 Apr;57(4):1241-1247. doi: 10.1002/jmri.28364. Epub 2022 Jul 18.
Arterial spin labeling (ASL) has shown potential for the assessment of penumbral tissue in patients with acute ischemic stroke (AIS). The postlabeling delay (PLD) parameter is sensitive to arterial transit delays and influences cerebral blood flow measurements.
To assess the impact of ASL acquisition at different PLDs for penumbral tissue quantification and to compare their performance regarding assisting patient selection for endovascular treatment with dynamic susceptibility contrast MRI (DSC-MRI) as the reference method.
Retrospective.
A total of 53 patients (59.98 ± 12.60 years, 32% women) with AIS caused by internal carotid or middle cerebral artery occlusion.
FIELD STRENGTH/SEQUENCE: A 3-T, three-dimensional pseudo-continuous ASL with fast-spin echo readout.
Hypoperfusion volume was measured using DSC-MRI and ASL with PLDs of 1.500 msec and 2.500 msec, respectively. Eligibility for endovascular treatment was retrospectively determined according to the imaging criteria of the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke trial (DEFUSE 3).
Kruskal-Wallis tests, Bland-Altman plots, Cohen's kappa, and receiver operating characteristic analyses were used. The threshold for statistical significance was set at P ˂ 0.05.
Hypoperfusion volume for ASL with a PLD of 1.500 msec was significantly larger than that for DSC-MRI, while the hypoperfusion volume for a PLD of 2.500 msec was not significantly different from that of DSC-MRI (P = 0.435). Bland-Altman plots showed that the mean volumetric error between the hypoperfusion volume measured by DSC-MRI and ASL with PLDs of 1.500/2.500 msec was -107.0 mL vs. 4.49 mL. Cohen's kappa was 0.679 vs. 0.773 for DSC-MRI and ASL, respectively, with a PLD of 1.500/2.500 msec. The sensitivity and specificity for ASL with a PLD of 1.500/2.500 msec in identifying patients eligible for treatment were 89.74% vs. 97.44% and 92.86% vs. 64.29%, respectively.
In AIS, PLDs for ASL acquisition may have a considerable impact on the quantification of the hypoperfusion volume.
3 TECHNICAL EFFICACY: Stage 2.
动脉自旋标记（ASL）已显示出在评估急性缺血性卒中（AIS）患者半暗带组织方面的潜力。标记后延迟（PLD）参数对动脉通过延迟敏感，并影响脑血流量测量。
评估不同PLD下ASL采集对半暗带组织定量的影响，并将其在辅助选择血管内治疗患者方面的性能与以动态磁敏感对比增强MRI（DSC-MRI）为参考方法进行比较。
回顾性研究。
共有53例由颈内动脉或大脑中动脉闭塞引起的AIS患者（年龄59.98±12.60岁，女性占32%）。
场强/序列：3T，具有快速自旋回波读出的三维伪连续ASL。
分别使用DSC-MRI和PLD为1500毫秒及2500毫秒的ASL测量低灌注体积。根据缺血性卒中影像评估后血管内治疗试验（DEFUSE 3）的影像标准，回顾性确定血管内治疗的 eligibility。
使用Kruskal-Wallis检验、Bland-Altman图、Cohen's kappa检验和受试者操作特征分析。统计学显著性阈值设定为P＜0.05。
PLD为1500毫秒的ASL低灌注体积显著大于DSC-MRI，而PLD为2500毫秒的低灌注体积与DSC-MRI无显著差异（P = 0.435）。Bland-Altman图显示，DSC-MRI与PLD为1500/2500毫秒的ASL测量的低灌注体积之间的平均体积误差分别为-107.0毫升和4.49毫升。DSC-MRI与PLD为1500/2500毫秒的ASL的Cohen's kappa分别为0.679和0.773。PLD为1500/2500毫秒的ASL在识别适合治疗的患者时的敏感性和特异性分别为89.74%对97.44%和92.86%对64.29%。
在AIS中，ASL采集的PLD可能对低灌注体积的定量有相当大的影响。
3 技术效能：2级。
