多延迟动脉自旋标记与计算机断层扫描灌注在急性缺血性卒中半暗带体积中的比较
Multidelay Arterial Spin Labeling Versus Computed Tomography Perfusion in Penumbra Volume of Acute Ischemic Stroke.
作者信息
Yan Chuming, Yu Fan, Zhang Yingjie, Zhang Miao, Li Jingkai, Wang Zixin, Lu Jie, Ma Qingfeng
机构信息
Department of Neurology (C.Y., Y.Z., Z.W., Q.M.), Xuanwu Hospital Capital Medical University, Beijing, China.
Department of Radiology (F.Y., M.Z., J.L., J.L.), Xuanwu Hospital Capital Medical University, Beijing, China.
出版信息
Stroke. 2023 Apr;54(4):1037-1045. doi: 10.1161/STROKEAHA.122.040759. Epub 2023 Mar 14.
BACKGROUND
Multidelay arterial spin labeling (ASL) is a novel perfusion method of ASL, with arterial transit time (ATT) calculated by multiple postlabeling delays to correct cerebral blood flow (CBF). We verify the accuracy of multidelay ASL in evaluating the ischemic penumbra and perfusion levels in patients with acute ischemic stroke, compared with computed tomography perfusion (CTP).
METHODS
Patients with acute ischemic stroke with anterior circulation large vessel occlusion received baseline CTP, multidelay ASL, and diffusion-weighted imaging (DWI) in succession. Multidelay ASL image was processed to reconstruct ATT, CBF without ATT correction, and CBF corrected by ATT. The consistency of hypoperfusion and ischemic penumbra volume calculated by CTP and multidelay ASL were quantified by intraclass correlation coefficient (ICC) in 2-way mixed effects, absolute agreement, and single measure. Wilcoxon signed-rank test was used to compare the difference in penumbra volume between CTP, corrected ASL, and uncorrected ASL.
RESULTS
Thirty patients were included. Hypoperfusion volume based on multidelay ASL with different thresholds were 117.95 (87.77-151.49) mL for corrected relative CBF<40%, 130.29 (85.99-249.37) mL for CBF corrected by ATT<20 mL·100g·min, no statistical difference (>0.05) compared with the volume of CTP, and consistency was almost excellent (ICC, 0.91) and substantial consistent (ICC, 0.727). The volumes of ischemic penumbra were 91.00 (42.68-125.27) mL for corrected relative CBF<40%-DWI, 108.94 (62.03-150.86) mL for CBF corrected by ATT<20 mL·100 g·min-DWI, which showed no statistical difference compared with the penumbra volume of CTP (>0.05). The consistency was excellent (ICC, 0.822) and moderate (ICC, 0.501), respectively. The volume of uncorrected relative CBF <40%-DWI was 209.57 (123.21-292.45) mL, statistically larger than corrected relative CBF <40%-DWI (<0.001) and CTP (<0.001). The volume of uncorrected CBF<20 mL·100g·min-DWI was 186.23 (86.56-298.22) mL, statistically larger than CBF corrected by ATT<20 mL·100g·min-DWI (<0.001) and CTP(<0.001).
CONCLUSIONS
The volume of ischemic penumbra determined by CBF/DWI mismatch based on multidelay ASL is consistent with CTP. The penumbra volume calculated by CBF adjusted by ATT is more accurate.
背景
多延迟动脉自旋标记（ASL）是一种新型的ASL灌注方法，通过多个标记后延迟来计算动脉通过时间（ATT），以校正脑血流量（CBF）。我们将多延迟ASL与计算机断层扫描灌注（CTP）相比较，验证其在评估急性缺血性脑卒中患者缺血半暗带和灌注水平方面的准确性。
方法
前循环大血管闭塞的急性缺血性脑卒中患者依次接受基线CTP、多延迟ASL和扩散加权成像（DWI）检查。对多延迟ASL图像进行处理，以重建ATT、未校正ATT的CBF以及经ATT校正的CBF。通过组内相关系数（ICC）在双向混合效应、绝对一致性和单一测量中对CTP和多延迟ASL计算的灌注不足和缺血半暗带体积的一致性进行量化。采用Wilcoxon符号秩检验比较CTP、校正后的ASL和未校正的ASL之间半暗带体积的差异。
结果
纳入30例患者。对于校正后相对CBF<40%，基于多延迟ASL的不同阈值的灌注不足体积为117.95（87.77 - 151.49）mL；对于经ATT校正的CBF<20 mL·100g·min，灌注不足体积为130.29（85.99 - 249.37）mL，与CTP体积相比无统计学差异（>0.05），一致性几乎为优（ICC，0.91）且高度一致（ICC，0.727）。对于校正后相对CBF<40% - DWI，缺血半暗带体积为91.00（42.68 - 125.27）mL；对于经ATT校正的CBF<20 mL·100 g·min - DWI，缺血半暗带体积为108.94（62.03 - 150.86）mL，与CTP的半暗带体积相比无统计学差异（>0.05）。一致性分别为优（ICC，0.822）和中等（ICC，0.501）。未校正的相对CBF <40% - DWI体积为209.57（123.21 - 292.45）mL，在统计学上大于校正后相对CBF <40% - DWI（<0.001）和CTP（<0.001）。未校正的CBF<20 mL·100g·min - DWI体积为186.23（86.56 - 298.22）mL，在统计学上大于经ATT校正的CBF<20 mL·100g·min - DWI（<0.001）和CTP（<0.001）。
结论
基于多延迟ASL的CBF/DWI不匹配所确定的缺血半暗带体积与CTP一致。经ATT调整的CBF计算的半暗带体积更准确。
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