3D-CUBE T1和SWI对急性缺血性脑卒中动脉血栓诊断的临床价值

目的探讨3D-CUBE T₁与SWI对急性缺血性脑卒中(AIS)责任动脉血栓的临床价值。方法选取AIS(0~7天)患者71例,行DWI、MRA、SWI和矢状位3D-CUBE T₁全脑扫描,并对SWI原始图像进行最小强度投影(MinIP)的轴位重建。3D-CUBE T₁原始图像采用MIP重组出轴位、冠状位、矢状位、斜位和曲面重建。采用χ²检验比较AIS的SWI的动脉磁敏感征(SVS)和3D CUBE T₁的高信号血管征(CUBE vascular hyperintensity,CVH)责任动脉血栓阳性率,分析上述2种成像方法对责任动脉血栓的检出率。结果71例AIS患者的超急性期8例、急性期42例和亚急性早期21例。在71例AIS患者中有74根责任血管,SWI显示45根SVS征,其中MCA 35根、ICA 0根、ACA 2根、PCA 4根、VA 3根、BA 1根。3D CUBE T₁显示有67根CVS征,其中MCA 34根、ICA 12根、ACA 2根、PCA 9根、VA 7根和BA 3根。SVS与CVH责任动脉血栓阳性的血管分别为45根和67根,分别占总数的60.8%和90.5%。CVH显示的责任动脉血栓阳性率高于SVS,差异有显著统计学意义(χ²=17.766,P<0.001)。CVH与SVS对MCA血栓的检测具有高度一致性(χ²=0.214,P>0.05),ICA、ACA、PCA、VA和BA的CVH显示的责任动脉血栓阳性率高于SVS,差异有显著统计学意义(χ²=16.044,P<0.001)。结论高分辨3D CUBE T₁序列能够直接显示责任动脉血栓部位和信号差异,诊断准确性明显优于SWI,为临床无创、早期准确诊断动脉血栓提供了新的影像检查技术及优化检查流程。

Value of 3D-CUBE T1 and SWI in the diagnosis of arterial thrombosis in acute ischemic stroke

Objective The research of the comparation of 3D-CUBE T₁ and SWI of responsible arterial thrombosis of acute ischemic stroke(AIS)had been conducted in this article.Methods Retrospective analysis was performed on 71 AIS(0~7 day)patients from February 2019 to August 2020,including 45 males and 26 females,aged 41~84 years,with a median age of 66.7 years.All patients underwent conventional MRI,MRA,SWI and sagittal 3D-CUBE T₁ whole brain scanning,and the original SWI image was reconstructed by minimum intensity projection(MinIP).The original image of 3D-CUBE T₁ was reconstructed into axial,coronal,sagittal,oblique and curved positions by MIP.Theχ² test was used to compare the positive rates of arterial magnetic sensitivity(SVS)of AIS SWI and the CUBE vascular hyperintensity(CVH)of 3D CUBE T₁ and the detection rates of the two imaging methods were analyzed.Results There were 8 cases of hyperacute stage,42 cases of acute stage and 21 cases of subacute early stage in 71 patients with AIS.There were 74 responsible vessels in the 71 patients with AIS,and SWI showed 45 SVS signs,including MCA35,ICA0,ACA2,PCA 4,VA3 and BA 1.The 3D CUBE T₁ showed 67 CVS,including 34 MCA34,12 ICA12,ACA2,9 PCA,7 VA7 and 3 BA.There were 45 vessels positive for SVS and 67 vessels positive for CVH responsible artery thrombosis,accounting for 60.8%and 90.5%of the total,respectively.The CVH showed higher positive rate than SVS,and the difference was statistically significant(χ²=17.766,P<0.001).The detection of MCA thrombosis by CVH and SVS was highly consistent(χ²=0.214,P>0.05).CVH of ICA,ACA,PCA,VA,BA and PICA showed a higher positive rate of responsible artery thrombosis than SVS,and the difference was statistically significant(χ²=16.044,P<0.001).Conclusion The high resolution 3D CUBE T₁ sequence can directly show the location and signal difference of the responsible artery thrombosis,and the diagnostic accuracy is significantly better than SWI.It provides a new imaging technique and an optimized examination process for the clinical non-invasive and early accurate diagnosis of arterial thrombosis.