磁共振3D ASL灌注成像对动脉瘤性蛛网膜下腔出血迟发性脑缺血患者早期预后的评价

目的迟发性脑缺血严重影响并导致动脉瘤性蛛网膜下腔出血(aneurismal subarachnoid hemorrhage,a SAH)患者预后不良。通过磁共振三维动脉自旋标记(three-dimension arterial spin labeling,3D ASL)从血流动力学方面早期预测迟发性脑缺血的发生,以指导a SAH患者的预防性治疗,进而改善其预后。方法回顾性分析2015年11月-2016年6月我院收治的30例a SAH患者,术后随访3个月,将所有a SAH患者自然分为DCI组和非DCI组,另外选取同期收治的10例动脉瘤未破裂出血患者作为对照组。所有患者均在起病后3~14d内行磁共振3D ASL检查,分析a SAH患者的血流动力学变化与早期预后的相关性。结果 3组脑血流灌注异常程度存在差异,且差异有统计学意义(Chi-Square统计量为(17.540,P=0.000))。a SAH患者脑血流灌注减低程度与m RS评分呈显著正相关(r=0.955,P=0.000)。结论 DCI的发生与患者早期预后显著相关;磁共振3D ASL作为一种有效的检测工具,可以用于a SAH的早期预后评估。

The Prognostic Evaluation Value of MRI Three-dimension Arterial Spin Labeling in Aneurismal Subarachnoid Hemorrhage with Delayed Cerebral Ischemia

Objective Delayed cerebral ischemia (DCI) seriously affect and lead to aneurismal subarachnoid hemorrhage(aSAH) with poor prognosis. From the aspectof hemodynamics, three-dimension arterial spin labeling(3D ASL) early predicts occurrence of cerebral ischemia, to guide the preventive treatment of aneurysmal subarachnoid hemorrhage patients, and to improve prognosis.Methods Totally 30 cases with SAH were respectively analyzed, all patients underwent magnetic resonance on days 3~14 d, assessing prognosis of patients with Modified Rankin scale (MRS ).In addition, during the same period, 10 cases of aneurysm no-repture hemorrhage patients were selected as control group. All patients were divided into DCI group and non-DCI group. Analyze the relevance of hemodynamic changes of patients with aSAH and early prognosis.Results Differences between 3 groups in degree of cerebral blood flow perfusion abnormalities, and the difference is statistically significant(Chi-Square=17.540, P=0.000). The degree of cerebral perfusion and mRS score was significantly positive correlation(r=0.955, P=0.000). Conclusion The occurrence of DCI was associated with a significant early prognosis. 3D ASL, may be an early useful tool to early prognosis evaluation.