3D-ASL技术评估脑梗死患者脑白质血流灌注异常情况及与认知功能的相关性分析

郝巧梅; 张海三; 马小静; 牛振; 张勇

doi:10.16766/j.cnki.issn.1674-4152.003505

3D-ASL技术评估脑梗死患者脑白质血流灌注异常情况及与认知功能的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.003505

1.
濮阳市安阳地区医院MRI室，河南濮阳 455000
2.
新乡医学院第二附属医院影像科，河南新乡 453002
3.
郑州大学第一附属医院影像科，河南郑州 450001

基金项目:

河南省自然科学基金项目 222300420562

详细信息

通讯作者:
张海三，E-mail: zhs386@163.com

中图分类号: R743.34 R445.2
计量
- 文章访问数: 21
- HTML全文浏览量: 14
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-12
- 网络出版日期: 2024-07-20

Evaluate the abnormal white matter blood perfusion by 3D-ASL technique and its correlation with cognitive function in patients with cerebral infarction

1.
MRI Room, Anyang District Hospital, Puyang, Henan 455000, China

摘要

摘要: 目的采用三维动脉自旋标记技术(3D-ASL)评估脑梗死患者脑白质血流灌注状况，采用蒙特利尔认知评估量表(MoCA)评估患者认知功能，分析脑白质血流灌注情况与认知功能之间的关系。方法收集2020年3月—2023年3月期间濮阳市安阳地区医院收治的123例脑梗死患者的临床资料，采用MRI 3D-ASL检测各脑白质区脑血流量(CBF)。根据患者出院后3个月是否发生认知功能障碍(CD)分为对照组(74例)及CD组(49例)。采用logistic回归分析模型明确脑梗死CD发生的影响因素，Pearson相关性分析研究脑梗死患者脑白质区CBF值与MoCA评分的相关性，ROC曲线分析脑白质区CBF值对脑梗死患者CD发生的预测效能。结果 123例患者中CD发生率为39.84%(49/123)；CD组MoCA评分低于对照组(P<0.05)。Logistic回归分析显示，高水平Hcy及额叶、顶叶及枕叶白质区的低水平CBF值是脑梗死患者发生CD的独立危险因素(P<0.05)；Pearson相关性分析结果显示，患者额叶、顶叶及枕叶CBF值与MoCA评分均呈正相关关系(P<0.05)；ROC曲线分析结果显示，额叶、顶叶及枕叶CBF值及三者联合预测脑梗死患者发生CD的AUC分别为0.542、0.634、0.633、0.793，三者联合的预测效能高于单独检测(P<0.05)。结论脑梗死CD患者存在脑白质血流灌注异常，额叶、顶叶及枕叶CBF值与MoCA评分呈正相关关系，三者联合对脑梗死后CD的发生具有较高的预测价值。
- 脑梗死 /
- 三维动脉自旋标记技术 /
- 脑白质 /
- 血流灌注异常 /
- 认知功能 /
- 相关性
Abstract: Objective Three-dimensional arterial spin labeling (3D-ASL) is used to assess the white matter blood perfusion status of cerebral infarction patients, the Montreal cognitive assessment (MoCA) is used to assess the cognitive function of patients, and the relationship between white matter blood perfusion status and cognitive function is analyzed. Methods Clinical data of 123 patients with cerebral infarction admitted to Anyang Regional Hospital in Puyang City from March 2020 to March 2023 were collected, and cerebral blood flow (CBF) in each white matter region was detected by MRI 3D-ASL. Patients were divided into control group (74 cases) and cognitive dysfunction (CD) group (49 cases) according to whether CD occurred 3 months after discharge. Logistic regression analysis model was used to determine the factors affecting the occurrence of cerebral infarction CD. Pearson correlation was used to analyze the correlation between white matter CBF and MoCA score in patients with cerebral infarction. Receiver operating characteristic curve (ROC) was used to analyze the predictive effect of CBF in white matter region on CD occurrence in patients with cerebral infarction. Results Among the 123 patients, the incidence of CD was 39.84% (49/123), and the MoCA score of CD group was lower than that of control group (P<0.05). Logistic regression analysis showed that high level of Hcy and low level of CBF in frontal, parietal and occipital white matter areas were independent risk factors for the occurrence of cerebral infarction CD (P<0.05). Pearson correlation analysis showed that CBF values in frontal, parietal and occipital lobes were positively correlated with MoCA scores (P<0.05). ROC analysis results showed that the CBF value of frontal, parietal and occipital lobes and the AUC of the CBF value combined with the CBF value of the three lobes were 0.542, 0.634, 0.633 and 0.793, respectively, and the predictive efficiency of the CBF value combined with the CBF value of the three lobes was higher than that of the single detection (P<0.05). Conclusion There is abnormal white matter blood perfusion in patients with cerebral infarction CD. The CBF values of frontal, parietal and occipital lobes are positively correlated with MoCA scores. The combination of the three has high predictive value for the occurrence of CD after cerebral infarction.
- Cerebral infarction /
- 3D arterial spin labeling technology /
- White matter of brain /
- Abnormal blood perfusion /
- Cognitive function /
- Correlation

HTML全文

图 1 MRI 3D-ASL扫描血流灌注图

注：患者男性，75岁，颈动脉狭窄脑梗死。A为PLD 1.5时左、右侧额叶CBF值为61 mL/(min·100 g)、47 mL/(min·100 g)；B为左、右侧枕叶CBF值为52 mL/(min·100 g)、43 mL/(min·100 g)；C为左、右侧顶叶CBF值为52 mL/(min·100 g)、38 mL/(min·100 g)。

Figure 1. MRI 3D-ASL perfusion imaging

下载: 全尺寸图片幻灯片

图 2 额叶、顶叶及枕叶CBF值预测脑梗死患者发生CD的ROC曲线

Figure 2. ROC Curve predicting cognitive decline in stroke patients based on frontal, parietal, and occipital lobe CBF values

下载: 全尺寸图片幻灯片

表 1 2组脑梗死患者临床资料比较

Table 1. Comparison of clinical data between two groups of stroke patients

组别	例数	性别[例(%)]			年龄[例(%)]		受教育程度[例(%)]					高血压史[例(%)]
组别	例数	男性	女性		≥60岁	<60岁	高中以下			高中至专科	本科及以上	有	无
CD组	49	32(65.31)	17(34.69)		26(53.06)	23(46.94)	20(40.82)			19(38.78)	10(20.41)	19(38.78)	30(61.22)
对照组	74	50(67.57)	24(32.43)		45(60.81)	29(39.19)	29(39.19)			31(41.89)	14(18.92)	25(33.78)	49(66.22)
统计量		0.068^a			0.725^a		0.042^a					0.320^a
P值		0.795			0.394		0.967					0.572

组别	例数	糖尿病史[例(%)]			脑部疾病史[例(%)]		梗死史[例(%)]			梗死位置[例(%)]		梗死面积[例(%)]
组别	例数	有	无		有	无	有	无		左侧	右侧	≤3 cm²	>3 cm²
CD组	49	11(22.45)	38(77.55)		12(24.49)	37(75.51)	9(18.37)	40(81.63)		23(46.94)	26(53.06)	32(65.31)	17(34.69)
对照组	74	14(18.92)	60(81.08)		13(17.57)	61(82.43)	10(13.51)	64(86.49)		45(60.81)	29(39.19)	52(70.27)	22(29.73)
统计量		0.227^a			0.872^a		0.532^a			2.295^a		0.335^a
P值		0.634			0.350		0.466			0.130		0.562

组别	例数	TC (x±s，mmol/L)		TG (x±s，mmol/L)		PT (x±s，s)	APTT (x±s，s)		D-D (x±s，mg/L)		NIHSS评分(x±s，分)	Hcy (x±s，mmol/L)
CD组	49	4.53±1.23		1.26±0.22		10.81±1.13	26.51±3.99		1.33±0.35		12.76±3.46	8.62±1.79
对照组	74	4.76±1.16		1.30±0.29		10.54±1.38	25.36±4.36		1.24±0.27		4.84±1.13	7.86±1.53
统计量		1.051^b		0.821^b		1.139^b	1.481^b		1.550^b		18.304^b	2.519^b
P值		0.295		0.413		0.257	0.141		0.124		<0.001	0.013
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组脑梗死患者脑白质区CBF值比较[x±s，mL/(min·100 g)]

Table 2. Comparison of CBF values in the white matter regions between two groups of cerebral infarction patients[x±s, mL/(min·100 g)]

组别	例数	额叶	顶叶	颞叶	枕叶	胼胝体	半卵圆区
CD组	49	21.22±4.10	46.52±7.19	32.62±6.23	17.52±3.23	37.46±7.11	21.48±4.36
对照组	74	23.69±3.86	51.57±6.78	33.38±6.55	20.42±3.62	38.33±7.36	22.23±4.71
t值		3.389	3.948	0.642	4.537	0.650	0.891
P值		0.001	<0.001	0.522	<0.001	0.517	0.374

下载: 导出CSV

表 3 脑梗死患者发生CD影响因素的logistic回归分析

Table 3. Logistic regression analysis of factors influencing CD in patients with cerebral infarction

变量	B	SE	Waldχ²	P值	OR值	95% CI
NIHSS评分	0.726	0.416	3.025	0.071	2.068	0.906~4.539
Hcy	1.169	0.421	7.659	0.030	3.205	1.405~6.956
CBF值
额叶	1.133	0.425	7.107	<0.001	3.105	1.365~7.063
顶叶	1.421	0.556	6.532	<0.001	4.141	1.820~9.421
枕叶	1.264	0.471	7.202	<0.001	3.540	1.556~8.052

下载: 导出CSV

表 4 额叶、顶叶及枕叶CBF值对脑梗死患者发生CD的预测价值

Table 4. Predictive value of frontal, parietal, and occipital cbf levels for cerebral dysfunction in stroke patients

项目	截断值	灵敏度(%)	特异度(%)	AUC	95% CI	约登指数
额叶CBF值	22.56 mL/(min·100 g)	53.06	63.51	0.542	0.450~0.632	0.166
顶叶CBF值	49.08 mL/(min·100 g)	57.14	68.92	0.634	0.542~0.719	0.261
枕叶CBF值	18.94 mL/(min·100 g)	71.43	52.70	0.633	0.541~0.718	0.241
联合		77.55	82.43	0.793	0.711~0.861	0.600

下载: 导出CSV

参考文献(20)

[1]	JINAWONG K, APAIJAI N, CHATTIPAKORN N, et al. Cognitive impairment in myocardial infarction and heart failure[J]. Acta Physiol (Oxf), 2021, 232(1): e13642. DOI: 10.1111/apha.13642.
[2]	RAN F, LIU F, ZHANG Y, et al. Serum uric acid and high-sensitivity c-reactive protein as predictors of cognitive impairment in patients with cerebral infarction[J]. Dement Geriatr Cogn Disord, 2020, 49(3): 235-242. doi: 10.1159/000507806
[3]	YIN X, ZHOU Y, YAN S, et al. Effects of cerebral blood flow and white matter integrity on cognition in CADASIL patients[J]. Front Psychiatry, 2019, 14(9): 741.
[4]	路红霞, 李云霞, 张朋娜, 等. 脑血流灌注对遗忘型轻度认知功能障碍患者认知功能影响因素分析[J]. 中国药物与临床, 2021, 21(19): 3221-3223. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202119006.htm LU H X, LI Y X, ZHANG P N, et al. Influencing factors of cerebral blood perfusion on cognitive function in patients with amnestic mild cognitive impairment[J]. Chinese Remedies and Clinics, 2021, 21(19): 3221-3223. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202119006.htm
[5]	JOSEPH C R. Utilizing 3D arterial spin labeling to identify cerebrovascular leak and glymphatic obstruction in neurodegenerative disease[J]. Diagnostics (Basel), 2021, 11(10): 1888. doi: 10.3390/diagnostics11101888
[6]	JOSHI D, PRASAD S, SAINI J, et al. Role of arterial spin labeling (ASL) images in Parkinson' s disease (PD): a systematic review[J]. Acad Radiol, 2022, 9(23): S1076-6332.
[7]	中国中西医结合学会神经科专业委员会. 中国脑梗死中西医结合诊治指南(2017)[J]. 中国中西医结合杂志, 2018, 38(2): 136-144. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ201802003.htm Neurology Committee of Chinese Association of Integrated Traditional and Western Medicine. Chinese guidelines for the diagnosis and treatment of cerebral infarction with integrated traditional and western medicine (2017)[J]. Chinese Journal of Integrated Traditional and Western Medicine, 2018, 38(2): 136-144. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ201802003.htm
[8]	YE B, WEI D, PAN L. Montreal cognitive assessment of cognitive dysfunction after basal ganglia stroke[J]. Acta Neurol Belg, 2022, 122(4): 881-884. doi: 10.1007/s13760-022-01967-4
[9]	牛祥, 王本孝, 卜红伟. 氯吡格雷联合丁苯酞对急性脑梗死患者血清VEGF bFGF Ang-1水平及认知功能的影响[J]. 河北医学, 2022, 28(2): 318-322. doi: 10.3969/j.issn.1006-6233.2022.02.029 NIU X, WANG B X, BU H W. Effect of clopidogrel combined with butylbenzene peptide on serum levels of VEGF bFGF Ang-1 and cognitive function in patients with acute cerebral infarction[J]. Hebei Medicine, 2022, 28(2): 318-322. doi: 10.3969/j.issn.1006-6233.2022.02.029
[10]	王虹, 王柳清, 张万里, 等. 静脉溶栓时间与急性轻型脑梗死及短暂性脑缺血发作患者早期认知功能的关系[J]. 中华全科医学, 2023, 21(1): 45-49. doi: 10.16766/j.cnki.issn.1674-4152.002808 WANG H, WANG L Q, ZHANG W L, et al. Relationship between time of intravenous thrombolysis and early cognitive function in patients with acute mild ischemic stroke and transient ischemic attack[J]. Chinese Journal of General Practice, 2023, 21(1): 45-49. doi: 10.16766/j.cnki.issn.1674-4152.002808
[11]	SHOU Q, ZHAO C, SHAO X, et al. Transformer-based deep learning denoising of single and multi-delay 3D arterial spin labeling[J]. Magn Reson Med, 2024, 91(2): 803-818. doi: 10.1002/mrm.29887
[12]	CABRERA J Á, URMENETA ULLOA J, JÍMENEZ DE LA PEÑA M, et al. White-matter lesions and cortical cerebral blood flow evaluation by 3D arterial spin-labeled perfusion MRI in asymptomatic divers: correlation with patent foramen ovale ocurrence[J]. J Clin Med, 2023, 12(8): 2866. DOI: 10.3390/jcm12082866.
[13]	李栋学, 徐超, 曾宪春, 等. 动脉自旋标记技术定量分析阿尔茨海默病不同阶段脑血流量[J]. 中国医学影像技术, 2021, 37(2): 194-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202102011.htm LI D X, XU C, ZENG X C, et al. Arterial spin labeling quantitative analysis of cerebral blood flow in different stages of Alzheimer disease[J]. Chinese Journal of Medical Imaging Technology, 2021, 37(2): 194-199. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202102011.htm
[14]	ZHOU J, HE J, WANG W. Application of 3D-ASL in hemodynamic analysis and prognosis evaluation of vascular cognitive impairment[J]. Am J Transl Res, 2022, 14(11): 7960-7968.
[15]	NAQVI I, HITOMI E, LEIGH R. Sustained opening of the blood-brain barrier with progressive accumulation of white matter hyperintensities following ischemic stroke[J]. Brain Sci, 2019, 9(1): 16. doi: 10.3390/brainsci9010016
[16]	LI R R, HE YS, LIU M, et al. Analysis of correlation between cerebral perfusion and KIM score of white matter lesions in patients with Alzheimer' s disease[J]. Neuropsychiatr Dis Treat, 2019, 18(15): 2705-2714.
[17]	李云霞, 彭琨, 李俊彤, 等. 3D-ASL在中重度OSAHS患者脑血流灌注及认知功能改变的应用研究[J]. 中国医学计算机成像杂志, 2022, 28(1): 13-18. https://www.cnki.com.cn/Article/CJFDTOTAL-YJTY202201003.htm LI Y X, PENG K, LI J T, et al. Application of 3D-ASL in cerebral blood flow perfusion and cognitive function changes in patients with moderate to severe OSAHS[J]. Chinese Computed Medical Imaging, 2022, 28(1): 13-18. https://www.cnki.com.cn/Article/CJFDTOTAL-YJTY202201003.htm
[18]	KURODA T, ONO K, HONMA M, et al. Cerebral white matter lesions and regional blood flow are associated with reduced cognitive function in early-stage cognitive impairment[J]. Front Aging Neurosci, 2023, 16(15): 1126618. DOI: 10.3389/fnagi.2023.1126618.
[19]	BANGEN K J, THOMAS K R, SANCHEZ D L, et al. Entorhinal perfusion predicts future memory decline, neurodegeneration, and white matter hyperintensity progression in older adults[J]. J Alzheimers Dis, 2021, 81(4): 1711-1725. doi: 10.3233/JAD-201474
[20]	李荣宗, 聂容荣, 卢春玲, 等. 大面积脑梗死后的老年患者颅内血流动力学、脑白质病变对认知功能的影响[J]. 空军医学杂志, 2021, 37(6): 496-499. doi: 10.3969/j.issn.2095-3402.2021.06.010 LI R Z, NIE R R, LU C L, et al. Effects of intracranial hemodynamics and white matter lesions on cognitive function in elderly patients with massive cerebral infarction[J]. Medical Journal of Air Force, 2021, 37(6): 496-499. doi: 10.3969/j.issn.2095-3402.2021.06.010