Objective To explore the clinical value of 3D pseudo-continuous arterial spin labeling (3d-pcasl) perfusion imaging in detecting the change of acute cerebral infarction before and after thrombolysis,and to evaluate the curative effect. Methods Conventional MRI, DWI and 3D-pcASL perfusion imaging were performed on 32 cases of acute cerebral infarction before and after thrombolysis 1-3 day. And then, the CBF values of the lesions of penumbra were measured. Results The results of DWI and 3D-pcASI images from 32 cases of acute cerebral infarction before thrombolysis show high signal and low perfusion, and low perfusion range of ASL images from 30 patients were significantly lower than that in DWI images. The perfusion increased after the patients with acute cerebral infarction received thrombolysis treatment. CBF values of the infarction zone increased, and the ischemic penumbra region showed high creeping and columnar shape perfusion signals. The mean values of CBF quantitatively measured in the infarction tissues around the core ROI before and after treatment were (13.84±1.62) and (63.99±8.69), respectively. The difference in mean value of CBF among the two groups was statistically significant(t=31.81,P<0.01). 1 case of acute cerebral infarction before thrombolysis indicate low perfusion, and the area and the CBF value did not change. Another case had very high perfusion, the reason was post infarction hemorrhagic. Conclusions 3D-pcASL image has a high application value in thrombolytic therapy in patients with acute cerebral infarction and evaluating the curative effect.%目的 探讨三维假连续式动脉自旋标记灌注成像(3D-PCASL)技术检查对急性脑梗死溶栓前、后的意义及疗效判别.方法 对32例急性(1-9h)脑梗死患者溶栓治疗前及治疗后1～3d行常规MRI序列、DWI及3D-PCASL检查,并定量测量溶栓前后半暗带区脑血流灌注(CBF)值大小.结果 治疗前32例脑梗死患者DWI、ASL图像显示为高信号和低灌注,30例患者ASL图像低灌注区域范围明显大于DWI图像;溶栓治疗后检查显示30例梗塞区呈高灌注改变,CBF值明显增大,周围半暗带出现匍匐走行、条柱状高灌注信号,定量测量梗死核心周围区ROI在治疗前后的CBF平均值分别为(13.84±1.62)ml/(100g·min)、(63.99±8.69)ml/(100g·min),差异有统计学意义(t=31.81,P<0.01);另1例治疗前、后均呈低灌注区,面积和CBF值无明显改变;1例异常特高灌注为梗死后出血改变.结论 3D-PCASL检查对急性脑梗死患者溶栓治疗判断及疗效评估随访具有重要临床价值.
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