Evaluate the abnormal white matter blood perfusion by 3D-ASL technique and its correlation with cognitive function in patients with cerebral infarction
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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。 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. -
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
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
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(%)] 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 0.068a 0.725a 0.042a 0.320a 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(%)] 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 0.227a 0.872a 0.532a 2.295a 0.335a 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 1.051b 0.821b 1.139b 1.481b 1.550b 18.304b 2.519b 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。 
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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
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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
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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
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