Study On The Correlation Between 3D-pcASL Perfusion Imaging And Traditional Chinese Medicine Dialectical Typing Of Acute Ischemic Stroke

Objective:To apply 3.0T magnetic resonance three-dimensi-onal pseudocontinuous artery spin labeling（3D-pcASL）perfusion imaging technology to scan patients with acute ischemic stroke,and to analyze the relationship between 3D-pcASL technology and traditional Chinese medicine dialectical typing of patients with acute ischemic stroke,in order to improve the objectivity and accuracy of traditional Chinese medicine syndrome differentiation.Methods:80 patients with acute ischemic stroke from September 2017 to September 2018 were selected as experimental group,20healthy volunteers as control group,and all patients were classified into two types of TCM according to the Standard for Diagnosis and Evaluation of Therapeutic Effect of Stroke,which are mainly divided into two categories:Meridians and Viscera,the Meridians include:the syndrome of ganyangbaokang,fengtanyuxue,tanrefushi,qixuxueyu,yinxufengdong;the viscera include:the syndrome of fenghuoshangrao,tanshimengshen,tanreneibi,yuanqibaituo.Using Siemens Skyra 3.0T MR scanner of Germany,all patients were examined by routine MR sequence（including T1WI/T2WI/FLAIR）,DWI,3D-pcASL.Record the location,number and area of lesions on conventional MR and DWI images.CBF values of infarction core area（ICA）and high signal area of DWI and mismatch area（MA）of CBF pseudocolor perfusion abnormality area（CBF-CBF 1,MA-CBF 1）and CBF values of opposite mirror area（ICA-CBF 2,MA-CBF 2）were measured on CBF pseudocolor maps.SPSS17.0 statistical software was used for analysis.RESULTS:（1）The experimental group included 80 AIS patients,43 males and 37 females,aged 60.55±8.38 years.In this study,69 cases（86.25%）of AIS patients were classified as meridians,including 23 cases（28.75%）of ganyangbaokang syndrome,21 cases（26.25%）of fengtanyuxue syndrome,5 cases（6.25%）of tanrefushi syndrome,7 cases（8.75%）of qixuxueyu syndrome,13 cases（16.25%）of yinxufengdong syndrome.There were 11 cases（13.75%）with viscera,including 8 cases（10%）of fenghuoshangrao syndrome,3 cases（3.75%）of tanshimengshen syndrome.In the control group,there were 12 males and 8 females,with an average age of39.25±4.14 years.（2）Single lesion was common in the meridians 71%（49/69）,and multiple lesions were common in the viscera 91%（10/11）.Lacunar infarction was the most common lesion in the meridians 49%（34/69）,followed by focal infarction 32%（22/69）,large infarction 19%（13/69）,large-area infarction of the viscera 73%（8/11）,and lacunar infarction 27%（3/11）.In this study,the meridian is the most common infarction site.The lesions of the middle meridian are mostly located in the brain lobe and basal ganglia,followed by the center of the semioval,less in the cerebellum and brainstem.The ganyangbaokang syndrome is mostly located in the parietal lobe and basal ganglia,the fengtanyuxue syndrome is mostly located in the center of the semioval and basal ganglia,and tanrefushi,qixuxueyu,yinxufengdong syndrome are mostly found in the basal ganglia.The lesions of the viscera were mostly found in the lobes and brainstem of the brain,but rarely in the basal ganglia,semioval center and cerebellum.Chi-square test showed that there were significant differences in the number,area and location of the lesions between the meridians and viscera.（3）This study showed that S_ICA<S_APA in 61cases,S_ICA>S_APA in 2 cases,S_ICA≈S_APA in 17 cases;69 cases of meridian patients showed isoperfusion in 3 cases,hypoperfusion in 57 cases,9 cases showed patchy hyperperfusion area scattered in the hypoperfusion area,including 4 cases of ganyangbaokang,2 cases of fengtanyuxue syndrome,1case of tanrefushi syndrome,2 cases of yinxufengdong syndrome;11 cases of viscera patients showed hypoperfusion;All 20 healthy volunteers in group A showed equal perfusion.For patients with S_ICA<S_APA,ICA-CBF1,ICA-CBF2and ICA-rCBF in the middle meridians and viscera were 12.58±4.63,49.71±3.07,0.26±0.09,12.50±1.82,50.12±8.47 and 0.25±0.05,respectively.MA-CBF1,MA-CBF2 and MA-rCBF in the middle meridians and viscera were24.59±8.91,49.19±1.33,0.50±0.18,17.66±1.74,49.12±2.43 and 0.36±0.04.There were no significant differences in ICA-CBF1,ICA-CBF2,ICA-rCBF and MA-CBF2 between the middle meridians and the viscera（P>0.05）,but there were significant differences in MA-CBF1 and MA-rCBF between the middle meridians and the viscera（P<0.05）.Conclusion:1.Conventional MR and DWI sequences have high application value in the diagnosis of AIS.The basic signs provided by them,such as the size of the lesion,the number of lesions,the location of the lesion,have a certain correlation with the meridians and viscera,which provides the imaging basis for the classification of AIS in traditional Chinese medicine.2.Most AIS patients showed low perfusion on ASL perfusion images.CBF and rCBF values in MA region were different in patients with middle meridians and viscera,which could provide hemodynamic basis for the identification of middle meridians and viscera.3.Isoperfusion or scattered hyperperfusion may be associated with recanalization of blood vessels and formation of collateral circulation in some patients with middle meridians,suggesting that patients with middle meridians may have a better prognosis.