Perfusion Injury In Acute Mild Traumatic Brain Injury Based On DSC-MRI And 3D-pCASL

Objective:Dynamic susceptibility contrast-enhanced magnetic resonance imaging(DSC-MRI)and three dimensional pulsed continuous arterial spin labeling(3D-pCASL)were used to explore the characteristics of perfusion injury in acute stage of mild traumatic brain injury(mTBI)patients,and the application advantages of DSCMRI and 3D-pCASL were compared.Materials and Methods:Thirty patients with acute mTBI who met the inclusion criteria and exclusion criteria were collected,and conventional MRI sequences(T1WI,T2WI,T2-FLAIR,diffusion weighted imaging(DWI),susceptibility-weighted imaging(SWI),3D-pCASL and DSC-MRI scans were performed during the same examination.Image data was post-processed using the Philips Intellispace portal workstation.CBF value,rCBF value,rCBV value and MTT value were measured in the local perfusion abnormality area on the brain injury side and in the contralateral normal mirror area.CBF values,rCBF values,rCBV values and MTT values in the abnormal area of local perfusion measured by 3DpCASL and DSC-MRI were analyzed and compared with the contralateral normal mirror area.The correlation between CBF values in abnormal perfusion areas measured by 3D-pCASL sequence and rCBF values in abnormal perfusion areas measured by DSC-MRI sequence was analyzed.Results:In the acute stage of mTBI patients,the CBF value in the local decreased perfusion area was 29.43±11.02(mL·min-1·100g-1),and the CBF value in the contralateral normal mirror area was 37.14±11.05(mL·min-1·100g-1).The difference was statistically significant(t=-15.031,P=0.000).The rCBF value of the local decreased perfusion area was 165.79±10.78(mL·min-1·100g-1),and the rCBF value of the contralateral normal mirror area was 231.74±12.46(mL·min-1·100g-1).The difference was statistically significant(t=-8.047,P=0.000).The rCBV value of the local decreased perfusion area was 14.14±6.90(mL·100g-1),and the rCBV value of the contralateral normal mirror area was 22.32±7.15(mL·100g-1).The difference was statistically significant(t=-10.255,P=0.000).The MTT value of the local decreased perfusion area was 5.80±1.27 s,and that of the contralateral normal mirror area was 5.06±0.96 s.The difference was statistically significant(t=5.623,P=0.000)、CBF values in the decreased perfusion area measured by 3D-pCASL sequence were positively correlated with those in the decreased perfusion area measured by DSCMR I sequence,and the correlation coefficient r value was 0.586**,P<0.01,which was statistically significant.Conclusion:CBF,rCBF and rCBV values in the acute stage of mTBI patients were significantly lower than those in the contralateral normal mirror area,and the MTT value was also significantly longer,suggesting that the local brain injury area was in the state of low perfusion,and there were also areas of reduced cerebral perfusion in the areas where no obvious bleeding and edema were found.CBF values measured by 3D-pCASL and DSC-MRI have a good correlation with rCBF values,and 3D-pCASL can be used as the preferred method of MR perfusion-weighted imaging(PWI)examination in patients with acute mTBI.When abnormal perfusion conditions are found,DSC-MRI examination can be performed to obtain more perfusion information,such as relative cerebral blood volume(rCBV),mean transit time(MTT),etc.DSC-MRI and 3D-pCASL can quantitatively detect the acute cerebral perfusion injury in patients with mTBI,which provides the direction and basis for further clinical diagnosis and treatment options selection.