| OBJECTIVE:To explored clinical utility of magnetic resonance three dimensional-pseudo continuous arterial spin labeling(3D-pCASL)imaging technique for assessment of cerebral blood flow(CBF)in patients with moderate to severe carotid artery stenosis before and after underwent carotid endarterectomy(CEA).RESEARCH METHOD:Study retrospective of patients diagnosed with carotid artery stenosis from September 2021 to January 2023 admitted to our hospital,who before and after underwent CEA have been performed conventional magnetic resonance imaging study with 3D-pCASL and dynamic susceptibility contrast-enhanced perfusion weighted imaging(DSC-PWI)were selected as the study subjects.The Scanning method and parameters for MRI study used 3D-pCASL with different post labeling delay(PLD)times of 1.5 second and 2.0 second,and then compared to DSC-PWI parameters for accurate analysis of cerebral blood flow value in different region of interest(ROI)before and after CEA.The inspection images data was performed in MRI computer system.The ROI including frontal lobe,temporal lobe,watershed area and basal region of ipsilateral cerebral hemisphere correspondent to the carotid artery stenotic side were taken with circle an area of 50 mm2.The cerebral blood flow values were obtained by automatic measurement at the corresponding position and then the CBF value on the contralateral side of cerebral hemisphere was obtained by mirroring and using statistic software of SPSS25.0 for statistical data analysis.Paired samples t test was performed according to the data were normally distributed with P value<0.05 was considered statistically significant.The modified rankin scale score(mRs)was used for assessment of clinical outcome with descriptive statistical data analysis.RESULTS:This study research found the data collected with total of 250 cases diagnosed with carotid artery stenosis,which 65 of them well documented and met the inclusion criteria for conventional MRI imaging study with 3D-pCASL and DSC-PWI before and after underwent CEA.The average age was 64.78 from 50-82 years old,there was predominantly male with 35 patients and female 30 patients,the most patients have been diagnosed with severe carotid artery stenosis 55 cases,moderate 10 cases and predominantly with symptomatic carotid artery stenosis.The right carotid artery stenosis 35 cases and left carotid artery stenosis 30 cases.Other more,53 cases had unilateral,and 12 cases had bilateral carotid artery stenosis.The images analysis using 3D-pCASL with different PLD time of 1.5 second and 2.0 second the result found that,for 65 cases the cerebral blood flow in frontal lobe,temporal lobe,watershed area,and basal region before surgery reveled with ipsilateral cerebral hypoperfusion respectively to the stenotic side,there was after surgery demonstrated with Ipsilateral CBF improvement with statistically significant P value<0.05.There was no significant difference compared to contralateral side after surgery.The DSC-PWI using single parameter of relative CBF found that,on some ROI before and after surgery demonstrated with not statistically significant.However,Mean transit time(MTT)and time to peak(TTP)before surgery were prolonged there were after surgery decreased significantly.Moreover,the cerebral blood volume(CBV)before CEA was decreased there was after CEA the CBV was improved significantly.Perioperative clinical outcome using mRs for assessment of 65 cases with favorable outcome and non-disabling stroke consistent with post operative CBF improvement measured by 3D-pCASL.CONCLUSION:The 3D-pCASL same as DSC-PWI,the 3D-pCASL can accurately assess cerebral perfusion status before and after CEA.Moreover,compared with DSC-PWI,the 3DpCASL has the advantages of simple to operate,time saving,no contrast injection and good repeatability.It is especially suitable method for patients who are allergic to contrast media and have poor liver and kidney function.The 3D-pCASL was expected to become an alternative method for assessing cerebral perfusion status before and after CEA. |
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