| Objective: To explore the application value of high-resolution3.0T MRI and3D-pCASL technology in unilateral Middle cerebral artery atherosclerotic stenosis orocclution.Materials and methods: patients with unilateral Middle cerebral artery (MCA)atherosclerotic stenosis (degree of stenosis was≥50%) diagnosed by3D-TOF MRAor HR-MRI were collected3D-pCASL sequence was to evaluate their cerebral tissueperfusion. Inclusion criteria are as follows: Degree of stenosis≥50%of unilateralmiddle cerebral artery diagnosised by3D-TOF MRA or HR-MRI. Patients with anyof the following features were excluded from the analysis:(1) co-existent ipsilateralextracranial internal carotid artery stenosis (degree of stenosis>50%) or luminalirregularity;(2) non-atherosclerotic vasculopathy, such as dissection, vasculitis, ormoyamoya disease (3) cerebral hemorrhage, brain tumors, craniocerebral trauma andother diseases of the nervous system;(4) the image quality was poor. Patients withMCA stenosis were divided into two groups: symptomatic groups, asymptomaticgroup, patients with MCA occlusion were divided into infarction group andnon-infarction group. Symptomatic patients were considered for inclusion if therewas an ischemic stroke or transient ischemic attack in the distribution of the stenoticMCA within the proceeding four weeks. Asymptomatic patients were considered forinclusion if there was no history of cerebrovascular event or there was no ischemicevent occurred in a vascular territory inside the affected. Infarction group andnon-infarction is defined whether there was an ischemic stroke inside the affected. Atlast, MCA stenosis rate, brain tissue perfusion value, brain tissue perfusion valueincluding cerebral blood flow (CBF) and affected side relative cerebral blood flow(rCBF) were measured, and the correlation between the degree of atherosclerosisstenosis diagnosised by HR-MRI and3D-TOF-MRA and cerebral perfusion, clinicalsymptoms and cerebral perfusion in patients with unilateral middle cerebral arterystenosis or occlusion by using3D-pCASL technology were performed. Result:73patients met the inclusion criteria were enrolled in the study. Meanage was58years (rang46-70years) and55%were male. Both3D-TOF-MRA andHR-MRI can found42patients with unilateral MCA occlusion, unilateral MCAstenosis can be found in31patients, the mean degree of MCA stenosis in3D-TOF-MRA was67%±12%, and the mean MCA degree of stenosis in HR-MRIwas61%±9%, the difference between3D-TOF-MRA and HR-MRI is statisticallysignificant (t=3.90, p＜0.001).In the examination of ASL, the mean value of CBF of the affected side ofsymptomatic group was45.8±16.2ml/(100g*min), the mean value of CBF of themirror side was54.1±8.7ml/(100g*min), the mean value of rCBF was0.85±0.27, themean value of CBF of the affected side of asymptomatic group was52.5±11.8ml/(100g*min), the mean value of CBF of the mirror side was52.6±9.3ml/(100g*min),the mean value of rCBF was1.00±0.15. In symptomatic and asymptomatic group, thevalue of CBF of the affected side between the two groups hasn’t statistical difference(t=-1.29, p=0.206), the value of rCBF also hasn’t statistical difference (t=-1.76,p=0.089). In symptomatic group, the mean value of CBF between affected side andmirror side has statistical difference (t=-2.33, P=0.034). In asymptomatic group, themean value of CBF between affected side and mirror side hasn’t statistical difference(t=-0.03, p=0.976).The mean value of CBF of the affected side of infarction group was28.6±9.9ml/(100g*min), the mean value of CBF of the mirror side was55.9±12.0ml/(100g*min), the mean value of rCBF was0.52±0.16, the mean value of CBF ofthe affected side non-infarction group was51.9±14.0ml/(100g*min), the mean valueof CBF of the mirror side was53.6±9.6ml/(100g*min), the mean value of rCBF was0.97±0.22, in infarction group and non-infarction group, the mean value of CBF ofthe affected side between the two groups has statistical difference (t=6.26, p <0.001), the mean value of rCBF also has statistical difference (t=7.53, p <0.001), ininfarction group, the mean value of CBF between affected side and mirror side hasstatistical difference (t=-10.51, p＜0.001), in non-infarction group, the mean value ofCBF between affected side and mirror side has no statistical difference (t=-0.63,p=0.531). The mean value of CBF of the affected side of unilateral MCA stenosis groupwas49.2±14.7ml/(100g*min), the mean value of CBF of the mirror side was53.4±8.9ml/(100g*min), the mean value of rCBF was0.92±0.23. The mean value ofCBF of the affected side of unilateral MCA occlusion group was39.5±16.9ml/(100g*min), the mean value of CBF on mirror side was54.6±10.9ml/(100g*min),the mean value of rCBF was0.73±0.30. The mean value of CBF of the affected sidebetween the two groups has statistical difference (t=2.53, p=0.013), the mean value ofrCBF also has statistical difference (t=2.86, p=0.006), the mean value of CBF of themirror side between the two groups has no statistically difference (t=-0.5, p=0.618).Conclusion:1、Lumen and the artery wall structure of MCA could be showedsuccessfully by using3.0T HR-MRI.3D-TOF-MRA has a tendency to overestimatethe degree of stenosis of MCA when compared with HR-MRI. However, it showedconsistency in MCA occlusion. HR-MRI can evaluate not only the middle cerebralartery stenosis, but also show the structure of the middle cerebral artery wall.2、3D-pCASL technology could reflect the perfusion changes of cerebral tissuewhen atherosclerotic middle cerebral artery stenosis or occlusion. Futhermore,perfusion changes often occur in the symptomatic cerebral hemisphere and normalASL perfusion results may indicate that exists of re-perfusion or collateral circulation.It could provide valuable information for clinical treatment and prognosis estimation. |
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