Application Of Multiparametric 3D-pCASL Technique In Assessing Cerebral Blood Flow Reserve Capacity Of Unilateral Moyamoya Disease At Rest

Objectives:To evaluate the cerebral blood flow reserve capacity of patients with moyamoya disease under resting collateral circulation by using multiple 3D-pCASL markers to predict the risk of ischemic stroke in patients with moyamoya disease.Materials and Methods:Collected 252 patients with moyamoya disease diagnosed by DSA or MRA at the Second Affiliated Hospital of Nanchang University from October 2015 to November 2017,and excluded 53 patients with moyamoya disease who did not perform a complete magnetic resonance imaging scan,and excluded cerebral hemorrhage Symptoms: 40 patients admitted to the hospital,85 patients with bilateral moyamoya disease,12 patients with atherosclerosis,and 16 patients with unclear images.A total of 46 patients were selected according to the study conditions.According to the results of clinical comprehensive information,they were divided into asymptomatic group(12 cases in total,including 5 males and 7 females),TIA group(16 cases in total,7 males and 9 females),and infarction group(18 cases in total,male 9).Example,female 9).The ASL uses 3D-pCASL technology and uses two different labeling delay time(PLD)parameters to obtain the outer watershed area,the inner watershed area,the outer watershed area,and the basal ganglia area(head of the caudate nucleus).The cerebral blood flow(CBF)obtained at 1525 ms is defined as CBF 1,2525 ms.The cerebral blood flow obtained is defined as CBF 2 and then the estimated cerebral blood flow reserve capacity of the collateral circulation(?CBF=CBF2-CBF1)),Compare the ?CBF of the asymptomatic group,the TIA group,and the infarct group.The chi-square test was used for the risk factors among the three groups of patients;univariate analysis of variance(ANOVA)was used to analyze the ?CBF between the three groups: basal ganglia,pre-external watershed,internal watershed,and post-outward watershed.p <0.05 was statistically significant.The ?CBF of the basal ganglia,posterior and outer watershed,inner watershed,and outer watershed of the TIA group and the infarct group was analyzed by ROC curve.The AUC was calculated and the critical value,sensitivity and specificity of each brain area were obtained.Result:1.Comparison of ?CBF values between asymptomatic group,TIA group,and infarction group in basal ganglia: There was no significant difference in ?CBF between asymptomatic group and TIA group(p>0.05);asymptomatic group and infarction group,TIA group,and infarct group ?CBF value All had statistically significant differences(p<0.05).The ?CBF in the infarct group was lower than that in the asymptomatic group and TIA group.2.Comparison of ?CBF values between asymptomatic group,TIA group,and infarct group before and outside the watershed area: Significant statistical difference between asymptomatic group and TIA group,asymptomatic group and infarcted group,TIA group and infarct group(p<0.05)..The asymptomatic group ?CBF>TIA group ?CBF>infarct group ?CBF.3.The ?CBF values in the asymptomatic,TIA and infarct groups in the inner watershed area were compared: there was a significant difference in the ? CBF between the asymptomatic group and the TIA group,the asymptomatic group and the infarct group and between the TIA group and the infarct group(p<0.05).In the asymptomatic group,?CBF>TIA group ?CBF>infarct group ?CBF.4.The ?CBF values in the asymptomatic,TIA and infarct groups in the outer watershed area were not statistically significant(p>0.05).There was no significant difference in ? CBF between the asymptomatic group and the TIA group,the asymptomatic group and the infarct group,and the TIA group and the infarct group..5.ROC curve analysis results of ? CBF in brain regions of TIA group and infarct group showed that the area under the curve of basal ganglia area and posterior exterior watershed area was small,and the sensitivity and specificity were not high.Whether the prediction of TIA progressed to cerebral infarction was not effective;The area under the curve in the watershed area and the inner watershed area exceeds 0.90,and the sensitivity and specificity are high.Whether or not the prediction of TIA progresses to high cerebral infarction performance can be achieved.Conclusion1.The use of multi-parameter 3D-pCASL technology can not only provide a more comprehensive assessment of the cerebral blood flow in patients with moyamoya disease,but also can calculate the estimated cerebral blood flow reserve?CBF in the collateral circulation at rest.The analysis of changes in brain area ?CBF can predict the risk of future ischemic stroke in patients with moyamoya disease.Among them,?CBF in the outer watershed and inner watershed area had the highest test efficiency.2.The ?CBF obtained by using the multi-parametric 3D-pCASL technique cannot estimate the cerebral blood flow reserve under stress,but because the ASL technique is fast,accurate,non-invasive,and non-radiative,the ?CBF can be used as an assessment of MMD patients.Collateral circulation of cerebral blood flow reserve indicators.