Abstract:

Objective  To explore the clinical value of magnetic resonance three-dimensional arterial spin labeling(3D-ASL) in predicting the severity and prognosis of patients with acute ischemic stroke(AIS).

Methods  According to the National Institutes of Health Stroke Scale(NIHSS) score, 128 AIS patients diagnosed in our hospital were divided into mild group, moderate group and severe group. All the subjects underwent the 3D -ASL scan examination on the day of admission to obtain the cerebral blood flow(CBF) in infarcted area. The protein level of Apelin-13 in serum was detected by enzyme-linked immunosorbent assay. At two weeks after admission, the neurological function recovery of patients was evaluated with modified Rankin Scale（mRS）, and the activity of daily life(ADL) was evaluated with the modified Barthel Index(MBI). The correlation between CBF in cerebral infarction area on the day of admission and NIHSS score, Apelin-13 protein level, mRS score, MBI index was analyzed. Receiver operating characteristic(ROC) curve was drawn to determine the CBF cut-off value for predicting the severity of AIS.

Results  On the day of admission, the NIHSS score of moderate group and severe group was significantly higher than that of mild group, while the CBF value in cerebral infarction area and Apelin-13 protein level in serum were significantly lower than those in mild group. The NIHSS score of severe group was significantly higher than that of moderate group, while the CBF value in cerebral infarction area and Apelin-13 protein level in serum were significantly lower than those in moderate group. The CBF value in cerebral infarction area was negatively correlated with NIHSS score, and positively correlated with Apelin-13 protein level in serum. At two weeks after admission, the MBI index of moderate group and severe group was significantly lower than that of mild group, while mRS score was higher than that of mild group. The MBI index of severe group were significantly lower than that of moderate group, while mRS score was higher than that of moderate group. The CBF value in cerebral infarction area was positively correlated with MBI index, and negatively correlated with mRS score on the day of admission. The CBF cut-off value in mild group and moderate group was 20.5 mL·min-1·100 g-1, and the area under ROC curve was 0.946. The CBF cut-off value in moderate group and severe group was 13.5 mL·min-1·100 g-1, and the area under ROC curve was 0.924.

Conclusion  Noninvasive 3D-ASL on the day of admission can be used to predict the severity and prognosis of AIS patients, which has guiding significance for the application and adjustment of treatment methods.

Key words: stroke, magnetic resonance imaging； spin labels