广西医学

目的探讨磁共振动态磁敏感对比灌注成像（DSC⁃PWI）原始血流图评估急性前循环大血管闭塞性脑卒中侧支循环的效果。方法选取131例单侧颈内动脉或大脑中动脉M1、M2段闭塞的大脑中动脉供血区急性缺血性脑卒中患者作为研究对象，采用组内相关系数（ICC）分析观察者对DSC⁃PWI原始血流图、血管高信号征（FVH）评估脑侧支循环评分的一致性，以及DSC⁃PWI原始血流图、FVH与数字减影血管造影（DSA）评估脑侧支循环等级的一致性，分析DSC⁃PWI原始血流图、FVH与DSA脑侧支循环评分、DWI⁃ASPECTS评分的相关性。结果（1）两名观察者对DSC⁃PWI原始血流图、FVH评估脑侧支循环评分的一致性均较好（ICC值分别为0.939、0.876，均P<0.001）。（2）DSC⁃PWI原始血流图与DSA评估脑侧支循环等级的一致性较好（ICC=0.839，P<0.001），FVH与DSA评估脑侧支循环等级的一致性较差（ICC=0.470，P<0.001）。（3）DSC⁃PWI原始血流图评估脑侧支循环的评分与DSA评估脑侧支循环的评分相关性较强（rs=0.840，P<0.001），FVH评估脑侧支循环的评分与DSA评估脑侧支循环的评分相关性中等（rs=0.488，P<0.001）。（4）DSC⁃PWI原始血流图评估脑侧支循环评分与DWI⁃ASPECTS评分的相关性中等（rs=0.477，P<0.001），FVH评估脑侧支循环评分与DWI⁃ASPECTS评分的相关性较弱（rs=0.346，P<0.001）。结论 DSC⁃PWI原始血流图可以准确评估急性前循环大血管闭塞后脑的侧支循环分级，并与急性脑梗死的严重程度相关，可以作为一种评估脑侧支循环的影像方法。

Objective To explore the effect of magnetic resonance dynamic susceptibility contrast perfusion⁃weighted imaging (DSC⁃PWI) primitive hemogram for the evaluation of collateral circulation in acute anterior circulation large⁃vessel occlusive stroke. Methods A total of 131 patients with acute ischemic stroke in middle cerebral artery territory with unilateral internal carotid artery or middle cerebral artery occlusion in M1 and M2 segments were selected as the research subjects. The interclass correlation coefficient (ICC) was adopted to analyze the consistency of observer assessment on collateral circulation scores by DSC⁃PWI primitive hemogram and FLAIR vascular hyperintensity (FVH), and the consistency of assessment on collateral circulation grading by DSC⁃PWI primitive hemogram, FVH and digital subtraction angiography (DSA). The correlation of DSC⁃PWI primitive hemogram, FVH with DSA collateral circulation score, and DWI⁃ASPECTS score was analyzed. Results (1) Both observers interpreted favorable consistency of assessment on collateral circulation score by DSC⁃PWI primitive hemogram and FVH (ICC values in 0.939 and 0.876, respectively, all P<0.001). (2) The consistency of assessment on collateral circulation grading by DSC⁃PWI primitive hemogram and DSA was favorable (ICC=0.839, P<0.001), whereas the consistency of assessment on collateral circulation grading by FVH and DSA was poor (ICC=0.470, P<0.001). (3) The correlation of DSC⁃PWI primitive hemogram for the evaluation of collateral circulation score with DSA assessment of collateral circulation score was relatively strong (rs=0.840, P<0.001), while FVH for the assessment of collateral circulation score depicted medium correlation with DSA for the assessment of collateral circulation score (rs=0.488, P<0.001). (4) The correlations of DSC⁃PWI primitive hemogram and FVH for the assessment of collateral circulation scores with DWI⁃ASPECTS score were medium and weak, respectively (rs=0.477, P<0.001; rs=0.346, P<0.001). Conclusion DSC⁃PWI primitive hemogram can accurately evaluate the collateral circulation grading of acute anterior circulation large⁃vessel occlusive stroke, and is related to severity of acute cerebral infarction, which can be regarded as an imaging method for evaluating collateral circulation.