Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5586-5594
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5586
Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia
Yan-Yan Jiang, Zhi-Lin Zhong, Min Zuo
Yan-Yan Jiang, Department of Magnetic Resonance, Wuhan Asia General Hospital, Wuhan 430056, Hubei Province, China
Zhi-Lin Zhong, Department of Radiology, Wuhan Yaxin General Hospital, Wuhan 430056, Hubei Province, China
Min Zuo, Department of Radiology, Wuhan Hanyang Hospital, Wuhan University of Science and Technology, Wuhan 430050, Hubei Province, China
Author contributions: Jiang YY and Zhong ZL contributed equally to this study, and should be regarded as co-first authors, Jiang YY and Zhong ZL designed the study and collected the data; Zuo M drafted the manuscript, Zuo M and Jiang YY analyzed and interpreted data.
Institutional review board statement: This study was approved by the Wuhan Yaxin General Hospital Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Zuo, BM BCh, Associate Chief Physician, Department of Radiology, Wuhan Hanyang Hospital, Wuhan University of Science and Technology, No. 53 Moohu Road, Anyang District, Wuhan 430050, Hubei Province, China. ypzm0518@163.com
Received: January 6, 2022
Peer-review started: January 6, 2022
First decision: February 14, 2022
Revised: March 1, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 16, 2022
Processing time: 153 Days and 21.3 Hours
Abstract
BACKGROUND

Early thrombolytic therapy is crucial to treat acute cerebral infarction, especially since the onset of thrombolytic therapy takes 1-6 h. Therefore, early diagnosis and evaluation of cerebral infarction is important.

AIM

To investigate the diagnostic value of magnetic resonance multi-delay three-dimensional arterial spin labeling (3DASL) and diffusion kurtosis imaging (DKI) in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.

METHODS

Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included. All patients in the acute stage underwent magnetic resonance-based examination, and the data were processed by the system’s own software. The apparent diffusion coefficient (ADC), average diffusion coefficient (MD), axial diffusion (AD), radial diffusion (RD), average kurtosis (MK), radial kurtosis (fairly RK), axial kurtosis (AK), and perfusion parameters post-labeling delays (PLD) in the focal area and its corresponding area were compared. The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging (T2WI) was analyzed.

RESULTS

The DKI parameters of focal and control areas in the study subjects were compared. The ADC, MD, AD, and RD values in the lesion area were significantly lower than those in the control area. The MK, RK, and AK values in the lesion area were significantly higher than those in the control area. The MK/MD value in the infarct lesions was used to determine the matching situation. MK/MD < 5 mm was considered matching and MK/MD ≥ 5 mm was considered mismatching. PLD1.5s and PLD2.5s perfusion parameters in the central, peripheral, and control areas of the infarct lesions in MK/MD-matched and -unmatched patients were not significantly different. PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and -unmatched patients were significantly lower than those in peripheral and control areas. The MK and MD maps showed a lesion area of 20.08 ± 5.74 cm2 and 22.09 ± 5.58 cm2, respectively. T2WI showed a lesion area of 19.76 ± 5.02 cm2. There were no significant differences in the cerebral infarction lesion areas measured using the three methods. MK, MD, and T2WI showed a good correlation.

CONCLUSION

DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction. 3DASL can effectively determine the changes in perfusion levels in the lesion area. There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

Keywords: Magnetic resonance; Multi-delay 3D arterial spin labeling; Diffusion kurtosis imaging; Acute ischemic cerebral infarction; Perfusion; Nerve function

Core Tip: Through the analysis and research of patients in the hospital, we have concluded that diffusion kurtosis imaging (DKI) parameters show that there is a significant difference between the lesions of patients with acute ischemic cerebral infarction and the control area. Three-dimensional arterial spin labeling can effectively determine the changes in the perfusion level of the diseased area. The infarct size diagnosed by DKI is highly correlated with T2-weighted imaging.