Application Value of 3D-ASL Combined with T2FLAIR in Assessing Collateral Circulation inPatients with Acute Ischemic Stroke/ZHANG Chaofan，LE Wenpeng，ZHANG Guangming，HONG Xin，WAN Chenhao.//Medical Innovation of China，2025，22（16）：152-156

[Abstract]Objective：To explore the application value of 3D-arterial self-labeling （3D-ASL） combined withT ₂ -fluid attenuated inversion recovery （TFLAIR） in evaluating collateral circulation in patients with acute ischemic stroke （AIS）.Method： A retrospective analysis was conductedon the clinical data of1O2 patients with AIS admittedtotheFirstPeople'sHospitalofFuzhoufromJune2O21toMay2O24.According tothedegreeofstenosis of the middle cerebral artery （MCA），they were divided into the MCA negative group （stenosis degree lt;50% n =43） and the MCA positive group （stenosis degree ⩾50% n =59）. Compared the relative cerebral blood flow （rCBF）， highsignal vascular sign （HVS）grades and thechanges in scoresof the national institutesof health stroke scale（NIHSS） at admission and discharge （△NIHSS） between the two groups.The MCA positive group was divided into the ATA （+） group （n=38） and the ATA（-） group （ n =21） accordingtowhether the arterial transit artifact （ATA） sign appeared in 3D-ASL，and the rCBFof the two groups was measured. Measured the rCBFof patients with diffrent HVS grades; the receiver operating characteristic （ROC） curve was applied to analyze the evaluation value of ATA combined with HVS forcollateral circulation inAIS.Result：There was significant difference in HVSclassfication between the MCA negative group and the MCA positive group （ P lt;0.05），and both rCBF and △NIHSS in the MCA positive group were lower than those in the MCA negative group （ P lt;0.05）. The rCBF and △NIHSS in the ATA （-） group were lower than those in the ATA（+） group （ P lt;0.05）.With the increaseofHVS grade，bothrCBFand △NIHSSin MCA positive patients increased （ P lt;0.05）. The sensitivity，specificity， positive predictive value， negative predictive value and accuracy rateof ATA combined with HVS in evaluating colateral circulation in AIS were allhigher than those of a single detection.Conclusion： The ATA signs of3D-ASL and the HVSofTFLAIRboth have certain evaluation values for collateral circulation in AIS，and the combined evaluation value of the two is higher.

[Key Words] Acute ischemic stroke Collateral circulation 3D-arterial self-labeling T₂ -fluid attenuated inversion recoveryArterial penetration artifactsHigh signal vascular sign

First-author's address： Department of Imaging， the First People's Hospital of Fuzhou，Fuzhou 344000，China

doi：10.3969/j.issn.1674-4985.2025.16.036

急性缺血性脑卒中（AIS）是患者由于脑动脉出现严重狭窄或闭塞导致的局部脑血流降低，进而引起脑部缺氧、缺血甚至坏死所致的脑功能缺损。在中国，脑卒中每年发病人数约551万，致残率高达 70%～80% ，死亡率约为149.49/10万，AIS在所有脑卒中类中占 60%～70%^[1-2] 。AIS 患者侧支循环是指脑动脉闭塞时，其他血管网络通过代偿作用维持脑组织的血液供应，良好的侧支循环建立可减轻神经损伤，进而改善患者预后，报道指出，动脉自旋标记（ASL）成像对AIS患者侧支循环建立情况具有较高的评估价值[3。三维动脉自选标记（3D-ASL）是一种通过内源性示踪剂进行磁共振灌注成像的先进技术，将动脉血水质子作为标记物对患者脑血流进行评估。动脉穿行伪影（ATA）是指因到达延迟或速度减缓血流未能及时扩散至组织中，从而形成ASL灌注图中的伪影，研究表明，3D-ASL中的ATA征象及血管高信号（FVH征）对AIS患者缺血半暗带（IP）、血流灌注情况及核心梗死区有较高的诊断效能[4]。 T₂- 液体衰减反转恢复（TFLAIR）是一种磁共振成像技术，高信号血管征（HVS）是在FLAIR序列上静脉或动脉血管出现管状、条状或点状的高信号表现，HVS往往提示了颅内大动脉严重狭窄或闭塞[5。基于上述背景，本研究采用ATA联合HVS评估AIS侧支循环，探讨其应用价值。现报道如下。

1资料与方法

1.1一般资料

回顾性分析2021年6月—2024年5月抚州市第一人民医院收治的102例AIS患者的临床资料。纳入标准：符合文献[6]《中国急性缺血性脑卒中早期血管内介入诊疗指南2018》；均于发病 ^72h 内行磁共振成像（MRI）、磁共振血管成像（MRA）检查，并确诊为AIS；……