The value of combined use of 3D arterial spin-labeled perfusion imaging and susceptibility weightedimaging in the thera-py of acute large cerebral infarction

ZHANG Guowei; CHEN Feng; LI Zhongwei; WANG Aijie; LIANG Hui; WANG Ying; REN Jinyan; ZHANG Guanghui

Abstract：Objective To investigate the value of 3D arterial spin labeling (3D-ASL) and susceptibility weighted imaging ( SWI) in guiding treatment plan of the acute large cerebral infarction.Methods We retrospectively studied findings of ASL and SWI in 63 patients with acute large cerebral infarction.The patients included 4 patients before therapy, 4 patients after intra-arte-rial thrombolysis, 5 patients after intra-venous thrombolysis, 33 patients after anticoagulant therapy.12 patients were rechecked after 30~60 days.According to different treatment plan, two experienced neuroradiologists statistical analyzed independently and separately imaging findings of ASL and SWI of the acute large cerebral infarction.Neurologists evaluated clinical prognosis by u-sing NIHSS (National Institutes of Health Stroke Scale) score.Results 1) Hyperperfusion was observed on ASL in 14/46 pa-tients, and hypoperfused regions in 32/46 patients;2) In 4 patients with intra-arterial thrombolysis, partial or most hyperperfu-sion was observed on ASL, and signs of hemorrhage within or around hypoperfusion areas were detected by SWI;3) In 5 patients with intra-venous thrombolysis, 3 patients showed hyperperfusion on ASL, the other two cases showed hypoperfusion.Sign of hem-orrhage was detected by using SWI in 1/5 patient;4) Hyperperfusion was shown on ASL in 7/33 patients with anticoagulant ther-apy, 5 of them showed sign of hemorrhage on SWI.Hypoperfusion was observed on ASL in 26/33 patients with anticoagulant ther-apy, 10 of them were observed sign of hemorrhage on SWI.4 patients with atrial fibrillation, which often took orally anticoagulant medicine, showed hyperperfusion on ASL after anticoagulant therapy;5) Increased microvessels inside or around hypoperfusion areas were detected by SWI in 24/46 patients, and thrombosis within middle cerebral artery was showed by SWI in 9/46 patients;6) A case of patients was death, NIHSS score did not change in 5 patients, the rest patients were improved on NIHSS score after theraphy.Conclusion The combined use of 3D ASL and SWI has important clinical utility in guiding the therapy for the acute large cerebral infarction.