Objective:To explore the clinical significance of magnetic resonance three dimension arterial spin labeling(3D-ASL)in assessing cognitive impairment of patients with ischemic leukoaraiosis(ILA).Methods:A total of 102 ILA patients admitted to Chongqing Qianjiang National hospital from January 2022 to September 2023 were selected as the case group,and 50 volunteers who underwent physical examination were included in healthy control group according to gender and age matching principles during the same period.The 102 patients were further divided into a cognitive impairment group(35 cases)and a cognitive normal group(67 cases)according to the assessed results of the Montreal cognitive assessment(MoCA)scale.The cerebral blood flow(CBF)value was obtained through conducted 3D-ASL examination.Using multiple logistic regression analysis to identify the relative factors that can affect the occurrence of cognitive impairment in ILA patients,and drawing receiver operating characteristic(ROC)curve to analyze the predictive value of CBF value for the occurrence of cognitive impairment in ILA patients.Results:The paraventricular CBF value,subcortical CBF value,and whole brain CBF values in the case group(13.15±3.25)ml/(100g·min),(10.38±3.45)ml/(100g·min)and(43.59±7.81)ml/(100g·min)were lower than those in the control group(24.45±5.10)(100g·min),(22.65±5.64)ml/(100g·min)and(59.42±10.29)ml/(100g·min),with statistically significant differences(t=14.430,10.276,8.195,P<0.05).Compared with the cognitive normal group,the cognitive impairment group had higher ILA grade,higher proportion of diabetes,older age,higher level of C-reactive protein,homocysteine and fibrinogen,and lower paraventricular CBF value,subcortical CBF value and CBF value of whole brain(x2=6.311,4.965,t=5.894,2.983,4.155,3.243,7.443,8.114,10.251,P<0.05).Multiple logistic regression analysis showed that low paraventricular CBF value,subcortical CBF value,and the whole brain CBF value were independent risk factors for cognitive impairment in ILA patients(OR=0.457,0.498,0.563,P<0.05).The result of ROC curve analysis showed that the area under curve(AUC)value of paraventricular CBF value,subcortical CBF value,and whole brain CBF value were respectively 0.831,0.792,and 0.784 in predicting cognitive impairment in ILA patients.The AUC value of the combination of the three indicators was 0.918,which was significantly higher than that of each single indicator(Z=3.198,3.542,4.112,P<0.05).Conclusion:Magnetic resonance 3D-ASL imaging has better assessment value for cerebral vascular perfusion in ILA patients.A decrease of CBF value can significantly increases the risk of occurring cognitive impairment in patients.The predictive value of the combined assessment of multiple regions of interest(ROI)has higher predictive value for occurrence of cognitive impairment,which can provide strong support for clinical decision-making and guiding the subsequent treatment.

Objective:To explore the clinical significance of magnetic resonance three dimension arterial spin labeling(3D-ASL)in assessing cognitive impairment of patients with ischemic leukoaraiosis(ILA).Methods:A total of 102 ILA patients admitted to Chongqing Qianjiang National hospital from January 2022 to September 2023 were selected as the case group,and 50 volunteers who underwent physical examination were included in healthy control group according to gender and age matching principles during the same period.The 102 patients were further divided into a cognitive impairment group(35 cases)and a cognitive normal group(67 cases)according to the assessed results of the Montreal cognitive assessment(MoCA)scale.The cerebral blood flow(CBF)value was obtained through conducted 3D-ASL examination.Using multiple logistic regression analysis to identify the relative factors that can affect the occurrence of cognitive impairment in ILA patients,and drawing receiver operating characteristic(ROC)curve to analyze the predictive value of CBF value for the occurrence of cognitive impairment in ILA patients.Results:The paraventricular CBF value,subcortical CBF value,and whole brain CBF values in the case group(13.15±3.25)ml/(100g·min),(10.38±3.45)ml/(100g·min)and(43.59±7.81)ml/(100g·min)were lower than those in the control group(24.45±5.10)(100g·min),(22.65±5.64)ml/(100g·min)and(59.42±10.29)ml/(100g·min),with statistically significant differences(t=14.430,10.276,8.195,P<0.05).Compared with the cognitive normal group,the cognitive impairment group had higher ILA grade,higher proportion of diabetes,older age,higher level of C-reactive protein,homocysteine and fibrinogen,and lower paraventricular CBF value,subcortical CBF value and CBF value of whole brain(x2=6.311,4.965,t=5.894,2.983,4.155,3.243,7.443,8.114,10.251,P<0.05).Multiple logistic regression analysis showed that low paraventricular CBF value,subcortical CBF value,and the whole brain CBF value were independent risk factors for cognitive impairment in ILA patients(OR=0.457,0.498,0.563,P<0.05).The result of ROC curve analysis showed that the area under curve(AUC)value of paraventricular CBF value,subcortical CBF value,and whole brain CBF value were respectively 0.831,0.792,and 0.784 in predicting cognitive impairment in ILA patients.The AUC value of the combination of the three indicators was 0.918,which was significantly higher than that of each single indicator(Z=3.198,3.542,4.112,P<0.05).Conclusion:Magnetic resonance 3D-ASL imaging has better assessment value for cerebral vascular perfusion in ILA patients.A decrease of CBF value can significantly increases the risk of occurring cognitive impairment in patients.The predictive value of the combined assessment of multiple regions of interest(ROI)has higher predictive value for occurrence of cognitive impairment,which can provide strong support for clinical decision-making and guiding the subsequent treatment.