3D-pCASL在烟雾病灌注状态评估中的临床应用
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摘要
目的探讨三维准连续式动脉自旋标记(3D-pCASL)成像技术在烟雾病(MMD)患者脑灌注状态评估中的临床应用。方法收集我院2016年1月-2019年3月于神经内科收治的MMD患者42例,均使用GE7503. 0T MRI机行常规序列及3D-pCASL序列检查,通过观察CBF伪彩图,将责任动脉供血区是否出现广泛动脉移行伪影(ATA)分为侧支代偿组和对照组,分别测量低灌注区范围及其CBF值。结果纳入MMD患者中,侧支代偿组患者24例,对照组患者18例,侧支代偿组责任动脉供血区低灌注范围为(724. 58±365. 76) mm~2,明显小于对照组,同时该区域CBF值为(59. 46±10. 87) ml/100 g×min,亦高于对照组,差异有统计学意义(P <0. 05)。侧支代偿组既往出现脑卒中比例为33. 33%(8/24),低于对照组66. 67%(12/18)。结论 3D-pCASL成像技术能够客观评估MMD患者的侧支循环代偿情况,反映其血流灌注真实水平,为临床治疗方案个性化选择及预后评估提供依据。
Objective To investigate the clinical application of three-dimensional quasi-continuous arterial spin labeling( 3 D-pCASL) imaging in the evaluation of cerebral perfusion in patients with moyamoya disease( MMD). Methods Forty-two patients with MMD admitted to the Department of Neurology in our hospital from January 2016 to March 2019 were collected. Routine sequence and 3 D-pCASL sequence were examined by GE750 3. 0 T MRI machine,and CBF pseudo-color map was observed. According to whether there was extensive arterial migration artifact in the responsible arterial supply area or not,the patients were divided into lateral branch compensation group and control group. The range of low perfusion area and its CBF value were measured respectively. Results Among the patients with MMD,there were 24 patients in the collateral compensation group and 18 patients in the control group. The low perfusion range of the responsible arterial blood supply area in the collateral compensation group was( 724. 58 ± 365. 76) mm~2,which was significantly smaller than that in the control group.At the same time,the CBF value in this area was( 59. 46 ± 10. 87)( ml/100 g × min),which was also higher than that in the control group. The difference was statistically significant( P < 0. 05). The incidence of stroke in the lateral branch compensation group was 33. 33%( 8/24),which was lower than that in the control group( 66. 67%/12/18). Conclusion 3 D-pCASL imaging can objectively evaluate the collateral circulation compensation in patients with MMD,reflect the true level of blood perfusion,and provide a basis for individualized selection of clinical treatment and prognosis evaluation.
Objective To investigate the clinical application of three-dimensional quasi-continuous arterial spin labeling( 3 D-pCASL) imaging in the evaluation of cerebral perfusion in patients with moyamoya disease( MMD). Methods Forty-two patients with MMD admitted to the Department of Neurology in our hospital from January 2016 to March 2019 were collected. Routine sequence and 3 D-pCASL sequence were examined by GE750 3. 0 T MRI machine,and CBF pseudo-color map was observed. According to whether there was extensive arterial migration artifact in the responsible arterial supply area or not,the patients were divided into lateral branch compensation group and control group. The range of low perfusion area and its CBF value were measured respectively. Results Among the patients with MMD,there were 24 patients in the collateral compensation group and 18 patients in the control group. The low perfusion range of the responsible arterial blood supply area in the collateral compensation group was( 724. 58 ± 365. 76) mm~2,which was significantly smaller than that in the control group.At the same time,the CBF value in this area was( 59. 46 ± 10. 87)( ml/100 g × min),which was also higher than that in the control group. The difference was statistically significant( P < 0. 05). The incidence of stroke in the lateral branch compensation group was 33. 33%( 8/24),which was lower than that in the control group( 66. 67%/12/18). Conclusion 3 D-pCASL imaging can objectively evaluate the collateral circulation compensation in patients with MMD,reflect the true level of blood perfusion,and provide a basis for individualized selection of clinical treatment and prognosis evaluation.
引文
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[2]刘卫明,伍晓六,蓝伟武,等.CT灌注成像对烟雾病脑血管重建术后患者血流动力学改变评价效果研究[J].中国CT和MRI杂志,2018,16(8):18-28.
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[7]王斌,朱风萍,周茜,等.运用MR血管成像及灌注加权成像评价烟雾病责任血管、术后重建血管及手术前后脑血流动力学变化的研究[J].中华放射学杂志,2014,48(5):381-385.
[8]巨昕薇,张帅,冯加纯,等.磁共振灌注成像在烟雾病患者脑血流动力学评估中的应用[J].吉林大学学报(医学版),2016,42(5):1024-1029.
[9]王二君.CT脑灌注联合血管成像在烟雾病血管重建术中的应用效果[J].中国实用神经疾病杂志,2017,20(3):73-75.
[10]李键,毛仁玲,冯江,等.颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-颞肌血管融合术治疗成年烟雾病的临床疗效及高灌注综合征[J].中风与神经疾病杂志,2017,34(6):542-544.
[11]王斌,周茜,姚振威,等.CT灌注与MR灌注加权成像对烟雾病血管重建术疗效的评价[J].中国医学计算机成像杂志,2015,21(1):64-68.
[12]种振,陈月芹,郭翔,等.CT灌注成像对出血型烟雾病血管重建术前后血流动力学的评价研究[J].实用放射学杂志,2018,34(11):1765-1768.
[13]王斌,姚振威,李征宇,等.MRA和MR灌注加权成像在不同类型烟雾病脑血流动力学中的研究[J]临床放射学杂志,2015,34(4):521-526.
[14]陈通,付爱军,朱军,等.CT灌注成像对非卒中型烟雾病血流动力学的分析[J].实用放射学杂志,2015,7(1):1-4.
[15]中华医学会放射学分会质量管理与安全管理学组,中华医学会放射学分会磁共振学组.动脉自旋标记脑灌注MRI技术规范化应用专家共识[J].中华放射学杂志,2016,50(11):817:824.
[16]朱文杰,张顺,姚义好,等.三维动脉自旋标记PWI评估烟雾病患者血管重建术后脑灌注变化[J].中国医学影像技术,2018,34(4):495-498.
[17]吕晋浩,娄昕.脑侧支循环的MRI研究进展[J].中华放射学杂志,2016,50(7):556-558.
[2]刘卫明,伍晓六,蓝伟武,等.CT灌注成像对烟雾病脑血管重建术后患者血流动力学改变评价效果研究[J].中国CT和MRI杂志,2018,16(8):18-28.
[3]周雪梅,付冬,蔡红法,等.全脑CT灌注联合CT血管成像在烟雾病搭术前后的应用分析[J].实用医学影像杂志,2018,19(5):392-394.
[4]任斌,段炼.2012年烟雾病(Willis环自发性闭塞)诊断治疗指南(日本)的解读[J].中国脑血管病杂志,2014,11(1):6-9.
[5]Hishikawa T,Sugiu K,Date I.Moyamoya disease:a review of clinical research[J].Acta Med Okayama,20l6,70(4):229-236.
[6]朱文杰,张顺,张水霞,等.三维动脉自旋标记与动态磁敏感对比灌注加权成像评估成年烟雾病患者脑血流动力学的对比研究[J].中华放射学杂志,2017,51(2):86-90.
[7]王斌,朱风萍,周茜,等.运用MR血管成像及灌注加权成像评价烟雾病责任血管、术后重建血管及手术前后脑血流动力学变化的研究[J].中华放射学杂志,2014,48(5):381-385.
[8]巨昕薇,张帅,冯加纯,等.磁共振灌注成像在烟雾病患者脑血流动力学评估中的应用[J].吉林大学学报(医学版),2016,42(5):1024-1029.
[9]王二君.CT脑灌注联合血管成像在烟雾病血管重建术中的应用效果[J].中国实用神经疾病杂志,2017,20(3):73-75.
[10]李键,毛仁玲,冯江,等.颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-颞肌血管融合术治疗成年烟雾病的临床疗效及高灌注综合征[J].中风与神经疾病杂志,2017,34(6):542-544.
[11]王斌,周茜,姚振威,等.CT灌注与MR灌注加权成像对烟雾病血管重建术疗效的评价[J].中国医学计算机成像杂志,2015,21(1):64-68.
[12]种振,陈月芹,郭翔,等.CT灌注成像对出血型烟雾病血管重建术前后血流动力学的评价研究[J].实用放射学杂志,2018,34(11):1765-1768.
[13]王斌,姚振威,李征宇,等.MRA和MR灌注加权成像在不同类型烟雾病脑血流动力学中的研究[J]临床放射学杂志,2015,34(4):521-526.
[14]陈通,付爱军,朱军,等.CT灌注成像对非卒中型烟雾病血流动力学的分析[J].实用放射学杂志,2015,7(1):1-4.
[15]中华医学会放射学分会质量管理与安全管理学组,中华医学会放射学分会磁共振学组.动脉自旋标记脑灌注MRI技术规范化应用专家共识[J].中华放射学杂志,2016,50(11):817:824.
[16]朱文杰,张顺,姚义好,等.三维动脉自旋标记PWI评估烟雾病患者血管重建术后脑灌注变化[J].中国医学影像技术,2018,34(4):495-498.
[17]吕晋浩,娄昕.脑侧支循环的MRI研究进展[J].中华放射学杂志,2016,50(7):556-558.