【摘要】 目的探讨磁共振血管成像(MRA)在烟雾病分期、分类中的应用价值以及MR灌注加权成像(PWI)判断不同类型烟雾病脑血流动力学的情况。方法搜集经DSA证实的28例烟雾病,按Suzuki分期(Ⅰ~Ⅵ期)方法分期,将尚未形成明显颅外至颅内侧支循环的Ⅰ、Ⅱ、Ⅲ期归第1类,将颅外向颅内侧支循环逐步明显的Ⅳ、Ⅴ、Ⅵ期归第2类。分别对DSA及MRA图像进行分期与分类,以DSA结果作为标准,比较MRA分期、分类结果的可靠性。运用MR PWI研究两类烟雾病患者脑血流动力学情况,测量患者拟手术侧及对侧大脑中动脉(MCA)分布区的灌注参数,包括脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及延迟时间(DT),计算拟手术侧MCA分布区/对侧MCA分布区灌注参数相对比值(r CBF、r CBV、r MTT及r DT值)。采用配对t检验比较不同类型烟雾病PWI灌注参数相对值的差异。结果 28例烟雾病患者DSA显示第1类16例,其中Ⅰ期0例,Ⅱ期5例,Ⅲ期11例;第2类12例,其中Ⅳ期9例,Ⅴ期2例,Ⅵ期1例。MRA显示第1类14例,其中Ⅰ期1例,Ⅱ期6例,Ⅲ期7例;第2类14例,其中Ⅳ期10例,Ⅴ期3例,Ⅵ期1例。MRA与DSA对比分期符合率仅为67.9%。PWI参数中MTT、DT两项参数对脑血流动力学变化敏感。第2类烟雾病患者拟手术侧MCA分布区/对侧镜像区的r MTT(2.35±0.49)及r DT(2.47±0.51)高于第1类r MTT(1.48±0.47)及r DT(1.51±0.56)(t值分别为4.46、4.87,P值均<0.05),第2类烟雾病患者拟手术侧MCA分布区/对侧镜像区的r CBF(0.72±0.16)及r CBV(0.75±0.27)与第1类r CBF(0.89±0.25)及r CBV(1.01±0.32)差异无统计学意义(t值分别为-1.28、-1.79,P值均>0.05)。结论MRA对烟雾病的分期有局限性,与DSA对比符合率低。PWI发现不同类型烟雾病的脑血流动力学参数r MTT和r DT存在差异。更多还原

【Abstract】 Objective To assess the clinical value of MRA in staging and classifying Moyamoya disease,and to evaluate perfusion weighted imaging( PWI) in judging cerebral hemodynamics of different types of Moyamoya disease. Methods A total of 28 patients with DSA-confirmed Moyamoya disease were collected. According to Suzuki’s staging criteria,stages of Ⅰ- Ⅲ were classified as type A,and the stages of Ⅳ- Ⅵ were classified as type B. The reliabilities of the stage and the classification of all patients diagnosed by MRA were evaluated by taking DSA findings as the standard. PWI was performed in all patients. Perfusion parameters in the regions supplied by terminal branches of middle cerebral artery( MCA) on operative side and on the contralateral side,including cerebral blood flow( CBF),cerebral blood volume( CBV),mean transit time( MTT),and delay time( DT),as well as relative ratio( ROI on operative side/ROI on contralateral side) of perfusion parameters( r CBF,r CBV,r MTT and r DT) were calculated. Using paired student’s t test the results were compared between different groups. Results Of the 28 patients,type A judged by DSA was seen in 16,including stage Ⅰ( n = 0),stage Ⅱ( n = 5) and stage Ⅲ( n = 11); type B was found in 12,including stage Ⅳ( n = 9),stageⅤ( n = 2) and stage Ⅵ( n = 1). With MRA,type A was observed in 14,including stage Ⅰ( n = 01),stage Ⅱ( n = 6)and stage Ⅲ( n = 7); type B was detected in 14,including stage Ⅳ( n = 10),stage Ⅴ( n = 3) and stage Ⅵ( n = 1). The staging coincidence between MRA and DSA was only 67. 9%. The two PWI parameters,MTT and DT,were very sensitive to the changes of cerebral hemodynamics. In type B,r MTT( 2. 35 ± 0. 49) and r DT( 2. 47 ± 0. 51) of MCA distributions on the scheduled operation side were higher than those on the contralateral side( r MTT: 1. 48 ± 0. 47 and r DT: 1. 51 ±0. 56) in type A,the differences were statistically significant( t = 4. 46,t = 4. 87 respectively,both P < 0. 05). No statistically significant differences in r CBF( 0. 72 ± 0. 16 vs 0. 89 ± 0. 25) and r CBV( 0. 75 ± 0. 27 vs 1. 01 ± 0. 32) existed between type A and type B( t =- 1. 28,t =- 1. 79,both P > 0. 05). Conclusion MRA has limitation in staging Moyamoya disease,the coincidence rate with DSA is as low as 67. 9%. PWI indicates that the hemodynamic parameters such as r MTT and r DT are different in two types of Moyamoya disease.更多还原