【摘要】 目的探讨磁共振三维假持续性脉冲自旋标记成像(3D-p CASL)和磁共振动态增强(DCE-MRI)评价烟雾病脑血流侧支循环和血管通透性的应用价值。方法回顾性分析17例同时进行了常规MRI、3D-p CASL和DCEMRI检查,并经DSA和/或3D MRA确诊的烟雾病患者资料。选取基底节层面,按照大脑前、中、后动脉供血分布范围,分为10个分区,利用3D-p CASL的血流标记图对10个分区的侧支循环进行评分(0、1、2和3分),并相应分为0,1,2和3组;利用3D-p CASL脑血流图分别计算相应分区的脑血流量(CBF)值;DCE-MRI按照相同选层和分区方法,测定血管容积交换常数(Ktrans)值;对0~3组CBF测值行单因素方差分析,Bonferoni法进行组间两两比较;对Ktrans行Kruskal-Wallis H检验(P<0.01差异有统计学意义)。结果 CBF组内差异有统计学意义(F=27.248,P<0.001),0~3组CBF值分别为32.7±10.68、39.11±15.13、57.08±13.99和54.84±15.45 ml·100g-1·min-1,两两比较,除0和1组以及2和3组间差异无统计学意义外,其他组间差异均有统计学意义(所有P<0.001);Ktrans组间比较差异无统计学意义(χ2=3.128,P=0.372),0~3组Ktrans值分别为0.021(0.007,0.028),0.019(0.014,0.038),0.020(0.009,039)和0.024(0.020,0.038),但其中2例合并亚急性梗死的3个分区和1例合并短暂性缺血发作的患者4个分区Ktrans较其他分区增高。结论运用3D-p CASL和DCE-MRI可定量评价烟雾病脑血流灌注和血管通透性。更多还原

【Abstract】 Objective To explore the application of DCE-( dynamic contrast enhancement) and 3D-pC ASL( pseudocontinuous arterial spin labeling) MRI in the quantitive evaluation of cerebrovascular collateral circulation and permeability in Moyamoya disease( MMD). Methods A prospective analysis of DCE- and 3D-pC ASL MRI was performed in 17 patients with MMD confirmed by DSA and / or 3D MRA. According to the feeding distribution of the anterior、middle and posterior cerebral artery,10 regions of interest from primitive CBF( cerebral blood flow) labeling maps of 3D-pC ASL MRI were drawn manually on each section through the level of basal ganglia,each region was scored with 0,1,2 and 3,respectively,the corresponding CBF values in the CBF map,and Ktransvalues in Ktransmap were measured. All the 170 regions were classified into 0,1,2 and 3 groups according to the scoring results. The statistical tests of ANOVA and Kruskal-Wallis H were used to compare CBF and Ktransvalues among 0- 3 groups,respectively.( P values of less than 0. 05 were considered to be significant). Results Significant difference was observed among 0- 3 groups with the CBF values of 32. 7 ±10. 68,39. 11 ± 15. 13,57. 08 ± 13. 99 和 54. 84 ± 15. 45,respectively( F = 247. 248,P < 0. 001); there were no significant difference in the comparisons of groups of 0 vs 1 and 2 vs 3,in contrast,other comparisons between groups were significant( all P < 0. 001). No significant difference of Ktransvalues were observed among 0- 3 groups with Ktransvalues of0. 021( 0. 007,0. 028),0. 019( 0. 014,0. 038),0. 020( 0. 009,039) and 0. 024( 0. 020,0. 038)( χ2= 3. 128,P =0. 372). Meanwhile,the increased values of Ktranswere observed in the three regions of two cases with subacute infarction and four regions of one case with TIA than other regions. Conclusion The combination of 3D-pC ASL and DCE-MRI is a feasible method to quantitively evaluate cerebrovascular perfusion and permeability in MMD.更多还原