磁共振灌注加权成像对蛛网膜下腔出血后脑血管痉挛患者脑血流动力学的评估  

Evaluation of hemodynamics with perfusion-weighted magnetic resonance imaging in patients with cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：冯宝海 周政 刘俊 杨辉 阴金波 张旋 张建忠 

机构地区：[1]第三军医大学第二附属医院神经外科,重庆410037

出　　处：《中国脑血管病杂志》2011年第3期119-124,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的观察动脉瘤性蛛网膜下腔出血(aSAH)后,磁共振灌注成像(PWI)显示脑血流参数的变化,探讨脑血流动力学与脑血管痉挛间的关系。方法选择aSAH≤7 d的患行38例,另选同期无SAH的颅内动脉瘤患者10例作为对照组。行全脑DSA俭查,观察患者脑血管痉挛(CVS)程度;行PWI检查,采集大脑前动脉(ACA)、大脑中动脉(MCA)供血区及基底核区(BSGL)的相应感兴趣区的相对脑血流量(rCBF)、相对脑血容量(rCBV)、平均通过时间(MTT)和达峰时间(TTP)参数。分析这些参数与CVS的相关性。结果①DSA检查显示,38例中,28例至少有1支血管痉挛,其中轻度痉挛有9例,中度痉挛有10例,重度痉挛有9例;10例末发现CVS。②与对照组比较,重度痉挛组ACA、MCA、BSGL供血区rCBF、rCBV均降低,且差异有统计学意义(P<0.05～0.01);而无痉挛组、轻度痉挛组、中度痉挛组、重度痉挛组各血管供血区的rCBF、rCBV均有降低趋势,但降低的程度不同。与对照组比较,轻度痉挛组、中度痉挛组、重度痉挛组ACA、MCA、BSGL供血区的MTT、TTP均有延长趋势,CVS越重,延长就越明显,其中,中、重度痉掌组差异有统计学意义(P<0.05～0.01)。③Spearman等级相关分析显示,CVS程度与各供血区的rCBF及rCBV呈负相关,r_s均<0.4,为低度相关;与MTT、TTP呈正相关,r_s:0.310～0.730,为中度相关。结论 PWI检查可以定量地提供脑组织血流灌注的信息。PWI检查所采集的各供血区rCBF、rCBV、MTT、TTP4个参数中,MTT和TTP参数与CVS程度的符合性更好。Objectives To observe the changes of cerebral blood flow parameters showed by perfusionweighted magnetic resonance imaging （PWI） in patients ＇after aneurysmal snbarachnoid hemorrhage （aSAH） and to investigate the correlation between cerebral hemodynamics and cerebral vasospasm （CVS）. Methods A total of 38 patients with aSAH （≤7 d） were selected for cerebral angiography. The severity of CVS was observed and PWI was performed. The parameters of regional cerebral blood flow （rCBF） , regional cerebral blood volume （rCBV） , mean transit time （MTT） , and time to peak （TTP） were collected in the territories of anterior cerebral artery, middle cerebral artery, and basal ganglia. The correlation between these parameters and CVS was analyzed. Results DSA showed that 28 of the 38 patients had vasospasm at least in one branch, 9 of them had mild vasospasm; 10 had moderate vasospasm, and 9 had severe vasospasm; 10 did not find any CVS. （2）As compared with the control group,the rCBF and rCBV in ACA, MCA, and BSGL territories in the severe vasospasm group were decreased, and there were significant differences （P 〈 0.05 to P 〈 0.01 ） , while the rCBF and rCBV in all the blood supply territories in the non-, mild, moderate, and severe vasospasm groups had a tendency of reduction, however, the degrees of reduction were different. As compared with the control group, the TI＇P and MTF had an increasing tendency in the ACA, MCA and BSGL territories in the mild, moderate, and severe vasospasm groups; among them, there was significant difference between the moderate and severe vasospasm groups （ P 〈 0.05 to P 〈 0.01 ）. （3The severity of CVS was negatively correlated with rCBF and rCBV, and it was positively correlated with TTP and MTT. Conclusions PWI may quantitatively provide the information of cerebral blood flow perfusion. Among the parameters of rCBF, rCBV, TTP, and MTT in all the blood supply territories collected by PWI, the parameters of TFP and MTT had better consisten

关 键 词：蛛网膜下腔出血 血管痉挛 颅内 磁共振血管造影术 血流动力学 

分 类 号：R743.35[医药卫生—神经病学与精神病学]