颈内动脉狭窄或闭塞患者不同灌注下的临床表现及其DTI特点  

Characteristics of clinical manifestations and the DTI in the internal carotid artery stenosis or occlusion with different perfusion

作　　者：曾雅清[1] 宋志彬[1] 周雁玲[1] 董延江[1] 

机构地区：[1]南方医科大学附属小榄人民医院神经内科,广东中山528415

出　　处：《海南医学》2013年第8期1121-1124,共4页Hainan Medical Journal

摘　　要：目的探索单侧颈内动脉重度狭窄或闭塞患者不同灌注情况下的白质变化特点及其临床表现。方法 30例颈内动脉重度狭窄或闭塞患者行灌注加权成像(Perfusion weighted imaging,PWI)及弥散张量成像(Diffusion tensor imaging,DTI)检查,根据PWI结果分为三组,对各组患者临床表现进行分析,对双侧半卵圆中心DTI及PWI进行定性、定量分析,并对不同灌注下各向异性(Fractional anisotropy,FA)及表观扩散系数(Apparent diffsion coefficent,ADC)值的变化特点进行分析,分析灌注及DTI各指标之间的相关性。结果 30例患者根据血流动力学特点及PWI特点分为Ⅰ期、Ⅱ期、Ⅲ期三组,各组之间临床表现存在统计学意义,Ⅲ期患者以脑梗塞表现居多(P=0.003),Ⅰ期患者以无症状居多(P=0.01),Ⅱ期患者以TIA表现为主(P=0.035)。不同灌注分期情况下,3期间rCBV、rMTT、rTTP(P=0.000,P=0.000,P=0.001)均数比较差异具有统计学意义,rCBF各期之间差异均无统计学意义(P=0.582)。患侧半卵圆中心FA值较对侧半卵圆中心FA值显著减低(P=0.004),双侧ADC值差异无统计学意义(P=0.601)。各灌注分期之间FA比值差异有统计学意义(P=0.021),且随着灌注减低,FA比值减低越明显。各组之间ADC比值差异无统计学意义(P=0.133)。FA比值与rTTP呈负相关(r=-0.451,P=0.021),与其他灌注参数无显著相关性。结论 PWI能早期综合性反映脑组织灌注情况,分析不同灌注下FA值能早期反应脑组织低灌注对脑白质损害的情况,且PWI的改变与DTI的改变是一致的,结合两者有利于对此疾病病理生理机制的了解,也有利于临床医师制订个体化治疗方案。Objective To investigate changing characteristics of white matter damage and the clinical manifestation in the unilateral internal carotid artery （ICA） severe stenosis or occlusion patients with different perfusion periods. Methods The PWI and DTI examine were performed in 30 unilateral internal carotid artery severe stenosis or occlusion patients. Three groups were divided according to the PWI results. Analyzed clinical manifestations of the patients, conduct- ed the qualitative and quantitative analysis in PWI and DTI in double sides bilateral centra semiovale, Analyzed the changing characteristics of the FA and ADC values with different perfusion and the correlation between DTI and PWI. Results Thirty patients was divided into three groups, as phase I, phase II, phase III, according to the hemodynamic characteristics and PWI characteristics. The clinical manifestation in groups are significantly different, patients in phase III manifesting cerebral infarction mainly （P=0.003）, patients in phase I manifesting asymptomatic mainly （P=0.01）, and patients in phase II with TIA performance mainly （P=0.035）. with different perfusion stages, the means of rCBV, rMTT, rTTP has sig- nificant difference between each period （respectively, P=0.000, P=0.000, P=0.001）. There are no significant statistical difference in the mean of rCBF between each period （P=0.582）. FA value in affacted side eentrum semiovale obviously decreased comparing with contralateral FA value （P=0.004）, ADC values in double sides have no significant difference （P= 0.601）. FA values in different perfusion stages between had significant difference （P=0.021）, and the FA ratio reduced obvi- ously following the perfusion reducing. The ADC ratio in each group had no significant difference （P=0.133）. There was a negative correlation between the FA ratio and rTTP （r=0.451, P=0.021）, and there was no significant correlation with other perfusion parameters. Conclusion PWI can early comprehensively reflect brain tissue p

关 键 词：颈内动脉 狭窄或闭塞 脑灌注成像(PWI) 弥散张量成像(DTI) 

分 类 号：R743[医药卫生—神经病学与精神病学]