急性脑梗死后交叉性小脑神经机能联系不能的扩散加权成像及动脉自旋标记研究  

Study crossed cerebellar diaschisis with acute cerebral infarction in DWI and ASL imaging

作　　者：闫呈新[1] 张渺娜 黄婧颖 张敏凤[1] 岳云[2] 张颜波[3] 朱建忠[1] YAN Chengxin;ZHANG Miaona;HUANG Jingying;ZHANG Minfeng;YUE Yun;ZHANG Yanbo;ZHU Jianzhong(Department of Medical Imaging,the Affiliated Hospital of Taishan Medical College,Tai'an 271000,China;Department of Hyperbaric Oxygen,the Affiliated Hospital of Taishan Medical College,Tai 'an 271000,China;Department of Neurology,the Affiliated Hospital of Taishan Medical College,Tai'an 271000,China)

机构地区：[1]泰山医学院附属医院影像科,山东泰安271000 [2]泰山医学院附属医院高压氧舱,山东泰安271000 [3]泰山医学院附属医院神经内科,山东泰安271000

出　　处：《实用放射学杂志》2019年第1期15-18,26,共5页Journal of Practical Radiology

基　　金：泰安市科技发展计划基金资助课题(2016NS1164)。

摘　　要：目的 探讨3.0T MR DWI与三维动脉自旋标记(3D-ASL)脑灌注成像技术在诊断单侧幕上急性脑梗死后交叉性小脑神经机能联系不能(CCD)的价值。 方法 回顾性分析42例单侧幕上急性脑梗死合并CCD的患者,定量地测量双侧小脑半球的ADC值和脑血流量(CBF)值,计算小脑半球灌注的不对称指数(AI),分析CCD现象的对侧小脑半球ADC值和CBF值的变化。 结果 42例CCD患者的双侧小脑半球在DWI图像上未见明显扩散受限信号。脑梗死区对侧小脑半球的ADC值平均为(0.686±0.031)×10^-3 mm^2/s,其同侧的ADC值平均为(0.695±0.042)×10^-3 mm^2/s,两者之间无统计学差异(t值=0.264,P=0.793>0.05);对照组双侧小脑半球的平均ADC值为(0.713±0.047)×10^-3 mm^2/s,与梗死对侧小脑相比,有统计学差异(P<0.05),与梗死同侧小脑相比,无统计学差异(P>0.05)。在3D-ASL上对侧小脑半球呈明显低灌注改变,以小脑半球下部为著,CBF平均值为(22.167±7.392)mL/(100 g×min),同侧小脑的CBF平均值为(37.201±8.495)mL/(100 g×min),两侧小脑半球灌注AI平均为(24.3±6.7)%,差异有统计学意义(t值=-19.98,P<0.001),幕上急性脑梗死均累及皮质-脑桥-小脑(CPC)的纤维束通路;幕上脑梗死对侧小脑ADC值的下降间接反映了局部脑组织毛细血管灌流情况,与3D-ASL结果有较好的一致性。 结论 幕上急性期脑梗死后可发生CCD现象,ADC值和CBF值可早期定量地评估小脑半球低灌注程度,判定有无CCD的发生,两者具有较好的一致性,是一种方便快捷的评价CCD现象的方法。Objective To investigate the value of 3.0T MR DWI and three dimensional arterial spin labeling(3D-ASL)cerebral perfusion imaging in the diagnosis of the crossed cerebellar diaschisis (CCDI after acute cerebral infarction on the unilateral supratentorial cerebral infarction.Methods 42 cases of unilateral supratentoriaI acute cerebral infarction with contralateral cerebellar hemispheric hypoperfusion were analyzed retrospectively in this study.The ADC and cerebral blood fiow(CBF)values of bilateral cerebellar hemispheres were quantitative measured by DWI and 3D-ASL.The asymmetry index (AI}of cerebellar hemisphere perfusion was calculated,and the change of ADC values and CBF values of the contralateral cerebellar hemisphere in CCD phenomenon were analyzed.Results In 42 patients with CCD,the bilateral cerebellar hemispheres did not show significant diffusion-limited signals on the DWI images.The mean ADC values of contralateral cerebellar hemispheres in the unilateral supratentorial cerebral infarction area was (0.686±0.031)×10^-3 mm^2/s,and the average ADC value of ipsilateral was (0.695±0.042)×10^-3mm^2/s.ADC values of both sides of the cerebellum in patients with acute cerebral infarction were decreased to different levels and paired sample t test showed no difference (t=0.264, P =0.793>0.05).The average ADC value of bilateral cerebellar hemispheres was (0.713±0.047)×10^-3mm^2/s in control group. Compared with the control groups,ADC values of the cerebellum of contralateral to infarction were statistically significant different in independent samples t test (P<0.05).Compared with the control groups,ADC values of the cerebellum of ipsilateral to infarction were not significantly different (P>0.05).In the 3D-ASL perfusion map,the contralateral cerebellar hemisphere of the supratentorial infarct showed obvious hypoperfusion,and the low perfusion area was located in the lower part of the cerebellar hemisphere,and the mean CBF was (22.167±7.392)mL/(100g×min).The average CBF of the ipsilateral cerebellar hemisph

关 键 词：急性脑梗死 交叉性小脑神经机能联系不能 扩散加权成像 动脉自旋标记 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R742.82[医药卫生—临床医学]