预测颈内动脉支架植入术和内膜剥脱术后升高的脑血流  

Predicting elevated CBF following carotid artery stenting and endarterectomy

作　　者：兰怡娜 吕晋浩 马笑笑[1] 娄昕[1] 马林[1] LAN Yi-na;LU Jin-hao;MA Xiao-xiao;LOU Xin;MA Lin(Department of Radiology,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院放射科,北京100853

出　　处：《磁共振成像》2018年第11期807-812,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:81671126;81730048);科技部国家重点研发计划(编号:2016YFC01001004)~~

摘　　要：目的利用三维准连续式动脉自旋标记灌注成像(three-dimensional pseudo-continuousarterialspinlabeling,3D-pCASL)预测颈内动脉支架植入术(carotidarterystenting,CAS)和颈内动脉内膜剥脱术(carotidendarterectomy,CEA)后升高的脑血流量(cerebralbloodflow,CBF),为CAS和CEA术后的脑血流动力学提供影像学预测指标,从而为术前患者手术方式的选择提供一定的参考。材料与方法从2015年11月到2017年2月,共连续纳入18例[平均年龄(61.6±8.2)岁,15例男性]有症状的单侧颈内动脉重度狭窄(70%~99%)患者,其中11例患者接受了CAS,7例患者接受了CEA。所有患者分别在术前7 d,术后连续24 h、48 h、72 h、96 h进行了连续四次扫描。扫描序列包括常规磁共振成像以及3D-pCASL,扫描仪器为同一台3.0 T MR (GE Discovery MR750)扫描仪。采用Pearson相关性分析评价术后升高的CBF分别与术前的软脑膜侧支血流和前向脑血流的相关性,以及降低的前向血流与侧支血流的相关性。P<0.05表示差异有统计学意义。结果侧支血流和CAS术后升高的CBF呈显著的正相关性(r=0.877,P=0.000),但与CEA术后升高的CBF无相关性(r=-0.099,P=0.833),尽管CEA术前有更高的侧支血流(P<0.05);在两者前向血流基本相同的前提下(P>0.05),前向血流和CEA术后升高的CBF呈显著的负相关(r=-0.905,P=0.005),但和CAS术后升高的CBF无相关性(r=-0.317,P=0.342)。结论软脑膜侧支血流和前向血流对CAS和CEA术后升高CBF的影响不同,这或许能为术前患者手术方式的选择提供一定的参考。Objective： The purpose of this study was to predict elevated cerebral blood flow （CBF） by three-dimensional pseudo continuous arterial spin labeling （3D-pCASL） in patients who underwent carotid artery stenting （CAS） and endarterectomy （CEA）, in the hope of providing a prognosis index for elevated CBF after CAS and CEA and fires to provide some references for the selection of surgical methods. Materials and Methods： Symptomatic eighteen patients [15 males and 3 females, age （61.6±8.2） years] with 70% 99% unilateral internal carotid artery （ICA） stenosis were consecutively enrolled, of these, 11 underwent CAS and 7 underwent CEA in a prospective cross-sectional study from November 2015 to February 2017. Routine MRI examinations and 3D -pCASL were performed using a 3.0 T system within 7 days prior to operations, and at 4 consecutive time-points （24, 48, 72, and 96 h） after the operations. Pearson＇s correlation for the relationships between elevated flow, antegrade flow, and collateral flow was determined. P〈 0.05 was considered statistically significant. Results： Collateral flow showed a significant positive correlation with elevated CBF （r =0.877, P= 0.000） after CAS, but no correlation with elevated CBF after CEA （r= 0.099, P=-0.833 ）, despite CEA had higher collateral flow than CA S （P〈 0.05）. Antegrade flow showed a significant negative correlation with elevated CBF （r =-0.905, P=0.005） after CEA, while no correlation with elevated CBF after CAS （r =-0.317, P=0.342）, when the antegrade flow is largely identical （P〉 0.05）. Conclusions： Leptomenigeal collateral and antegrade flow effecting on the elevated CBF are different after CAS and CEA, which may provide some references for the selection of surgical methods.

关 键 词：颈内动脉支架植入术 颈内动脉内膜剥脱术 脑血流量 三维准连续式动脉自旋标记灌注成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742[医药卫生—诊断学]