相位对比磁共振成像定量评估烟雾病患者血管重建术前后血流动力学  

Quantitative assessment of hemodynamics in patients with moyamoya disease before and after revascularization on phase-contrast magnetic resonance imaging

作　　者：段宇 徐斌 毛仁玲 高丰 冯江 陈功 李键 Duan Yu;Xu Bin;Mao Renling;Gao Feng;Fen Jiang;Chen Gong;Li Jian(Department of Neurosurgery,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Neurosurgery,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Imaging,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院神经外科,上海200040 [2]复旦大学附属华山医院神经外科,上海200040 [3]复旦大学附属华东医院影像科,上海200040

出　　处：《国际脑血管病杂志》2020年第3期185-190,共6页International Journal of Cerebrovascular Diseases

基　　金：上海市科委医学引导类支撑项目(18411962400)。

摘　　要：目的采用相位对比磁共振成像(phase-contrast magnetic resonance imaging,PC-MRI)评估烟雾病患者脑血管重建术术前及术后6个月时的血流动力学,分析术后发生脑过度灌注综合征(cerebral hyperperfusion syndrome,CHS)的危险因素。方法回顾性纳入2017年1月至2019年4月在复旦大学附属华东医院接受联合血管重建术的烟雾病患者。在术前及术后6个月行PC-MRI检查,记录颈内动脉、颈外动脉、颞浅动脉和椎动脉的血流速度、血流量以及血管管腔感兴趣区(regions of interest,ROI)面积。应用多变量logistic回归分析确定CHS的独立相关因素。结果共纳入80例烟雾病患者,男性35例(43.75%),年龄(42.4±10.1)岁(范围19~60岁)。术后6个月时颞浅动脉血流速度(P<0.05)、血流量(P<0.01)及ROI面积(P<0.01)均较术前显著增加,而椎动脉血流量变慢(P<0.05)。单变量分析显示,伴有糖尿病、优势半球侧手术、术前颞浅动脉血流速度加快、颈内动脉流量变小以及颈外动脉流量升高是烟雾病患者术后发生CHS的可能危险因素。多变量分析显示,优势半球侧手术[优势比(odds ratio,OR)4.627,95%可信区间(confidence internal,CI)1.019~21.009;P=0.047]、术前颞浅动脉血流量(OR 1.208,95%CI 1.053~1.387;P=0.007)和颈外动脉血流量(OR 0.139,95%CI 0.027~0.719;P=0.019)与术后CHS独立相关。结论PC-MRI能评估颅内外主要血管血流动力学参数,并可作为评价烟雾病术后风险的重要依据之一。Objective To evaluate the hemodynamics of patients with moyamoya disease before and 6 months after cerebral revascularization using phase-contrast magnetic resonance imaging(PC-MRI),and to analyze the risk factors for postoperative cerebral hyperperfusion syndrome(CHS).Methods Patients with moyamoya disease underwent combined revascularization in Huadong Hospital Affiliated to Fudan University from January 2017 to April 2019 were enrolled retrospectively.PC-MRI was performed before and 6 months after surgery.The blood flow velocity,blood flow and the region of interest(ROI)area of the vascular lumen in internal carotid artery,external carotid artery,superficial temporal artery and vertebral artery were recorded.Multivariate logistic regression analysis was used to determine the independent correlated factors of CHS.Results A total of 80 patients with moyamoya disease were included,including 35 males(43.75%),aged 42.4±10.1 years(range 19-60 years).The blood flow velocity(P<0.05),blood flow(P<0.01)and area of ROI(P<0.01)of the superficial temporal artery were significantly increased at 6 months after surgery compared with the before surgery,and the blood flow of the vertebral artery was slower compared with the before surgery(P<0.05).Univariate analysis showed that diabetes,predominant hemispheric operation,preoperative increased superficial temporal artery blood flow rate,reduced internal carotid artery flow,and increased external carotid artery flow were the possible risk factors for occurring CHS in patients with moyamoya disease after surgery.Multivariate logistic regression analysis showed that the predominant hemispheric operation(odds ratio[OR]4.627,95% confidence interval[CI]1.019-21.009;P=0.047),preoperative superficial temporal artery blood flow(OR 1.208,95%CI 1.053-1.387;P=0.007)and external carotid artery blood flow(OR 0.139,95%CI 0.027-0.719;P=0.019)were independently associated with postoperative CHS.Conclusions PC-MRI can evaluate the hemodynamic parameters of intracranial and extracranial major blo

关 键 词：烟雾病 脑血管重建术 手术后并发症 磁共振成像 脑血管循环 危险因素 

分 类 号：R651[医药卫生—外科学] R44[医药卫生—临床医学]