ASL灌注成像评价无症状型单侧颈内动脉重度狭窄或闭塞老年患者脑血流动力学改变及Willis环侧支代偿作用  

The evaluation on cerebral hemodynamics changes and collateral compensation of the circle of Willis by use of whole brain ASL perfusion imaging in elderly patients with asymptomatic unilateral internal caro-tid artery stenosis or occlusion to evaluate

作　　者：郝晓勇 吴江 杨朝慧 朱丽娜 牛衡 李璇 HAO Xiao-yong;WU Jiang;YANG Zhao-hui(Department of Magnetic resonance,Shanxi Cardiovascular Hospital,Taiyuan 030024,China)

机构地区：[1]山西省心血管病医院磁共振室,太原030024

出　　处：《放射学实践》2020年第4期462-466,共5页Radiologic Practice

基　　金：山西省重点研发计划(指南)项目(201703D321017-4)。

摘　　要：目的:通过对单侧颈内动脉重度狭窄或闭塞的无症状型老年患者行全脑ASL灌注成像,评估其脑血流动力学改变及Willis环侧支循环的代偿作用,为此类患者的早期血管再通治疗提供影像学依据。方法:搜集2018年7月-2019年8月在本院确诊为单侧颈内动脉重度狭窄或闭塞的42例无症状型老年患者(年龄≥60岁)的病例资料,其中男23例,女19例,年龄60~81岁。全部患者无明显神经系统定位体征,9例MRI平扫未见明显异常,33例MRI平扫发现少量腔隙性脑梗死。所有患者行TOF-MRA和全脑ASL成像检查,根据患者的TOF-MRA表现,将患者分为Willis环完整、Willis环不完整及Willis环部分完整共3组,测量并比较各组中健侧与患侧大脑半球的CBF值。结果:42例中左侧颈内动脉重度狭窄或闭塞24例、右侧18例。8例患者的Willis环完整,此组中患侧额叶、颞叶和顶叶的CBF值分别为(52.23±0.83)、(45.59±0.67)和(49.59±0.43)mL/(100g·min),健侧分别为(52.59±0.64)、(45.50±0.16)和(49.72±0.47)mL/(100g·min),各部位的双侧CBF值的差异均无统计学意义(P>0.05);13例患者的Willis环不完整,此组中患侧额叶、颞叶和顶叶的CBF值分别为(51.52±0.79)、(44.21±2.54)和(48.45±0.65)mL/(100g·min),健侧分别为(52.77±0.56)、(45.48±0.19)和(49.63±0.48)mL/(100g·min),各部位患侧与健侧间CBF值的差异均有统计学意义(P<0.05);21例患者的Willis环部分完整,此组中患侧额叶、颞叶和顶叶的CBF值分别为(52.09±0.95)、(45.59±0.64)和(49.57±0.48)mL/(100g·min),健侧分别为(52.57±0.69)、(45.48±0.17)和(49.79±0.48)mL/(100g·min),各部位双侧CBF值的差异均无统计学意义(P>0.05)。结论:全脑ASL灌注成像和TOF-MRA扫描可以早期了解脑动脉重度狭窄或闭塞后脑组织的血流灌注情况及侧支循环代偿途径和其代偿能力,对脑血管病的早期溶栓治疗、介入治疗、药物治疗、判断预后提供可靠的帮助。Objective:The purpose of this study was to evaluate the cerebral hemodynamics changes and the collateral compensation of the circle of Willis by use of whole brain ASL perfusion imaging in elderly patients with asymptomatic unilateral internal carotid artery stenosis or occlusion,so as to provide imaging evidence for early revascularization of these patients.Methods:42 elderly patients(≥60 years)with asymptomatic unilateral internal carotid artery stenosis or occlusion were collected from July 2018 to August 2019,including 23 males and 19 females,aged 60~81 years.All patients had no symptomatic nervous system localization signs,of which 9 cases had no obvious abnormality on MRI plain scan and 33 cases had a small amount of lacunar infarctions.TOF-MRA and ASL were performed in all patients.According to the results of TOF-MRA,the patients were divided into three groups:complete,partially complete and incomplete circle of Willis.The CBF values of ASL of the affected cerebral hemispheres were compared and analyzed with those of the contralateral cerebral hemispheres.Results:Of the 42 patients,24 were observed with severe stenosis or occlusion in the left internal carotid artery and the other 18 in the right.Among the 42 patients,the circle of Willis was complete in 8 cases,the CBFs of affected frontal,temporal and parietal lobe were(52.23±0.83),(45.59±0.67)and(49.59±0.43)mL/(100g·min);those of the healthy side were(52.59±0.64),(45.50±0.16)and(49.72±0.47)mL/(100g·min);there was no significant difference in the CBFs between the two sides(P>0.05).In the 13 patients with incomplete Wills circle,the CBFs of affected frontal,temporal and parietal lobe were(51.52±0.79),(44.21±2.54)and(48.45±0.65)mL/(100g·min);and the CBFs of the healthy side were(52.77±0.56),(45.48±0.19)and(49.63±0.48)mL/(100g·min);there was significant difference between the affected side and the healthy side(P<0.05).In the rest 21 patients with partially complete Willis circle,the CBFs of affected frontal,temporal and parietal lobe were(

关 键 词：颈内动脉病变 磁共振成像 WILLIS环 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] R534.4[医药卫生—诊断学]