不同延迟时间三维动脉自旋标记成像评估脑梗死患者侧支循环代偿的初步研究  

Evaluation of collateral circulation compensation in patients with cerebral infarction by three-dimensional arterial spin marker imaging with different delay time

作　　者：黄文明 夏盛伟 陶永君 周荣 陈克龙 支海鸯 Huang Wenming;Xia Shengwei;Tao Yongjun;Zhou Rong;Chen Kelong;Zhi Haiyang(Department of Radiology,Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Wenzhou,Zhejiang 325000,China;Department of Neurology,Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Wenzhou,Zhejiang 325000,China)

机构地区：[1]浙江中医药大学附属温州中医院放射科,325000 [2]浙江中医药大学附属温州中医院神经内科,325000

出　　处：《中国基层医药》2020年第11期1321-1325,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市公益性社会发展(医疗卫生)科技项目(Y20170221)。

摘　　要：目的探讨不同延迟时间的三维动脉自旋标记成像(3D-ASL)评估脑梗死患者侧支循环代偿状态的临床价值。方法采用1.5 T高场核磁共振(MR)扫描仪对2017年9月至2019年1月在浙江中医药大学附属温州中医院治疗的脑梗死患者24例进行多序列头颅MR检查。比较患者在标记延迟时间(PLD)=1.5 s与PLD=2.5 s时梗死区与对侧正常区的脑血流量(CBF)值的变化,根据患者3D-ASL(PLD=1.5 s与2.5 s)测量的病灶面积差将患者分为侧支循环代偿较强组与侧支循环代偿较弱组。比较患者入院时、入院15 d后的美国国立卫生研究院卒中量表(NIHSS)评分及Bathel指数的变化。结果PLD=1.5 s时3D-ASL测量结果显示,患者梗死区的CBF值为(33.70±20.83)mL/(100 g×min),明显低于对侧正常区(PLD=1.5 s)CBF值的(49.93±13.13)mL/(100 g×min)(t=3.229,P<0.05)。PLD=2.5 s时3D-ASL测量结果显示,患者梗死区的CBF值明显提高[(58.26±23.50)mL/(100 g×min)比(33.70±20.83)mL/(100 g×min)](t=3.831,P<0.05),对侧正常区的CBF值也显著提高[(68.29±14.03)mL/(100 g×min)比(49.93±13.13)mL/(100 g×min)](t=4.681,P<0.05),此时患者的梗死区CBF值仍明显低于对侧正常区[(58.26±23.50)mL/(100 g×min)比(68.29±14.03)mL/(100 g×min)](t=1.795,P<0.05)。侧支循环代偿较弱组(12例)患者在入院当天,Bathel指数明显高于侧支循环代偿较强组(12例)[(90.42±10.50)比(67.92±27.57)](t=2.642,P<0.05),NIHSS评分明显低于侧支循环代偿较强组[(1.25±1.01)分比(3.83±3.62)分](t=2.378,P<0.05);入院15 d后,两组患者BI指数、NIHSS评分差异均无统计学意义(均P>0.05)。结论不同延迟时间的3D-ASL可以有效、直观的反映脑梗死患者的侧支循环代偿情况,对患者病情的评估与临床治疗方案的拟定均有十分重要的参考价值。Objective To investigate the clinical value of three-dimensional arterial spin marker imaging(3D-ASL)for evaluating collateral circulation compensatory status in patients with cerebral infarction.Methods A total of 24 patients with cerebral infarction who were treated at Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine from September 2017 to January 2019 were examined by 1.5-T high-field MR scanner.The changes of cerebral blood flow(CBF)between the infarcted area and the contralateral normal area were compared when the labeled delay time(PLD)=1.5s and PLD=2.5s,and the patients were divided into the group with strong collateral circulation compensation and the group with weak collateral circulation compensation according to the difference in lesion area measured by 3D-ASL(PLD=1.5s and 2.5s).The changes of national institutes of health stroke scale(NIHSS)score and Bathel index at admission and 15 days after admission were compared.Results 3D-ASL measurement of PLD=1.5s showed that the CBF value in the infarcted area was(33.70±20.83)mL/(100g×min),which was significantly lower than that in the contralateral normal area(PLD=1.5s)[(49.93±13.13)mL/(100g×min)](t=3.229,P<0.05).When PLD=2.5s,ASL measurement results showed that the CBF value in the infarcted area increased significantly[(58.26±23.50)mL/(100g×min)vs.(33.70±20.83)mL/(100g×min)](t=3.831,P<0.05),and the CBF value in the contralateral normal area also increased significantly[(68.29±14.03)mL/(100g×min)vs.(49.93±13.13)mL/(100g×min)](t=4.681,P<0.05).At this time,the CBF value in the infarcted area was still significantly lower than that in the contralateral normal area[(58.26±23.50)mL/(100g×min)vs.(68.29±14.03)mL/(100g×min)](t=1.795,P<0.05).On the day of admission,the BI index of patients in the weak collateral circulation compensation group(12 cases)was significantly higher than that in the strong collateral circulation compensation group(12 cases)[(90.42±10.50)vs.(67.92±27.57)](t=2.642,P<0.05

关 键 词：磁共振成像 成像 三维 自旋标记物 时间因素 梗塞 大脑中动脉 侧支循环 脑血管循环 对比研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]