3D-pCASL及磁共振扩散峰度成像联合应用对皮质下动脉硬化性脑病的诊断价值研究  

Combination of 3D-pCASL and diffusion kurtosis imaging in the diagnosis of subcortical arteriosclerotic encephalopathy

作　　者：何晓一 史浩[1] 王均英 HE Xiaoyi;SHI Hao;WANG Junying(Department of Radiology,the First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging,Shandong Lung Cancer Institute,Shandong Institute of Neuroimmunology,Jinan 250014,China;Shandong First Medical University,Jinan 250062,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)放射科山东省医药卫生腹部医学影像学重点实验室山东省肺癌研究所山东省神经免疫研究所,济南250014 [2]山东第一医科大学,济南250062

出　　处：《磁共振成像》2021年第5期60-64,89,共6页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨扩散峰度成像(diffusion kurtosis imaging,DKI)及三维伪连续式动脉自旋标记(3D pseudo continuous arterial labeling,3D-pCASL)技术在皮质下动脉硬化性脑病(subcortical arteriosclerotic encephalopathy,SAE)中的诊断价值。材料与方法对临床已确诊的35例SAE患者和33例对照组进行常规MRI、3D-pCASL及DKI扫描,测量SAE组表现阳性病灶区(额、顶叶及双侧脑室额、枕角旁白质)、SAE组表现正常白质区(邻近病灶区的正常脑白质及胼胝体膝/压部、颞叶白质)及对照组相应脑区3组各向异性分数(fractional anisotropy,FA)值、平均扩散系数(mean diffusivity,MD)值、轴/径向扩散系数(axial/radial diffusivity,Da/Dr)值、峰度各向异性分数(anisotropy fraction of kurtosis,FAk)值、平均峰度系数(mean kurtosis,MK)值、和轴/径向峰度系数(axial/radial kurtosis,Ka/Kr)值,测量SAE组中病灶区、胼胝体膝/压部、颞叶白质区及对照组相对应区域的脑血流量(cerebral blood flow,CBF)值,进行统计学分析,研究两技术参数值与患者的简易精神量表(Mini-mental State Examination,MMSE)评分之间的相关性,并利用受试者工作特征分析两种技术在SAE中的诊断价值。结果SAE组所有白质病灶区、颞叶白质和胼胝体压部的CBF、FA和峰度参数值显著降低、扩散参数值显著增高,与对照组相应区域差异均有统计学意义(P<0.05);SAE组胼胝体膝部的FA、FAk、Kr和CBF值显著降低,扩散参数值显著增高(P<0.05)。SAE患者的顶、颞叶白质的CBF值和双侧脑室额角旁白质的FA、Kr值与MMSE评分呈正相关(r=0.496/0.392,P=0.003/0.020;r=0.488/0.437,P=0.003/0.009)。曲线下面积较大的为:胼胝体膝部的FA(0.957,P<0.001),胼胝体压部的CBF(0.946,P<0.001),联合颞叶白质的FA/MD/Dr/CBF(0.986,P<0.001)。结论DKI和3D-pCASL技术可敏感检测SAE患者在常规MRI检查正常的脑微结构的潜在性变化,间接反映患者的DKI/ASL参数与认知障碍之间的关系,并能有效�Objective:To explore the diagnostic value of diffusion kurtosis imaging(DKI)and 3D pseudo continuous arterial spin labeling(3D-pCASL)technologies in subcortical arteriosclerotic encephalopathy(SAE).Materials and Methods:Regular MRI,3D-pCASL and DKI scans were performed on 35 clinically diagnosed SAE patients and 33 control groups.The fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(Da),radial diffusivity(Dr),anisotropy fraction of kurtosis(FAk),mean kurtosis(MK),axial kurtosis(Ka)and radial kurtosis(Kr)were measured in three groups including the lesion areas of white matter(WM)in SAE group(frontal and occipital WM around the horns of bilateral ventricle),normal WM area of SAE group(normal WM adjacent to the lesion area,the genu/splenium of the corpus callosum,and temporal WM)and the control group.The CBF value was measured in SAE group(lesion areas,genu/splenium of the corpus callosum,and temporal WM)and the control group.These data acquired were statistically analyzed and the correlations between DKI/ASL derived parameters value and Mini-mental State Examination(MMSE)score of SAE patients were studied.The receiver operating characteristic(ROC)was used to analysis the diagnostic value in SAE by these two technologies.Results:Compared with the control group,the SAE group had a significant decline in the values of CBF,FA and kurtosis parameters in all WM lesion areas,and the values of diffusion parameters increased considerably(P<0.05).The significant changes,similar to WM lesions of SAE,were shown in some values of DKI parameters of the normal control group.Additionally,for SAE patients,MMSE showed positive correlation with CBF in parietal/temporal WM(r=0.496/0.392,P=0.003/0.020),and positively correlated with FA and Kr values of frontal WM around the horns of bilateral ventricle(r=0.488/0.437,P=0.003/0.009).Finally,FA in GCC,CBF in SCC,and the combined FA/MD/Dr/CBF in temporal WM showed high accuracy(AUCs 0.957/0.946/0.986)in distinguishing SAE patients from controls.Conclusions:For SAE patients,t

关 键 词：脑结构 皮质下动脉硬化性脑病 Binswanger’s病 扩散峰度成像 伪连续动脉自旋标记 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.1[医药卫生—诊断学]