动脉自旋标记脑灌注减低与双侧烟雾血管病变脑血管事件发生的相关性分析  

Correlation analysis between decreased cerebral perfusion measured from arterial spin labeling and cerebrovascular events in patients with bilateral moyamoya angiography

作　　者：王茂雪[1] 杨咏波[2] 王毅[2] 周飞[1] 李茗[1] 张冰[1] Wang Maoxue;Yang Yongbo;Wang Yi;Zhou Fei;Li Ming;Zhang Bing(Department of Radiology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,210008,China;Department of Neurosurgery,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院医学影像科,南京210008 [2]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《中华医学杂志》2021年第23期1778-1783,共6页National Medical Journal of China

基　　金：国家自然科学基金(81720108022,81971596,81701672);江苏省社会发展科技项目(BE2017707)。

摘　　要：目的探讨动脉自旋标记(ASL)脑灌注减低与双侧烟雾血管病变患者脑血管事件发生的相关性。方法回顾性收集2020年4至11月在南京鼓楼医院神经外科住院的27例双侧烟雾血管病变患者资料,均为单侧大脑半球脑梗死或脑出血,其中男10例,女17例,年龄35~66(55±9)岁。采用Wilcoxon配对符号秩检验定性分析患者双侧大脑半球动脉通过伪影(ATA)的差异,定量计算双侧大脑半球在标记后延迟时间(PLD)为1.5及2.5 s的脑血流量(CBF)图原始灰度均值、其分布曲线的峰度及偏度。用二元logistic回归分析ASL与病灶发生之间的关系。结果患者双侧大脑半球ATA在不同PLD时的差异均无统计学意义(P>0.05)。在PLD为1.5 s的CBF图像上,病灶侧大脑半球原始灰度均值(17.50±5.88)低于非病灶侧(20.80±5.51)(P<0.001)。峰度及偏度在双侧大脑半球差异有统计学意义(P<0.05)。在PLD为2.5 s的CBF图像上,病灶侧大脑半球原始灰度均值及灰度分布的偏度与非病灶侧差异有统计学意义(P<0.05),而峰度差异无统计学意义(P>0.05)。多因素回归分析发现病灶侧灰度值的减低与病灶的发生独立相关(ORPLD1.5=0.192,95%CI:0.047~0.783;ORPLD2.5=0.175,95%CI:0.050~0.615)。结论ASL检测到的灌注减低与烟雾血管病变患者发生脑血管事件具有独立相关性。Objective To explore the correlation between decreased cerebral perfusion measured from arterial spin labeling and cerebrovascular events in patients with bilateral moyamoya angiography(MMA).Methods Twenty-seven consecutive cases with bilateral MMA,who were admitted to the neurosurgery department of Nanjing Drum Tower Hospital from April to November 2020,were included in this retrospective study.Among them,10 were males and 17 were females,aged 35-66(55±9)years.These patients all presented with unilateral cerebral hemisphere cerebral infarction or cerebral hemorrhage.The Wilcoxon paired signed-rank test was used to qualitatively analyze the differences in the Arterial Transit Artifact(ATA)of the bilateral cerebral hemispheres.The mean gray value,the kurtosis and skewness of gray distribution curve of bilateral cerebral hemispheres on cerebral blood flow(CBF)images with post labeling delay(PLD)of 1.5 s and 2.5 s were quantitative calculated.The relationship between ASL and cerebrovascular event was determined using binary logistics regression analysis.Results No significant difference was observed in ATA between bilateral hemispheres on CBF images with PLDs of 1.5 s and 2.5 s(P>0.05).On the CBF images with a PLD of 1.5 s,the mean gray value of the cerebral hemisphere on the lesion side(17.50±5.88)was markly lower than that on the non-lesion side(20.80±5.51)(P<0.001),the kurtosis and skewness of gray distribution were significantly different between bilateral cerebral hemispheres(P<0.05);On the CBF images with a PLD of 2.5 s,the mean gray value and the skewness of the gray distribution on the lesion side of the cerebral hemisphere were statistically different from those on the non-lesion side(P<0.05),while the difference in kurtosis was not statistically significant between bilateral cerebral hemispheres(P>0.05).Multivariate regression analysis showed that the reduction of gray value on the side of the lesion was independently associated to the occurrence of the cerebrovascular events(ORPLD1.5=0.192,95%CI:0.047-

关 键 词：自旋标记物 动脉 烟雾血管病变 动脉通过伪影 

分 类 号：R743[医药卫生—神经病学与精神病学]