3D pCASL灌注成像及Rapid分析对症状性颅内动脉动脉硬化性狭窄危险因素的评估  

Evaluation of risk factors for symptomatic intracranial arterial arteriosclerotic stenosis by 3D pCASL perfusion imaging and Rapid analysis

作　　者：颜立群[1] 颜瑾 侯亚平[3] 董倩波 穆晓丹[1] 刘荣丽 YAN Li-qun;YAN Jin;HOU Ya-ping;DONG Qian-bo;MU Xiao-dan;LIU Rong-li(Department of Radiology,East Branch of the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Clinical Medicine,Tianjin Medical University,Tianjin,300070,China;Department of Components,Hebei Province Blood Center,Shijiazhuang050000,China)

机构地区：[1]河北医科大学第二医院东院区影像科,河北石家庄050000 [2]天津医科大学临床医学系,天津300070 [3]河北省血液中心成分科,河北石家庄050000

出　　处：《河北医科大学学报》2022年第8期956-961,共6页Journal of Hebei Medical University

基　　金：河北省医学科学研究重点课题计划(20200919)。

摘　　要：目的采用两个标记后延迟时间(post labeling delay,PLD)的三维伪连续动脉自旋标记(three-dimensional pseudo-continuous arterial spin labeling,3D pCASL)成像和MR灌注成像Rapid软件评估有和无临床症状的2组单侧大脑中动脉M1段狭窄患者的脑血流灌注差异及患者出现临床症状的危险因素。方法101例单侧大脑中动脉M1段动脉硬化性狭窄患者,均行两个PLD(1.5 s和2.5 s)的3D pCASL及磁共振灌注成像(perfusion weighted imaging,PWI)的Rapid软件分析。建立二元Logistic回归模型,以有无症状作为二分类因变量,将局部动脉狭窄率、狭窄动脉下游的早期到达血流比率(early-arriving flowproportion,EAFP)、晚期到达逆向血流比率(late-arriving retrograde flow proportion,LARFP),低灌注指数比(hypoperfusion intensity ratio,HIR)和患者的年龄、性别、吸烟史、同型半胱氨酸、血压、血脂及血糖指标作为自变量纳入模型进行分析。结果症状组与无症状组暴露因素的单因素比较显示2组间LARFP和HIR有显著差异,在校正了EAFP、动脉管腔狭窄率和其他临床相关指标后的症状性狭窄患者危险因素的Logistic回归分析结果显示:代表着侧支血流的LARFP和HIR是症状性狭窄的独立危险因素。结论颅内动脉狭窄下游管腔内的侧支血流是患者临床症状的决定因素。Objective To assess differences in cerebral blood flow perfusion and risk factors for clinical symptoms in two groups of patients with M1 segment of unilateral middle cerebral artery(MCA)stenosis with and without clinical symptoms by using three-dimensional pseudo-continuous arterial spin labeling(3D pCASL)imaging with two post-labeling delay(PLD)and Rapid software analysis of magnetic resonance perfusion-weighted imaging(PWI).Methods A total of 101 patients with M1 segment of unilateral MCA stenosis who underwent 3D pCASL with two PLD and Rapid soft ware analysis of magnetic resonance perfusion imaging(PWI).Binary logistic regression model was established,the presence or absence of symptoms was used as a binary dependent variable,and the local arterial stenosis rate,early-arriving flow proportion(EAFP),late-arriving retrograde flow proportion(LARFP),hypoperfusion intensity ratio(HIR)of downstream of the stenotic artery,and the patient′s age,gender,smoking history,homocysteine,blood pressure,blood lipids and blood glucose parameters were included in the model for analysis as independent variables.Results Univariate comparison of exposure factors in the symptomatic and asymptomatic group showed significant differences in LARFP and HIR between two groups,and logistic regression analysis of risk factors in patients with symptomatic stenosis after adjusting for EAFP,arterial stenosis rate,and other parameters showed that LARFP and HIR,which represented collateral blood flow,were independent risk factors for symptomatic stenosis.Conclusion Collateral blood flow indownstream of intracranial arterial stenosis is the determinant of clinical symptoms.

关 键 词：大脑中动脉 灌注指数 侧支循环 

分 类 号：R445.2[医药卫生—影像医学与核医学]