动脉自旋标记磁共振评估轻度脑外伤患者的脑血流变化  

Arterial spin labeling magnetic resonance evaluates changes of cerebral blood flow in patients with mild traumatic brain injury

作　　者：熊峰 李天惠 潘怡臻 刘玉玲 张杰 白丽君[1] XIONG Feng;LI Tianhui;PAN Yizhen;LIU Yuling;ZHANG Jie;BAI Lijun(Department of Biomedical Engineering,School of Life Science and Technology,Xi’an Jiaotong University,Key Laboratory of Biomedical Information Engineering Ministry of Education,Xi’an 710049;Department of Radiation Medicine,Military Preventive Medicine School,Air Force Medical University,Xi’an 710032,China)

机构地区：[1]西安交通大学生命科学与技术学院生物医学工程系,生物医学信息工程教育部重点实验室,西安710049 [2]空军军医大学军事预防医学系辐射防护医学教研室,西安710032

出　　处：《中南大学学报（医学版）》2022年第8期1016-1024,共9页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(82071993,81771914);陕西省杰出青年基金(2022JC-55);空军军医大学“凌云工程”翱翔计划-AXJHZJ。

摘　　要：目的:轻度脑外伤患者占脑外伤患者的80%以上。多数轻度脑外伤患者在CT检查上未见异常,因此绝大部分患者选择自我调养、恢复而非就医。事实上,轻度脑外伤发生后可能会导致持续性的认知功能下降和神经行为功能障碍,神经化学、代谢和细胞的改变可能会引发脑血流的改变,而脑血流的改变被认为是继发性损伤和脑修复缓慢的原因之一。本研究旨在利用动脉自旋标记(arterial spin labeling,ASL)磁共振成像技术评估轻度脑外伤患者脑血流值随病程进展的变化情况。方法:采集在温州医科大学附属第二医院门诊或急诊就医的43例轻度脑外伤患者的临床信息,同时纳入年龄、性别和受教育程度匹配的43例健康受试者作为对照组,所有受试者均接受脑部磁共振成像扫描,并进行临床神经心理学评估和认知功能评估。对其中22名轻度脑外伤受试者在急性期、第1个月、第3个月和第12个月进行随访。以对照组为基准,分析轻度脑外伤患者的异常脑血流区域,并以异常区域作为后续的感兴趣区(region of interest,ROI)。分析各ROI中的脑血流值与临床指征、认知功能的相关性以及轻度脑外伤患者在后续随访的各时间点ROI中脑血流值的变化。结果:与对照组比较,轻度脑外伤组急性期在皮质区域的双侧背外侧额上回和双侧辅助运动区以及在皮下核团的右侧壳核、尾状核、苍白球、旁海马区域的脑血流值显著升高(均P<0.01,TFCE-FWE校正)。脑血流值与神经心理学评分以及各认知域认知量表评分的相关性分析结果显示:轻度脑外伤组全脑(r=0.528,P<0.001)、右侧尾状核(r=0.512,P<0.001)、壳核(r=0.486,P<0.001)和苍白球(r=0.426,P=0.006)脑血流值与评估工作记忆能力的倒背数字广度测验(Backward Digit Span Task,BDST)评分呈正相关,而右侧苍白球脑血流值与创伤后应激障碍评分(Post-Traumatic Stress Disorder Cheeklist-CivilianObjective:The patients with mild traumatic brain injury(mTBI)accounts for more than80%of the patients with brain injury.Most patients with mTBI have no abnormalities in CT examination.Therefore,most patients choose to self-care and recover rather than seeking medical treatment.In fact,mTBI may result in persistent cognitive decline and neurobehavioral dysfunction.In addition,changes occurred in neurochemistry,metabolism,and cells after injury may cause changes in cerebral blood flow(CBF),which is one of the causes of secondary injury and slow brain repair.This study aims to evaluate the changes of CBF with the progression of the disease in patients with mTBI based on arterial spin labeling(ASL)magnetic resonance imaging technology.Methods:In the outpatient or emergency department of the Second Affiliated Hospital of Wenzhou Medical University,43 mTBI patients were collected as an mTBI group,and 43normal subjects with age,gender,and education level matching served as a control group.They all received clinical neuropsychology and cognitive function evaluation and magnetic resonance imaging.In the mTBI group,22 subjects were followed up at acute phase,1month,3 months,and 12 months.Based on the control group,the abnormal regions of CBF in the whole brain of m TBI patients were analyzed.The abnormal regions were taken as the regions of interest(ROI).The correlation of the values of the CBF in ROIs with clinical indications,cognitive function,and the changes of CBF in ROI at each time point during the follow-up were analyzed.Results:Compared with the control group,the CBF in the bilateral dorsolateral superior frontal gyrus and auxiliary motor areas in the cortical region,as well as the right putamen,caudate nucleus,globus pallidus,and parahippocampus in the subcutaneous regions in the acute phase of the mTBI group were significantly increased(all P<0.01,TFCE-FWE correction).The analysis results of correlation of CBF with neuropsychology and cognitive domain showed that in the mTBI group,whole brain(r=0.528,P<0.001),ri

关 键 词：轻度脑外伤 动脉自旋标记 脑血流 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R651.15[医药卫生—诊断学]