HR-MRI、3D-ASL综合评价ACI患者MCA重构、斑块特征及脑灌注水平的变化及其意义  

HR-MRI and 3D-ASL comprehensively evaluate the changes of MCA remodeling,plaque characteristics and cerebral perfusion level in ACI patients and their significance

作　　者：陈玉昆 滕佳岐 王娟[1] 秦丹 李优伟 谢明 CHEN Yu-kun;TENG Jia-qi;WANG Juan(Department of Radiology,Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院放射科,北京100144 [2]空军军医大学第二附属医院唐都医院神经内科,陕西西安713800

出　　处：《临床和实验医学杂志》2022年第17期1887-1890,共4页Journal of Clinical and Experimental Medicine

基　　金：北京市科技支撑重点项目(编号:Z101107052210002)。

摘　　要：目的探讨高分辨率磁共振(HR-MRI)、磁共振三维动脉自旋标记(3D-ASL)在评价急性脑梗死(ACI)患者大脑中动脉(MCA)重构、斑块特征及脑灌注水平变化中的价值。方法采取回顾性研究,选取2019年2月至2021年8月首都医科大学附属北京康复医院收治因头晕、言语不清、意识不清入院的患者209例进行研究,所有患者均接受HR-MRI检查、3D-ASL检查,根据诊断结果范围分为ACI 94例(ACI组)、非脑梗死患者115例(对照组)。对比两组患者的MCA血管壁及斑块特征;按照动脉重构特征将ACI组进行分层,正性重构患者53例、非正性重构患者41例,比较不同血管重构的ACI组患者MCA血管壁及斑块量化指标;分析ACI组患者MCA血管壁及斑块量化指标与NIHSS评分的相关性;采用3D-ASL观察患者脑灌注水平变化,对比ACI组治疗前后与对照组患者脑灌注水平。结果ACI组患者的LA MNL测定值(2.45±0.87)mm^(2),小于对照组[(3.29±0.92)mm^(2)],WA MNL、PA、RI值分别为(13.54±2.77)mm^(2)、(4.50±0.84)mm^(2)、(1.06±0.12),均大于对照组[(11.82±2.80)mm^(2)、(2.26±0.59)mm^(2)、(0.96±0.09)],差异均有统计学意义(P<0.05)。正性重构患者的PA值(4.93±0.81)mm^(2),大于非正性重构组患者[(3.93±0.66)mm^(2)],差异有统计学意义(P<0.05)。ACI患者的NIHSS评分与LA MNL呈显著负相关(P<0.05),NIHSS评分与PA、RI值呈显著正相关(P<0.05)。ACI组患者的患侧CBF值、CBF相对值均低于对照组,差异均有统计学意义(P<0.05);ACI组患者治疗后的患侧CBF值、CBF相对值均高于治疗前,差异均有统计学意义(P<0.05)。结论对于ACI患者,采用HR-MRI、3D-ASL检测方法可有效观察患者脑血管重构、斑块负荷、脑灌注水平情况,并且与患者神经功能缺损程度有关,同时对于评价患者治疗前后脑灌注水平变化有一定的临床价值。Objective To investigate the effects of high-resolution magnetic resonance(HR-MRI)and magnetic resonance three-dimensional arterial spin labeling(3D-ASL)in evaluating middle cerebral artery(MCA)remodeling,plaque characteristics and changes in cerebral perfusion in patients with acute cerebral infarction(ACI).Methods A total of 209 patients admitted to Beijing Rehabilitation Hospital,Capital Medical University from February 2019 to August 2021 due to dizziness,slurred speech and unconsciousness were selected for the study.All patients underwent HR-MRI examination and 3D-ASL examination.According to the diagnosis results The range is divided into 94 cases of ACI(ACI group)and 115 cases of non-cerebral infarction patients(control group),the MCA vessel wall and plaque characteristics of the two groups of patients were compared;and the ACI groups were stratified according to the characteristics of arterial remodeling,with 53 patients with positive remodeling and 41 patients with non-positive remodeling;the correlation between quantitative indexes of MCA vessel wall and plaque and NIHSS score in ACI group was analyzed;the changes of cerebral perfusion levels of patients were observed using 3D-ASL,and the cerebral perfusion levels of patients in the ACI group before and after treatment,and the control group were compared.Results The measured value of LA MNL in the ACI group was(2.45±0.87)mm^(2),which was smaller than that in the control group[(3.29±0.92)mm^(2)],the values of WA MNL,PA and RI in the ACI group were(13.54±2.77)mm^(2),(4.50±0.84)mm^(2),(1.06±0.12),respectively,which was higher than those in the control group[(11.82±2.80)mm^(2),(2.26±0.59)mm^(2),(0.96±0.09)],the differences were statistically significant(P<0.05).Among 94 patients with ACI,there were 53 patients with positive remodeling and 41 patients with non positive remodeling.The PA value of patients with positive remodeling was(4.93±0.81)mm^(2),which was greater than that of patients in non positive remodeling group[(3.93±0.66)mm^(2)],the diff

关 键 词：高分辨率磁共振 磁共振三维动脉自旋标记 急性脑梗死 动脉重构 斑块特征 脑灌注 

分 类 号：R743.3[医药卫生—神经病学与精神病学]