下肢动脉硬化闭塞症患者血管成形术后ASL及IVIM灌注与侧支循环的比较分析  

Evaluation of Calf Microcirculation in Patients with Peripheral Artery Disease by ASL and IVIM Magnetic Resonance Imaging

作　　者：唐辉[1] 所世腾[1] 俞璐[1] 胡颖 王嵇[1] 周滟[1] 路青 TANG Hui;SUO Shiteng;YU Lu;HU Ying;WANG Ji;ZHOU Yan;LU Qing(Department of Radiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine;Department of Radiology,Shanghai East Hospital,Tongji University)

机构地区：[1]上海交通大学医学院附属仁济医院放射科 [2]上海同济大学附属东方医院放射科

出　　处：《中国医学计算机成像杂志》2023年第3期295-299,共5页Chinese Computed Medical Imaging

基　　金：2019年上海市“医苑新星”青年医学人才培养资助计划(SHWRS(2020)_087);上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划(SHDC2020CR2008A)。

摘　　要：目的:利用磁共振动脉自旋标记(ASL)及体素内不相干运动(IVIM)成像技术评估下肢动脉硬化闭塞症(ASO)患者经腔内血管成形术(PTA)后小腿动脉侧支循环影响肌肉灌注情况。方法:收集我院28例确诊ASO患者,对其分别在PTA术前及术后进行小腿磁共振ASL、IVIM成像,以小腿肌肉最粗处为扫描中心。所得图像在GE ADW4.4工作站上进行处理。利用手动勾画感兴趣区(ROI),测得胫骨前肌、腓骨长肌、比目鱼肌及腓肠肌的BF值、f值、D值及D*值。在数字减影血管造影(DSA)影像上,参照磁共振扫描的定位中心,对患者术前及术后的侧支进行统计。将患者磁共振所测值与DSA显示侧支情况进行比较研究。结果:PTA术后胫骨前肌的ASL⁃BF变化量与该肌肉的侧支数量变化存在显著正相关(ρ=0.42,P=0.03),而其他参数在其他肌肉的变化量均未显示出与侧支数量变化的相关性(P>0.05)。胫骨前肌的ASL⁃BF变化量在侧支数量“增多、不变、减少”3个等级分别为(1.2±3.7)、(0.6±3.8)、-(4.2±3.8)mL·(100 g)^(-1)·min^(-1)(P=0.02),两两比较结果显示,胫骨前肌的ASL⁃BF变化量在侧支“减少”和“不变”以及“减少”和“增多”间均存在显著性差异(P=0.03、0.003)。结论:ASO患者PTA术后胫骨前肌ASL灌注变化显示出与小腿前侧肌群侧支数量变化的一致性。Purpose:To evaluate the effect of collateral circulation of calf artery on muscle perfusion in patients with atherosclerosis obliterans(ASO)after percutaneous transluminal angioplasty(PTA)by arterial spin labeling(ASL)and intravoxel incoherent motion(IVIM)magnetic resonance imaging.Methods:Twenty-eight patients with ASO in our hospital were enrolled.ASL and IVIM magnetic resonance imaging of the calf was performed before and after PTA.Image processing was processed on the GE adw4.4 workstation.The BF,f,D and D*values of tibialis anterior muscle,peroneus longus muscle,soleus muscle and gastrocnemius muscle were measured by manually placing regions of interest on these muscles.Using digital subtraction angiography(DSA)images and referring to the positioning center of magnetic resonance scanning,the collateral branches of ASO patients were counted before and after PTA.Quantitative MRI measurements were compared with collateral conditions on DSA.Results:There was a significant positive correlation between the ASL-BF change of the tibial anterior muscle and the number of collateral branches of the muscle after PTA(ρ=0.42,P=0.03),while the changes of other parameters in other muscles did not show significant correlation with the number of collateral branches(P>0.05).The ASL-BF changes of the tibialis anterior muscle were(1.2±3.7),(0.6±3.8),−(4.2±3.8)mL·(100 g)^(-1)·min^(-1)(P=0.02)in the collateral branch increased,unchanged,and decreased groups,respectively.The results of pairwise comparison showed that the ASLBF changes of the tibialis anterior muscle were significantly different between the collateral branch decreased and unchanged groups(P=0.03),and between the collateral branch decreased and increased groups(P=0.003).The changes of ASL perfusion of tibialis anterior muscle after PTA in ASO patients were consistent with the changes of the number of collateral branches of the anterior calf muscle group.Conclusion:ASL can be used to better evaluate the changes of blood perfusion of each muscle in ASO patients

关 键 词：磁共振成像 肌肉灌注 动脉自旋标记 体素内不相干运动 微循环 侧支循环 

分 类 号：R445.2[医药卫生—影像医学与核医学]