不同延迟时间动脉自旋标记与CT灌注成像在颈动脉内膜切除术前后的应用对比  

A comparative study between arterial spin labeling with different post labeling delay and CT perfusion in pre-and post-operative carotid endarterectomy

作　　者：徐慧敏[1] 刘颖[1] 霍然 王涛[2] 袁慧书[1] XU Huimin;LIU Ying;HUO Ran;WANG Tao;YUAN Huishu(Department of Radiology,Peking University Third Hospital,Beijing 100191,China;Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院放射科,北京100191 [2]北京大学第三医院神经外科,北京100191

出　　处：《实用放射学杂志》2023年第10期1694-1697,1716,共5页Journal of Practical Radiology

摘　　要：目的比较动脉自旋标记(ASL)与CT灌注成像(CTP)技术监测颈动脉内膜切除术(CEA)患者手术前后脑血流量(CBF)的一致性,并优化手术前、后ASL采用的标记后延迟时间(PLD)。方法24例因颈动脉狭窄行CEA的患者分别于术前2周、术后1周内行2组不同PLD的ASL[ASL_(1.5)(PLD=1.5 s)和ASL_(2.0)(PLD=2.0 s)]和CTP检查,获得CBF图像并测量CBF值。统计分析ASL_(1.5)、ASL_(2.0)与CTP测得的术前相对脑血流量(rCBF)、术后rCBF和术侧CBF变化率(DR_(CBF))之间的一致性。结果ASL和CTP对于测量术前、术后rCBF和DR_(CBF)具有强相关性(r=0.67~0.85,P<0.01)。以CTP为对照,ASL_(2.0)测得的术前rCBF比ASL1.5具有更小的偏倚(-0.02 vs-0.07),ASL_(2.0)和ASL_(1.5)测得的术后rCBF具有相同的偏倚(0.03)。对于测量DR_(CBF),手术前后PLD均为2.0 s(ASL_(2.0_2.0))和术前PLD为2.0 s、术后PLD为1.5 s(ASL_(2.0_1.5))的偏倚(0.31 vs 0.32)相似且均小于手术前后PLD均为1.5 s(ASL1.5_1.5)和术前PLD为1.5 s、术后PLD为2.0 s(ASL_(1.5_2.0))的偏倚(均为0.60)。结论ASL和CTP对于评估CEA手术前、后rCBF具有较好的一致性;然而ASL较CTP会显著高估CEA术后的DR_(CBF)。CEA术前ASL更为合适的PLD为2.0 s,而CEA术后可选择1.5 s或2.0 s。Objective To compare the consistency between arterial spin labeling(ASL)and computed tomography perfusion(CTP)in measuring the cerebral blood flow(CBF)of patients who underwent carotid endarterectomy(CEA),and to optimize the post labeling delay(PLD)of ASL for pre-and post-operative perfusion imaging.Methods A total of 24 patients who scheduled for CEA due to carotid stenosis were included in this study.ASL with two PLD(1.5 s and 2.0 s)and CTP were performed 2 weeks before and 1 week after CEA respectively to obtain the CBF maps and measure CBF values.The consistencies in measuring pre-and post-operative relative cerebral blood flow(rCBF)and difference ratio of CBF(DR_(CBF))on the operation side between ASL with PLD of 1.5 s(ASL_(1.5))or 2.0 s(ASL_(2.0))and CTP were also determined.Results There was strong correlation in measuring pre-and post-operative rCBF and DRCBF between ASL and CTP(r=0.67-0.85,P<0.01).Using CTP as the reference standard,smaller bias could be achieved in measuring rCBF by ASL_(2.0)(-0.02)than ASL_(1.5)(-0.07)before CEA.In addition,same bias(0.03)was obtained by ASL_(2.0) and ASL_(1.5) after CEA.The bias of ASL_(2.0_2.0)(0.31)and ASL_(2.0_1.5)(0.32)on DR_(CBF) measurement were similar and both were smaller than that of ASL_(1.5_1.5)(0.60)and ASL_(1.5_2.0)(0.60).Conclusion ASL and CTP have relatively good consistency in assessing pre-and post-operative rCBF;however,compared with CTP,ASL may significantly overestimate DRCBF.During perioperative ASL,the PLD of 2.0 s is better than 1.5 s for preoperative scan and both 1.5 s and 2.0 s are suitable for postoperative scan.

关 键 词：颈动脉狭窄 颈动脉内膜切除术 动脉自旋标记 计算机体层成像 灌注成像 脑血流量 

分 类 号：R543.5[医药卫生—心血管疾病] R445.2[医药卫生—内科学] R814.42[医药卫生—临床医学]