基于4D Flow MRI评估颈动脉狭窄及卒中相关血流动力学危险因素的研究  

Assessment of carotid artery stenosis and hemodynamic risk factors related to stroke based on 4D Flow MRI

作　　者：卢菲 孙梦瑶 马越[1] 江岳娈 孙洋[1] 佟丹[1] LU Fei;SUN Mengyao;MA Yue;JIANG Yueluan;SUN Yang;TONG Dan(Department of Radiology,the First Hospital of Jilin University,Changchun 130012,China;Department of Ultrasound,the First Hospital of Jilin University,Changchun 130012,China;Beijing Branch,Siemens Medical Systems Ltd.,Beijing 100102,China)

机构地区：[1]吉林大学第一医院放射线科,长春130012 [2]吉林大学第一医院超声科,长春130012 [3]西门子医疗系统有限公司北京分公司,北京100102

出　　处：《磁共振成像》2024年第2期14-22,47,共10页Chinese Journal of Magnetic Resonance Imaging

基　　金：吉林省医疗卫生人才专项(编号:JLSWSRCZX2021020)。

摘　　要：目的利用四维血流磁共振成像(4D flow magnetic resonance imaging,4D Flow MRI)在体分析单侧颈动脉中重度粥样硬化性狭窄血管血流动力学,探讨影响颈动脉粥样硬化性狭窄及其急性缺血性卒中的血流动力学相关危险因素。材料与方法收集2022年1月至12月经吉林大学第一医院收治的经超声诊断为单侧颈动脉中重度狭窄患者(研究组,n=20)和同期年龄及血管条件相匹配的正常志愿者(对照组,n=26),均行临床数据及磁共振数据采集,Flow影像数据经CVI 42软件获得血流量、血流速度、壁剪切力(wall shear stress,WSS)、最大压力梯度、能量损失(energy loss,EL)等血流动力学参数,通过t检验、Mann-Whitney秩和检验分析两组间血流动力学参数差异,并对急性期脑梗死及非急性期脑梗死进行亚组分析,探讨狭窄处血流动力学变化对卒中发生的影响。结果研究组的平均血流、最大血流、总容量及平均相对压差明显低于对照组(P<0.05),而最大能量损失、平均能量损失高于对照组(P<0.05);平均血流与狭窄程度呈负相关(r=-0.420,P<0.05);各狭窄血管狭窄上游、中心及下游的血流动力学在平均血流、平均速度、最小速度、最大血流、总容量、平均轴向WSS存在显著差异(P<0.05),且狭窄下游急性期脑梗死组最大压力梯度小于非急性期脑梗死组(P<0.05)。结论4D Flow MRI对颈动脉的可视化及量化分析发现能量损失有助于诊断颈动脉狭窄;低WSS及颈动脉狭窄下游最大压力梯度可能与急性缺血性卒中的发生有关。Objective:In this study,4D flow magnetic resonance imaging(4D Flow MRI)was employed to analyze the hemodynamics of moderate and severe atherosclerotic stenosis in unilateral carotid arteries and investigate the hemodynamic risk factors influencing carotid atherosclerotic stenosis and acute ischemic stroke.Materials and Methods:A total of 20 patients diagnosed with moderate to severe unilateral carotid atherosclerosis using ultrasonography were recruited from January to December at the First Hospital of Jilin University,along with age-and vascular condition-matched normal volunteers(n=26).Clinical data and magnetic resonance data were collected.Hemodynamic parameters such as blood flow,blood flow velocity,wall shear stress(WSS),maximum pressure gradient and energy loss were obtained by CVI 42 software.Compare the measured values between groups for statistical differences using t-tests or Mann Whitney U-tests and subgroup analysis was performed on acute cerebral infarction and non-acute cerebral infarction to explore the effect of hemodynamic changes at the stenosis on the occurrence of stroke.Results:The mean blood flow,maximum blood flow,total volume and mean relative pressure difference in the study group were significantly lower than those in the control group(P<0.05),while the maximum energy loss and average energy loss were higher than those in the control group(P<0.05).The mean blood flow was negatively correlated with the degree of stenosis(r=-0.420,P<0.05).There were significant differences in mean blood flow,mean velocity,minimum velocity,maximum blood flow,total volume,and verage axial wall shear stress in the upper,central and lower reaches of all stenosis vessels(P<0.05),and the maximum pressure gradient of downstream acute cerebral infarction group was lower than that of non-acute cerebral infarction group(P<0.05).Conclusions:Visualization and quantitative analysis of 4D Flow MRI shows that energy loss in addition to blood flow was helpful for realistic carotid artery stenosis.Low WSS and downstream m

关 键 词：颈动脉狭窄 缺血性卒中 危险因素 四维血流动力学 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]