基于DCE-MRI评估脑小血管病患者硬脑膜淋巴管功能的临床研究  

A Clinical Study of Evaluating the Meningeal Lymphatic Vessels Function by Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Patients with Cerebral Small Vessel Disease

作　　者：王旭彪 贺玉琴 冉禄森 田龙海 汪明欢[1] WANG Xubiao;HE Yuqin;RAN Lusen;TIAN Longhai;WANG Minghuan(Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Radiography,General Hospital of Central Theater Command,Wuhan 430070,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030 [2]武汉中部战区总医院放射诊断科,武汉430070

出　　处：《神经损伤与功能重建》2024年第3期125-129,156,共6页Neural Injury and Functional Reconstruction

基　　金：科技部重大研发计划(失眠-情绪失调共病的机制研究与诊疗策略优化,No.2021YC2502200)。

摘　　要：目的:基于多期相动态对比增强磁共振成像技术,探究不同临床特征和脑小血管病影像标志物的硬脑膜淋巴管功能差异。方法:招募2021年3月至2022年8月社区志愿者120例,评估脑小血管病影像学标志物后连续纳入符合标准的患者65例,根据影像学总负荷分为高负荷组和低负荷组。通过多期相(增强前期、增强期和增强末期)动态对比增强磁共振评估硬脑膜淋巴管流入功能和代谢功能,并利用单因素和多因素分析不同影像学标志物和临床特征与硬脑膜淋巴管功能的相关性。结果:高负荷组与低负荷组相比,硬脑膜淋巴管曲线下面积增大(2 830.54 v.s 2 450.87,P=0.032),达峰斜率增高(4.03 v.s 3.40,P=0.049),矫正混杂因素后仍有统计学差异(P=0.028,P=0.031)。存在深部白质高信号的患者硬脑膜淋巴管的流入(P=0.015)和代谢功能(P=0.020)受损而脑室旁白质高信号患者的流入(P=0.249)和代谢功能无明显变化(P=0.726)。认知功能和情绪状态不同的患者硬脑膜淋巴管功能无差异(P>0.05)。结论:脑小血管病影像标志物不同的患者硬脑膜淋巴管功能变化不同,且影像总负荷高的患者硬脑膜淋巴管的流入功能增强,提示硬脑膜淋巴管与脑小血管病的发病相关。Objective:To monitor the inflow and drainage function of meningeal lymphatic vessels(mLVs)in patients with cerebral small vessel disease(CSVD)on the basis of multiple phase dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and to explore the correlation between mLVs and imaging biomarkers as well as clinical features of CSVD.Methods:From March 2021 to August 2022,120 community volunteers were recruited.MRI data were collected to evaluate imaging biomarkers of CSVD.Sixty-five patients who met the criteria were continuously included and divided into a high total CSVD burden group and a low CSVD burden group according to the total MRI burden.Multiple phase DCE-MRI images(pre-enhancement,enhancement,and end-enhancement)were screened to assess the inflow and drainage functions of mLVs.Univariate and multivariate analyses were used to analyze the correlation between mLVs and imaging biomarkers as well as clinical features of CSVD.Results:The mLV area under the curve(2830.54 v.s 2450.87,P=0.032)and peak slope(4.03 v.s3.40,P=0.049)in the high total CSVD burden group were greater than those in the low CSVD burden group,and there was still a statistical difference after adjusting for confounding factors(P=0.028,P=0.031).Patients with deep white matter hyperintensities had impaired mLVs inflow(P=0.015)and drainage function(P=0.020),while the inflow(P=0.249)and drainage function(P=0.726)did not significantly change in patients with paraventricular white matter hyperintensities.There was no difference in the function of mLVs among patients with different cognitive and emotional states(P>0.05).Conclusion:Changes in the function of mLVs differ among patients with different imaging markers.In addition,patients with a high total CSVD burden have an increased inflow of mLVs,indicating the involvement of mLVs in the pathogenesis of CSVD.

关 键 词：脑小血管病 硬脑膜淋巴管 动态对比增强磁共振成像 影像标志物 

分 类 号：R741[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]