DSA联合3D ASL对优势侧椎动脉狭窄支架置入前后小脑半球血流动力学改变的评估  

Combined DSA and 3D ASL in evaluation of hemodynamic changes in the cerebellar hemisphere before and after stent implantation for dominant vertebral artery stenosis

作　　者：程晓悦[1] 乔鹏岗 姜彬[1] 张婷婷[1] 贺文[1] CHENG Xiaoyue;QIAO Penggang;JIANG Bin;ZHANG Tingting;HE Wen(Department of Radiology,Beijing Friendship Hospital Affiliated of Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《中国中西医结合影像学杂志》2024年第5期497-501,514,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：北京市自然科学基金面上项目(7242043)。

摘　　要：目的:探讨DSA联合3D动脉自旋标记技术(ASL)在椎动脉狭窄支架置入前后小脑半球血流动力学评估中的应用价值。方法:回顾性分析21例因优势侧椎动脉颅外段管腔狭窄行支架置入术患者的临床、DSA及ASL资料,评估不同标记后延迟时间(PLD)、椎动脉优势侧与非优势侧、支架置入术前后小脑半球不同供血区脑灌注的变化。结果:21例术前DSA显示优势侧椎动脉重度狭窄,支架置入部位均为优势侧椎动脉颅外段,术后狭窄均解除。PLD为2.5 s时,术前、术后,优势侧及非优势侧,小脑各供血区脑血流量(CBF)值均较PLD为1.5 s时高,差异均有统计学意义(均P<0.05)。术后在椎动脉优势侧,小脑上动脉供血区、小脑前下动脉供血区、小脑后下动脉供血区的CBF值均高于术前(包括PLD=1.5、2.5 s);椎动脉非优势侧,小脑上动脉供血区的CBF值高于术前(包括PLD=1.5、2.5 s)。结论:DSA联合ASL能定量评估小脑半球的血流动力学改变,优势侧椎动脉狭窄支架置入术能提高椎动脉优势侧小脑半球各区的脑血流灌注水平及椎动脉非优势侧的小脑半球小脑上动脉供血区的脑血流灌注水平。Objective:To assess the application value of the combined DSA and 3D arterial spin labeling(ASL)in evaluating cerebellar hemisphere hemodynamics before and after stent implantation for vertebral artery stenosis.Methods:A retrospective analysis was performed on the clinical,DSA and ASL data of 21 patients who underwent stent placement surgery for extracranial superior vertebral artery stenosis.Changes in cerebral perfusion of different blood supply areas in cerebellar hemisphere were assessed with various post-labeling delay(PLD),along both dominant and non-dominant the vertebral arteries,before and after stent implantation.Results:In 21 cases,preoperative DSA revealed severe stenosis of the dominant vertebral artery.Stent placement targeted the extracranial segment of the dominant vertebral artery,resulting in alleviation of arterial stenosis post-surgery for all patients.Compared to PLD=1.5 s,the cerebral blood flow(CBF)values at PLD=2.5 s were significantly higher before and after operation,from the dominant and non-dominant arteries,in different blood supply areas(all P<0.05).On the dominant vertebral arteries,the postoperative CBF values in the supplying areas of the superior cerebellar artery,the anterior inferior cerebellar artery and the posterior inferior cerebellar artery were all higher than the preoperative CBF values at both PLD=1.5 and 2.5 s(all P<0.05).On the non-dominant vertebral arteries,the postoperative CBF values in the superior cerebellar artery blood supply area were higher than the preoperative CBF values at both PLD=1.5 and 2.5 s(all P<0.05).Conclusions:The combination of DSA and ASL enables quantitative assessment of cerebellar hemispheric perfusion dynamics.Stent placement surgery improves cerebral perfusion in various regions of the cerebellar hemisphere on the dominant vertebral artery,as well as enhancing perfusion in the superior cerebellar artery blood supply area on the non-dominant vertebral artery.

关 键 词：椎动脉狭窄 支架 血管造影术 数字减影 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]