灌注磁共振技术评价颈动脉系统狭窄或闭塞的外科治疗

Surgical treatment of carotid system stenosis or occlusion - Evaluation by perfusion-weighted MRI.

目的 探讨运用灌注磁共振技术评价颈动脉系统狭窄或闭塞的3种外科治疗方法的疗效和预后。 方法 2003年3月至2004年5月,对32例颈动脉系统狭窄或闭塞的患者进行外科治疗,其中颈内动脉内膜切除2例,颞浅动脉-大脑中动脉血管吻合术13例,以及支架血管成形术17例。运用灌注磁共振技术对颈动脉系统狭窄或闭塞的外科治疗进行比较评价。结果 所有患者术前局部脑血流量没有显著性降低,但存在灌注明显延迟。术后与术前对比显示,所有患者灌注延迟的区域明显减少,其中分水岭区恢复正常,但大脑中动脉分布区仍存在灌注延迟。结论通过灌注磁共振技术,可以客观、准确地评价3种外科治疗方法前、后单侧前循环供血动脉狭窄患者的血流动力学状况。

Objective To evaluate surgical effect of stenosis or occlusion of carotid system by perfu-sion-weighted MRI technique. Methods From April 2003 to May 2004 , 32 patients with stenosis or occlusion of carotid system underwent endarterectomy ( n =2), Extracranial-intracranial arterial bypass ( n = 13), and percutaneous stent angioplasty ( n = 17) respectively. Results Preoperative perfusion-weighted MRI revealed normal regional cerebral blood flow in all patients, with delayed time to peak in both middle cerebral artery distribution and border zone. Postoperative perfusion-weighted MRI revealed normal time to peak in border zone, but abnormal in middle cerebral artery distribution. Evaluated by perfusion-weighted MRI, surgical treatment was proved to be a good method to improve hemodynamic disorder of this kind of disease. The early curative effect of endarterectomy and percutaneous stent angioplasty was proved to be better than extracranial-intracranial arterial bypass. Conclusion Perfusion-weighted MRI is a good method to evaluate hemodynamic character of stenosis or occlusion of carotid artery system. Surgical method is helpful to this kind of disease, and its curative effect can be evaluated impersonally and accurately by this new technique.