犬脑栓塞溶栓前后磁共振内镜术比较研究

A magnetic resonance endoscopy comparison of dog model with cerebral embolism between pre-thrombolysis and post-thrombolysis

目的应用磁共振仿真内镜(magneticresonancevirtualendoscopy,MRVE)技术对家犬脑栓塞模型及溶栓治疗后效果进行观察,探讨MRVE在超急性脑梗塞前后血管诊断效果。方法于数字减影血管造影术(DSA)下,用自体凝血块栓塞30只家犬脑部供血动脉,迅速行MR扫描,数据传输至工作站,进行MRVE检查,观察脑部血管,然后将栓塞家犬利用尿激酶进行溶栓治疗,再重新行MR扫描,观察比较栓塞前后及溶栓前后MRVE的改变。结果30只家犬于DSA下进行人工栓塞后(DSA为金标准,显示血栓100%),MRVE观察达优率867%(达到4或3级),准确率800%(与DSA结果相比),达良率100%(达到1或2级),达差率33%(达到“-”级);溶栓后,DSA显示再通25例,MRVE观察达优率700%,准确率560%,达良率33%,达差率267%,溶栓后较溶栓前MRVE观察效果差(χ2=70177,P<001)。结论MRVE对大脑栓塞后观察效果明显差,溶栓治疗后观察效果最差,故MRVE不适于溶栓后血管的观察。

Objective To inspect brain arteries of dog model with cerebral embolism by magnetic resonance virtual endoscopy (MRVE) technique and to evaluate diagnostic effect of MRVE on super-acute brain infarction before and after thrombolysis therapy. Methods Under BSA, brain arteries of 30 dogs were embolized with clots made from their own blood followed with rapid examination by MR. On workstation, source-imaging data were treated and arteries were inspected through MRVE. Then dogs with cerebral embolism were examined by MR again after they were treated with urokinase. Changes of MRVE results before and after treatment were compared. Results After embolism under DSA, MRVE examination showed that there were 86.7% of superior degree (category 4 or 3) and 80.0% of accuracy rate (compared with DSA results). There were 10.0% of middle degree (category 2 or 1) and 3.3% of inferior degree (category '-'). After treatment with urokinase, 25 cases were re-channelled. With MRVE, there were 70.0% of superior degree and 56.0% accuracy rate, there were 3.3% of middle degree and 26.7% of inferior degree. The observation effect of MRVE was worse in post-thrombolysis period than that in pre-thrombolysis period (χ2=7.017 7, P<0.01). Conclusions Effect of MRVE observation was poor markedly, while it was worst after thrombolysis. So MRVE observation is not qualified for the observation of vessels after embolism.