三维梯度回波血管成像与PWI在缺血性脑卒中的应用研究

Three-dimensional T2 star weighted angiography and DSC-perfusion MR imaging for ischemic stroke

目的探讨脑缺血性卒中患者病灶周围小静脉改变与脑血流灌注状态之间的关系。方法对29例单侧大脑半球缺血性脑梗死患者行常规T1WI、T2WI、3DSWAN、DSC-PWI扫描,其中10例治疗1周后复查,共39例次MR扫描。观察SWAN序列梗死灶周围小静脉改变,判断PWI病侧脑血流灌注状态,以卡方检验分析两者之间的关系。结果 39例次脑梗死患者中,26例病灶周围小静脉显示多、粗、黑,其中23例血流灌注量增加(19例呈侧支循环建立,1例再灌注,3例过度灌注),3例灌注不足;13例病灶周围小静脉显示稀、细、浅,其中9例呈灌注不足,3例侧支循环建立,1例再灌注,无过度灌注。经卡方检验,病灶周围小静脉改变与血流灌注状态之间的差异有统计学意义(P<0.05)。结论缺血性脑梗死病灶周围小静脉改变间接体现了缺血脑组织的血流动力学状态,病灶周围小静脉显示多、粗、黑可能与血流灌注量增加相关,小静脉显示稀、细、浅与灌注不足相关。

Objective： To investigate the relationship between perfusion MRI and the changes of small vessels around the infarction. Materials and Methods： Twenty- nine patients with ischemic infarction of unilateral hemicerebrum underwent T1WI, T2WI, 3D SWAN and DSC-PWI. Among these patients, 10 had follow-up MR scan after treatment. There were 39 person-time MR scans in total. Compared the changes of small vessels on 3D SWAN with the perfusion manifestation on DSC- PWI and analyze the relationship between them. Results： In the 39 cases, there were more, thick and black small vessels of 26 cases on 3D SWAN. Among them, 23 cases had hyperperfusion （19 collateral circulation, 3 reperfusion, 3 hyperperfusion and 1 hypoperfusion） on perfusion MRI; There were less, thin and light vessels of 13 cases. Among these 13 cases, 9 were hypoperfusion, 3 had collateral circulation and 1 was reperfusion. None of them was hyperperfusion. With chi square test, there was a significant difference between the small vessels change and the perfusion manifestation around the infarction lesion （P〈0.05）. Conclusion： The small vessels change around the infarction lesion indirectly reflect the perfusion manifestation, the small vessels become more, thick and black correlated with hyperperfusion, and the small vessels turned less, thin and light correlated with hypoperfusion.