瘀血性脑血管病的脑血流灌注改变:初步经验

Cerebral blood perfusion changes in congestive cerebral vascular disease: initial experiences

目的：探讨瘀血性脑血管病（CCVD）的脑血流灌注变化特点。方法：收集2006年~2009年间在我院经MR增强扫描和临床其他检查确诊的CCVD病例13例,其中颅内静脉窦血栓形成（DVT）8例,有脑水肿并发症的脑发育性静脉异常（DVA）5例,伴有静脉性脑梗死6例（均为DVT病例）。脑血流灌注成像采用磁共振动态磁敏感对比增强灌注加权成像（DSC-PWI）,原始数据传送至GE AW4.3工作站做图像后处理,得到平均通过时间（MTE）、负性增强积分（NEI）、达谷时间（TTM）和最大下降斜率（MSD）伪彩图。将脑病变分为两组,即静脉性梗死（VI）组和脑水肿（BE）组,比较两种不同病灶的血流灌注参数的异同。收集同期急性动脉性脑梗死（AI）病例9例,用同样方法比较AI与VI病灶血流灌注变化的异同。结果：在CCVD,VI和BE灶的MTE和TTM均增大,两组间差别无显著意义;但NEI和MSD两组间存在显著差异,在VI灶两参数均显著降低,而BE灶则有的升高,有的降低,改变不一致。在VI和AI的对比中,各灌注参数的变化趋势是一致的,虽然AI的MTE延长和NEI降低幅度更大,但统计学上差别无显著意义。结论：在CCVD,VI和BE灶的血流灌注值有显著差异,NEI和MSD的显著降低可能是脑血流灌注失代偿的反映。无论是VI还是AI,其血流灌注参数呈相同的变化趋势,提示脑血流灌注失代偿期的相同结果。

Objective：To investigate the cerebral blood perfusion changes in congestive cerebral vascular diseases（CCVD）.Methods：13 patients with CCVD confirmed by contrast enhanced MR imaging and other clinical data during 2006 to 2009 were included in the study.Of 13 cases,8 suffered from dural venous sinus thrombosis（DVT） and 5 complicated with cerebral developmental venous anomaly（DVA）.Among them,6 cases were complicated with cerebral venous infarction（all of them were DVT cases）.Cerebral blood perfusion imaging was performed with magnetic resonance dynamic susceptibility contrast-perfusion weighted imaging（DSC-PWI）.The primitive data were transmitted to a GE AW4.3 work station for post-processing,and thereby,false-color images of mean time to enhance（MTE）,negative enhancement integral（NEI）,time to minimum（TTM） and maximum slop of decrease（MSD） were obtained.The patients were divided into two groups according to the complicated cerebral lesions： venous infarction（VI） group and brain edema（BE） group.The cerebral blood perfusion parameters were compared between the two groups.9 cases of acute cerebral arterial infarction（AI） undergone brain MRI in the same period of time were collected.The cerebral blood perfusion data were compared with these of the VI.Results：In CCVD,both MTE and TTM were increased in VI group as well as in BE group.There was no statistically significant difference between the two groups.But for NEI and MSD,the differences between the two groups were statistically significant.In VI group,the two parameters were all markedly decreased,while in BE group,some cases showed increased,and others decreased.The changes were heterogenous.In comparison of the VI and AI foci,the perfusion parameters changed in the same direction.Although it seemed that the MTE lengthening and NEI decrease had a greater degree in AI foci,the differences between the two kinds of lesions were not statistically significant.Conclusion：In CCVD,the blood perfusion parameters are significantly different between the VI and BE foci.The marked decrease of NEI and MSD seems to be a reflect of cerebral blood perfusion decompensation.The blood perfusion changes have a same direction in both VI and AI,indicating a common result of decompensation.