三维伪连续脉冲动脉自旋标记技术与磁共振血管成像联合应用对后循环缺血评价

3D-PCASL with MRA combined application for evaluation of posterior circulation ischemia

目的探讨三维伪连续脉冲动脉自旋标记技术(3D-PCASL)与磁共振血管成像(MRA)联合应用在后循环缺血(PCI)评价和临床意义。方法对36例临床和影像确诊PCI,其中短暂性脑缺血发作(TIA)患者15例、脑梗死21例,患者均行常规头颅磁共振成像(MRI)、MRA、3D-PCASL检查。评价脑灌注状况与血管关系。结果 15例TIA患者中有10例3D-PCASL灌注图显示患侧脑血流(cerebral blood flow,CBF)为低灌注,占67%,5例为灌注正常,占33%。10例血管不规则狭窄供血分布区有8例灌注异常相一致,占53%;21例脑梗死患者中3D-PCASL灌注图均显示异常,其中患侧CBF为低灌注,占86%,3例为高灌注,占14%。18例血管不规则狭窄供血分布区有17例灌注异常,占81%。结论 3D-PCASL与MRA联合应用评价PCI分布情况、异常灌注区与责任血管基本相一致,特别是TIA早期诊断,是预防、减少或延迟脑梗死发生在最佳时机。3D-PCASL和MRA联合应用对PCI制定正确治疗方案和预后判断具有重要临床价值。

Objective To discuss 3D pseudo continuous pulse arterial spin labeling technique （3D-PCASL） with MRA combined use of posterior circulation ischemia （PCI） evaluation and clinical significance. Methods Thirty- six cases of clinical and imaging diagnosis of PCI, including transient ischemic attack （TIA） patients 15 cases, cere- bral infarction, 21 cases, patients were performed conventional head MRI （DWI and ADC） can, MRA, 3D-PCASL check. Evaluation of cerebral pertusion status relationship with blood vessels. Results Ten case~ of patients with TIA 3D-PCASL perfusion figure display of cerebral blood flow, cerebral blood flow （CBF） for low perfusion, accounted for 67%, 5 cases of normal perfusion, accounting for 33%. 10 cases of blood vessels irregular narrow area of 8 cases of abnormal perfusion is consistent, accounted for 53%; 21 cases of patients with cerebral infarction in 3D-PCASL perfu- sion figure display abnormal, in which one side CBF as low perfusion, accounted for 86%, 3 cases for high perfusion, accounting for 14%. 18 cases of blood vessels irregular narrow area 17 cases of abnormal perfusion, accounting for 81%. Conclusion 3D-PCASL distribution and joint application of MRA evaluation PCI, abnormal perfusion area and responsibility basic consistent blood vessels, especially early diagnosis, TIA is to prevent, reduce or delayed cerebral infarction occurred in time. 3D-PCASL make correct decisions and MRA combined application of PCI treatment plan and prognosis judgement has important clinical value.