三维动脉自旋标记PWI评估烟雾病患者血管重建术后脑灌注变化

Three-dimensional arterial spin labeling PWI in evaluating postoperative cerebral perfusion changes in patients with Moyamoya disease

目的探讨三维动脉自旋标记(3D-ASL)PWI技术评估烟雾病患者血管重建术后脑血流灌注变化的价值。方法收集经DSA确诊并接受联合血管重建术的19例烟雾病患者,全部患者均于术前、术后接受3D-ASL PWI及动态磁敏感对比增强PWI(DSC-PWI)。在术侧大脑中动脉供血区灌注改善最显著区域放置ROI,术前、术后于ASL图像测量脑血流量(CBF),于DSC-PWI图像测量达峰时间(TTP);比较手术前后CBF和TTP的差异以及临床症状、CBF和TTP的改善率。结果术侧大脑中动脉供血区术前、术后CBF分别为(41.40±11.36)ml/(100g·min)和(54.10±16.69)ml/(100g·min),差异有统计学意义(t=-4.273,P<0.01);术前、术后TTP分别为(28.66±3.21)s和(26.44±3.93)s,差异有统计学意义(t=-2.936,P<0.01);术后症状改善率[84.21%(16/19)]、CBF改善率[78.95%(15/19)]和TTP改善率[68.42%(13/19)]差异无统计学意义(P=0.625)。结论 3D-ASL PWI技术无创、无需使用对比剂,可用于评估烟雾病患者血管重建术后脑血流灌注的变化。

Objective To observe the value of three-dimensional arterial spin labeling （3D-ASL） PWI in evaluating postoperative cerebral perfusion changes in patients with Moyamoya disease. Methods Totally 19 patients of Moyamoya disease confirmed with DSA were enrolled. All the patients received revascularization. Before and after operation, 3D-ASL PWI and dynamic susceptibility contrast perfusion weighted imaging （DSC-PWI） were performed. ROI was located in the region with obvious perfusion changes supplied by middle cerebral artery on the operating side. Then the cerebral blood flow （CBF） was measured on 3D-ASL images, and time to peak （TTP） was measured on DSC-PWI images before and after operation. The differences of CBF and TTP before and after operation were compared, as well as the improvement rate of CBF, TTP and clinical symptoms. Results Before and after operation, CBF was （41.40±11.36） ml/（100 g ·min） and （54.10±16.69） ml/（100 g · min）, respectively, and the difference was statistically significant （t=-4. 273, P〈0.01）. TTP was （28.66±3.21）s and （26.44±3.93）s, respectively, and the difference was also statistically significant （t= -2. 936,P〈0.01）. The improvement rate of clinical symptoms was 84.21% （16/19）, of CBF was 78.95% （15/19） and of TTP was 68.42% （13/19）, the differences of improvement rate had no statistically significant （P〈0. 625）. Conclusion 3D-ASL PWI is noninvasive, no contrast agent need to be used, and can be used to evaluate perfusion changes after operation of revascularization in patients with Moyamoya disease.