联合动脉自旋标记灌注成像及扩散加权成像监测外伤后脑微循环变化

Application of arterial spin labeling and diffusion weighted imaging in monitoring changes of cerebral microcirculation in traumatic brain injury

目的探讨联合应用动脉自旋标记灌注成像及扩散加权成像评估创伤性脑损伤(TBI)中的脑微循环变化。方法使用3.0T磁共振对45例TBI患者行常规、动脉自旋标记(ASL)、扩散加权成像(DWI)及磁共振成像液体衰减反转恢复(FLAIR)序列扫描,对比分析TBI患者脑挫伤区与对侧镜区的相对脑血流量(rCBF)及表观弥散系数(ADC)值,评价脑微循环变化情况。结果 8例患者,脑挫伤区rCBF值(354.43±67.58)ml·(100g)-1·min-1,高于对侧镜区(268.43±45.57)ml·(100g)-1·min-1(P=0.035),脑挫伤区ADC值(834.78±43.48)mm2/s,高于对侧镜区ADC值(729.00±54.19)mm2/s(P=0.042);22例患者,脑挫伤区rCBF值(144.29±49.33)ml·(100g)-1·min-1,低于对侧镜区脑组织rCBF值(280.14±69.54)ml·(100g)-1·min-1(P=0.018),脑挫伤区ADC值(546.35±57.38)mm2/s,低于对侧镜区脑组织ADC值(733.67±63.45)mm2/s(P=0.038)。15例患者,脑挫伤区rCBF值(44.21±18.24)ml·(100g)-1·min-1,低于对侧镜区rCBF值(273.59±57.68)ml·(100g)-1·min-1(P=0.013),脑挫伤区ADC值(1500.43±40.57)mm2/s,高于对侧镜区ADC值(738.67±53.45)mm2/s(P=0.016)。结论 ASL灌注成像结合DWI及ADC图,可用于评估TBI脑微循环改变情况,为临床制定相应的早期治疗方案提供依据,改善脑外伤患者的预后。

Objective To assess the value of arterial spin labeling(ASL)and diffusion weighted imaging(DWI)in monitoring changes of cerebral microcirculation in traumatic brain injury.Methods Forty-five patients with traumatic brain injury(TBI)underwent MRI examination including routine scan,ASL and DWI sequence.The rCBF and ADC values of the cerebral contusion,perilesional edemas and normal contralateral cerebral parenchyma acquired by ASL and DWI were analyzed to evaluate changes of cerebral microcirculation.Results In 8 patients,rCBF of cerebral contusion zone were(354.43±67.58)ml·(100 g)^-1·min^-1,higher than that of normal brain tissue(P=0.035),while ADC value of cerebral contusion zone were(834.78±43.48)mm^2/s,higher than that of normal brain tissue(P=0.042).In 22 patients,rCBF of cerebral contusion zone were(144.29±49.33)ml·(100 g)^-1·min^-1,lower than that of the normal brain tissue(P=0.018),while ADC value of brain contusion were(546.35±57.38)mm^2/s,lower than that of normal brain tissue(P=0.038).In 15 patients,rCBF of cerebral contusion zone were(44.21±18.24)ml·(100 g)^-1·min^-1,lower than that of normal brain tissue(P=0.013),and ADC value of cerebral contusion zone(1500.43±40.57)mm^2/s,higher than that of normal brain tissue(P=0.016).Conclusions ASL perfusion combined with DWI can be used for assessing the changes of cerebral microcirculation in traumatic brain injury,providing vital information for clinical corresponding treatment and improving the prognosis of patients with traumatic brain injury.