动脉自旋标记技术对缺血型和出血型烟雾病患者脑灌注情况的评估

Evaluation of cerebral perfusion in patients with ischemic and hemorrhagic moyamoya disease by arterial spin labeling

目的应用磁共振动脉自旋标记灌注成像技术评价缺血型及出血型烟雾病患者的脑血流灌注情况,探讨2种类型烟雾病脑血流灌注的不同。方法选取2018年中国科学技术大学附属第一医院经临床确诊为烟雾病的患者33例,其中男性12例,女性21例,年龄10~60岁,平均年龄(42.86±12.52)岁,所有患者均行常规MR序列成像(T1WI、T2WI、T2-FLAIR)、磁敏感加权成像(SWI)和三维伪连续式动脉自旋标记(3D pCASL)灌注成像检查,根据患者临床表现、常规MR序列成像及SWI成像将烟雾病患者分为缺血型烟雾病组(16例)和出血型烟雾病组(17例)。获得2组患者病变区域及对侧脑组织灌注脑血流量(CBF)值,并比较在不同标记延迟时间(PLD)设定的情况下2组间的差异。结果当PLD=1.5 s时,缺血组、出血组组间病灶侧CBF值比较差异无统计学意义[(16.36±4.46)mL/(100 g·min)vs.(17.43±4.96)mL/(100 g·min),t=0.649,P=0.521];当PLD=2.5 s时,缺血组、出血组组间病灶侧CBF值比较差异有统计学意义[(35.56±10.75)mL/(100 g·min)vs.(25.97±11.04)mL/(100 g·min),t=2.528,P=0.017]。结论使用不同PLD的动脉自旋标记脑灌注成像能够评价不同类型烟雾病患者脑血流灌注情况,为临床医生选择适当的治疗方式和预测转归提供客观依据。

Objective To evaluate the cerebral perfusion situation of the patients with ischemic and hemorrhagic moyamoya disease using arterial spin labeling.Methods Thirty-three patients with moyamoya disease,including 12 males and 21 females,aged 10-60 years old,were selected from our hospital in 2018.All patients underwent convention MRI(T1 WI,T2 WI,T2-FLAIR),susceptibility weighted imaging(SWI)and arterial spin labeling imaging(ASL).According to the MRI and SWI images,the patients were divided into ischemic group(16 patients)and hemorrhagic group(17 patients).CBF values in the lesion area and contralateral brain tissue were obtained,and the differences between the two groups under different post-labeling delay(PLD)settings were compared.Results When PLD=1.5 s,there were no significant differences in the CBF between two groups(ischemic 16.36±4.46 vs.hemorrhagic 17.43±4.96,t=0.649,P=0.521).When PLD=2.5 s,there were significant differences between the two group(ischemic 35.56±10.75 vs.hemorrhagic 25.97±11.04,t=2.528,P=0.017).Conclusion Arterial spin labeling perfusion imaging with different PLD times can evaluate cerebral blood perfusion in patients with different types of moyamoya disease and provide objective basis for clinicians to select appropriate treatment methods and predict outcomes.