DSC-PWI在缺血性脑血管病中的应用价值

Application value of DSC-PWI in ischemic cerebrovascular disease

目的探讨动态磁敏感对比增强灌注成像(DSC-PWI)在缺血性脑血管病(ICVD)脑血流灌注状态中的应用价值。方法回顾性分析临床确诊的31例缺血性脑血管病的常规MRI、磁共振弥散加权成像(DWI)、磁共振血管成像(MRA)及DSC-PWI图像,重点分析其参数相对脑血流量(rCBF)、相对脑血容量(rCBV)、平均通过时间(MTT)、达峰时间(TTP)变化,归纳其特征。结果31例缺血性脑血管病中,灌注不足16例,rCBF明显减少、rCBV减少、MTT延长、TTP延长,包含短暂性脑缺血发作(TIA)4例,大血管病变7例,小血管病变5例;侧支循环形成9例,包含代偿良好3例,rCBF正常、rCBV正常、MTT延长、TTP延长;代偿不良6例,rCBF减低、rCBV正常或增加、MTT延长、TTP延长;血流再灌注3例,rCBF正常或轻度增加、rCBV增加、MTT缩短或正常、TTP缩短;过度灌注3例,rCBF显著增加、rCBV显著增加、MTT缩短、TTP缩短。结论DSC-PWI能够可靠地反映缺血性脑血管病患者的灌注状态及侧支循环代偿情况,从而指导临床治疗方案选择,明显改善患者预后。

Objective To explore the application value in cerebral blood perfusion status of dynamic susceptibility contrast enhanced perfusion weighted imaging(DSC-PWI)in ischemic cerebrovascular disease(ICVD).Methods Retrospective analysis of 31 cases ICVD head magnetic resonance imaging(MRI),diffusion weighted imaging(DWI),magnetic resonance angiography(MRA)and DSC-PWI image in clinical diagnosis,and selectively analyze parameters including relative cerebral blood flow(r CBF),relative cerebral blood volume(r CBV),mean transit time(MTT)and time to peak(TTP)for generalize its characteristics.Results 31 cases of ICVD,16 cases hypoperfusion,r CBF decreased significantly,r CBV decreased,MTT and TTP prolonged,include 7 cases of large vessel disease and 5 cases of small vessel disease.The collateral circulation formed 9 cases,including 3 cases with good compensation,r CBF normal,r CBV normal,MTT and TTP prolonged,6 cases with bad compensation,r CBF decreased,r CBV normal or increased,MTT and TTP prolonged.The blood reperfusion in 3 cases,r CBF normal or slightly increased,r CBV increased,MTT shortened or normal,and TTP shortened.The excessive perfusion in 3 cases,r CBF significantly increased and r CBV significantly increased,with MTT and TTP shortened.Conclusions DSC-PWI can reliably reflect the perfusion state and collateral circulation compensation of ICVD,so as to guide the selection of clinical treatment program and significantly improve the prognosis of patients.