3D-ASL不同标记延迟时间及脑白质病变评分在血管性认知障碍疾病中的临床价值研究

Clinical value study of different post label delay of 3D-ASL and white matter lesion score in vascular cognitive impairment

目的探讨磁共振三维动脉自旋标记(3D arterial spin labeling,3D-ASL)成像中不同标记后延迟时间(post label delay,PLD)及脑白质病变(white matter lesions,WMLs)评分与血管性认知障碍(vascular cognitive impairment,VCI)脑血流量(cerebral blood flow,CBF)的关系。材料与方法收集确诊缺血性脑小血管病患者52例,使用蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)行认知功能评估并分为认知障碍组(30例)及认知正常组(22例),采用不同PLD(1.5、2.5 s)行3D-ASL脑灌注成像,应用GE AW4.5工作站对双侧额顶颞叶、海马及丘脑等脑区进行镜面对称测量(CBF1.5、CBF2.5),并对患者WMLs评分,比较两组差异及WMLs评分/MoCA量表评分与各脑区CBF的相关性。结果①VCI组与对照组WMLs评分分别为4.87±1.68及2.77±1.66;MoCA量表评分分别为18.77±2.98及28.18±0.96,差异均有统计学意义(P=0.000)。②VCI患者CBF1.5在双侧额顶颞叶、海马及右侧丘脑等脑区明显减低,而CBF2.5只在双侧额颞叶、海马脑区减低;仅左侧/右侧额叶CBF1.5与CBF2.5差异具有统计学意义(P=0.000、0.019);在全部患者各脑区中,左侧、右侧额叶CBF1.5/CBF2.5与WMLs评分呈显著负相关(r1.5=-0.567、-0.590/r2.5=-0.553、-0.558;P<0.05)。③MoCA量表评分与CBF1.5(双侧额颞叶、海马、右侧丘脑)/CBF2.5(双侧额叶、海马、左侧颞叶、右侧丘脑)呈正相关,额叶相关性最高(左、右额叶:r1.5=0.806、0.688/r2.5=0.719、0.620;P=0.000)。结论PLD1.5对VCI脑低灌注检出更敏感,PLD2.5显示低灌注范围更精确;WMLs与VCI严重程度呈正相关。

Objective:To study the correlation between different post label delay(PLD)of magnetic resonance 3D arterial spin labeling(3D-ASL)technology,white matter lesions(WMLs)scores and cerebral blood flow(CBF)in vascular cognitive impairment(VCI).Materials and Methods:A total of 52 patients with ischemic cerebrovascular disease diagnosed in the department of neurology were collected.The MoCA scale was used for cognitive function assessment and the patients were divided into the cognitive impairment group(30 cases)and the cognitive normal group(22 cases).the 3D-ASL brain perfusion imaging techniques with different PLD(1.5 s,2.5 s)was performed,and GE AW4.5 image post-processing software was applied to perform mirror symmetry measurements(CBF1.5,CBF2.5)in bilateral frontal parietal temporal lobe,hippocampus and thalamus.The WMLs scores of the two groups were compared and the correlation between WMLs score/MoCA scale score and CBF values of each brain area.Results:①The WMLs scores of the VCI group and the control group were 4.87±1.68 and 2.77±1.66,respectively;the scores of the MoCA scale were 18.77±2.98 and 28.18±0.96,respectively,the differences were statistically significant(P=0.000).②In patients with VCI,CBF1.5 is significantly decreased in the bilateral frontal-temporal lobe,hippocampus,and right thalamus,while CBF2.5 is only reduced in the bilateral frontal-temporal lobe,hippocampus;only the difference between CBF1.5 and CBF2.5 in the left/right frontal lobe was statistically significant(P=0.000/0.019).In all brain regions of all patients,the left and right frontal lobe CBF1.5/CBF2.5 were significantly negatively correlated with WMLs scores(r1.5=-0.567,-0.590/r2.5=-0.553,-0.558;P<0.05).MoCA scale score was positively correlated with CBF1.5(bilateral frontotemporal lobe,hippocampus,right thalamus)/CBF2.5(bilateral frontal lobe,hippocampus,left temporal lobe,right thalamus),with the highest frontal lobe correlation(left and right frontal lobe:r1.5=0.806,0.688/r2.5=0.719,0.620;P=0.000).Conclusions:PLD1.5 is more sensitive to detection of VCI cerebral hypoperfusion,while PLD2.5 is more accurate in showing the range of hypoperfusion.WMLs was positively correlated with VCI severity.