成人出血型与缺血型烟雾病的3D pCASL侧支分布特点比较

Comparison of 3D pCASL Collateral Distribution Characteristics Between Adult Hemorrhagic and Ischemic Moyamoya Disease

目的比较成人出血型与缺血型烟雾病(MMD)在磁共振三维准连续动脉自旋标记(3D pCASL)的侧支分布特点。方法回顾性分析2018年6月~2020年2月安徽省立医院南区神经外科收治的出血型及缺血型MMD患者共71例,将其分为出血组34例和缺血组37例,均于搭桥术前行MR常规序列、3D pCASL及磁化率加权成像(SWI)序列检查,基于Alberta卒中项目早期CT前循环及后循环评分法(ASPECTS及pc-ASPECTS法)将3D pCASL血流图分成27个区,根据各区动脉通过伪影(ATA)的强度进行赋值,比较出血型与缺血型患者前循环、后循环、脑深部、脑浅部ATA值的差异。结果出血型MMD患者后循环、脑深部ATA值高于缺血型,脑浅部、前循环ATA值低于缺血型患者,差异均有统计学意义(P<0.05);出血型MMD患者脑深部ATA值高于脑浅部,差异有统计学意义(P<0.05);缺血型MMD患者脑深部ATA值与脑浅部比较,差异无统计学意义(P>0.05)。结论成人出血型烟雾病患者侧支循环分布以后循环、脑深部为主,缺血型烟雾病患者侧支循环分布以前循环、脑浅部为主。

Objective To compare the collateral distribution characteristics of adult hemorrhagic and ischemic moyamoya disease(MMD)in MRI three-dimensional quasi-continuous arterial spin labeling(3D pCASL).Methods A total of 68 patients with hemorrhagic and ischemic MMD admitted to the Department of Neurosurgery of the Southern District of Anhui Provincial Hospital from June 2018 to February 2020 were retrospectively analyzed.All patients underwent conventional MR sequence,3D pCASL and magnetic susceptibility before bypass surgery.Weighted imaging(SWI)sequence inspection,Based on the early CT pre-circulation and post-circulation scoring method(ASPECTS and pc-ASPECTS method)of the Alberta stroke project,the 3D pCASL blood flow map was divided into 27 areas.Assign values according to the intensity of arterial passage artifacts(ATA)in each area,and compare the differences in ATA values of anterior circulation,posterior circulation,deep brain,and superficial brain between hemorrhagic and ischemic patients.Results The ATA values of posterior circulation and deep brain of hemorrhagic MMD patients were higher than those of ischemic type,and ATA values of superficial brain and anterior circulation were lower than that of ischemic patients,the difference was statistically significant(P<0.05);The ATA value of deep brain of patients with hemorrhagic MMD was higher than that of superficial brain,the difference was statistically significant(P<0.05);There was no significant difference in the ATA value between the deep brain and the superficial brain in patients with ischemic MMD(P>0.05).Conclusion In adults with hemorrhagic moyamoya disease,the collateral circulation is mainly distributed in the posterior circulation and the deep brain,and in patients with ischemic moyamoya disease,the collateral circulation is mainly distributed in the anterior circulation and the superficial brain.