DKI及ESWAN技术在评估原发性高血压患者脑实质微结构改变中的应用

Evaluation of microstructural changes of brain parenchyma in patients with essential hypertension by diffuse kurtosis imaging and enhanced T2 star weighted angiography

目的探讨弥散峰度成像(DKI)及增强梯度回波T2*加权血管成像(ESWAN)序列在评估原发性高血压患者脑实质微结构改变中的应用价值。方法前瞻性选择汕头大学第二附属医院自2019年4月至2019年9月收治的原发性高血压患者27例,作为原发性高血压组。根据是否存在脑微出血(CMBs)将其再分为原发性高血压CMBs组(8例)及原发性高血压非CMBs组(19例)。选取同期性别、年龄、受教育程度匹配的健康体检者16例为正常对照组。对所有受试者行头颅常规MRI及DKI、ESWAN序列检查,测定受试者双侧海马回、半卵圆中心、尾状核头部、内囊后肢、丘脑、红核、黑质、桥脑、小脑的平均峰度(MK)值、平均弥散系数(MD)值及各向异性分数(FA)值。结果与正常对照组比较,原发性高血压组患者左侧半卵圆中心、双侧尾状核头部、左侧内囊后肢、双侧丘脑MK值明显降低,右侧丘脑MD值明显升高,左侧内囊后肢FA值明显降低,差异均有统计学意义(P<0.05)。与原发性高血压非CMBs组、正常对照组比较,原发性高血压CMBs组患者左侧海马回、左侧半卵圆中心、双侧尾状核头部、左侧内囊后肢、双侧丘脑、左侧黑质MK值明显降低,右侧丘脑MD值明显升高,左侧内囊后肢FA值明显降低,差异均有统计学意义(P<0.05)。结论原发性高血压患者未出现神经功能缺损阶段海马回、半卵圆中心、尾状核头部、内囊后肢、丘脑、黑质的脑微结构已有改变,且合并CMBs的原发性高血压患者改变更加明显;DKI及ESWAN序列检查可有效评估原发性高血压患者早期的脑实质微结构改变。

Objective To evaluate the microstructural changes of brain parenchyma in patients with essential hypertension by diffuse kurtosis imaging(DKI)and enhanced T2 star weighted angiography(ESWAN).Methods A prospective study was performed;27 patients with essential hypertension,admitted to our hospital from April 2019 to September 2019,and 16 healthy subjects matched with gender,age and education level were enrolled in our study.According to the presence or absence of cerebral microbleeds(CMBs),patients with essential hypertension were divided into essential hypertension with CMBs group(n=8)and essential hypertension without CMBs group(n=19).MRI,DKI and ESWAN were performed on all subjects.The mean kurtosis(MK),mean diffusivity(MD)and fractional anisotropy(FA)of bilateral hippocampal gyrus,centrum semiovale,caudate head,posterior limb of internal capsule,thalamus,red nucleus,substantia nigra,pons,and cerebellum were measured.Results As compared with the healthy subjects,the patients with essential hypertension had significantly lower MK values in the left semioval center,bilateral caudate head,left posterior limb of internal capsule,and bilateral thalamus,significantly higher MD value in the right thalamus,and statistically lower FA value in the left posterior limb of internal capsule(P<0.05).The essential hypertension with CMBs group had significantly lower MK values in left hippocampus gyrus,left centrum semiovale,bilateral caudate head,left posterior limb of internal capsule,bilateral thalamus,and left substantia nigra,significantly higher MD value in right thalamus,and significantly lower FA value in left posterior limb of internal capsule as compared with essential hypertension without CMBs group and healthy control group(P<0.05).Conclusion In patients with essential hypertension,the brain microstructural changes are found in the hippocampus,centrum semiovale,caudate head,posterior limb of internal capsule,thalamus and substantia nigra;these changes are more obvious in essential hypertension patients with CMBs;DKI and ESWAN can effectively assess the early brain microstructure changes in patients with essential hypertension.