三维动脉自旋标记灌注成像技术在脑小血管病合并认知功能障碍中的应用

Application of 3D-ASL perfusion imaging in patients with cerebral small vessel disease complicated with cognitive dysfunction

目的运用三维动脉自旋标记(3D-ASL)灌注成像技术测量不同脑区的脑血流量(CBF),探讨其在脑小血管病(CSVD)合并认知功能障碍中的应用价值。方法选择商丘市第一人民医院2020-01—2021-03在神经内科门诊或住院的CSVD患者,依据认知功能障碍评分,分为CSVD合并认知功能障碍组(CSVD-VCI)和CSVD无认知功能障碍组(CSVD-NCI),并选择同期体检的志愿者为对照组(CN)。收集患者一般资料,记录各组磁共振3D-ASL不同脑区CBF值,分析各组脑血流灌注特点、简易智能精神状态检查量表(MMSE)评分和蒙特利尔认知评估量表(MoCA)评分的相关性。结果CSVD-VCI组认知功能较CSVD-NCI组和CN组均有下降(P<0.05),后2组认知功能评分差异无统计学意义(P>0.05),3组间MMSE与MoCA两种评分量表呈正相关。3组双侧额叶、双侧顶叶、双侧颞叶、双侧半卵圆区和双侧丘脑的CBF值差异均有统计学意义(P<0.05),双侧枕叶的CBF值差异无统计学意义(P>0.05)。CSVD-NCI组双侧额叶、双侧颞叶、双侧丘脑的CBF值低于CN组,差异有统计学意义(P<0.05);CSVD-VCI组双侧额叶、双侧顶叶、双侧颞叶、双侧半卵圆区、双侧丘脑的CBF值较CSVD-NCI组和CN组降低,差异有统计学意义(P<0.05)。CSVD-VCI组患者双侧额叶、双侧顶叶、双侧颞叶、双侧枕叶、左侧丘脑、左侧半卵圆区与MMSE评分呈正相关(P<0.05);双侧额叶、双侧顶叶、双侧颞叶、左侧枕叶、双侧半卵圆区与MoCA评分呈正相关(P<0.05)。结论3D-ASL能敏感监测CSVD患者脑血流灌注异常,且脑血流灌注随认知障碍的出现进一步下降。MMSE联合MoCA可作为临床筛查CSVD合并认知功能障碍患者的有效工具。

Objective Three-dimensional arterial spin labeled(3D-ASL)perfusion imaging technology was used to measure cerebral blood flow(CBF)in different brain regions,and explore its application value in cere⁃bral small vessel disease(CSVD)with cognitive dysfunction.Methods The CSVD patients in the outpatient or in⁃patient department of neurology in the First People's Hospital of Shangqiu from January 2020 to March 2021 were selected and divided into the CSVD combined with cognitive impairment group(CSVD-VCI)and the CSVD non-combined with cognitive impairment group(CSVD-NCI)according to the cognitive impairment score,and the volunteers in our hospital during the same period were selected as the control group(CN).The general data of the patients were collected,and the CBF values in different brain regions of magnetic resonance 3D-ASL in each group were recorded.The characteristics of cerebral blood perfusion,the correlation between MMSE score and Mo⁃CA score were analyzed.Results The cognitive function of CSVD-VCI group was lower than that of CSVD-NCI group and CN group(P<0.05).There was no significant difference in the scores of cognitive function between the latter two groups(P>0.05),and MMSE and MoCA were positively correlated among the three groups.There were statistically significant differences in CBF values of bilateral frontal lobe,bilateral parietal lobe,bilateral temporal lobe,bilateral semioval region and bilateral thalamus among the three groups(P<0.05),but the CBF values in bi⁃lateral occipital lobe were not significantly different(P>0.05).The CBF values of bilateral frontal lobe,bilateral temporal lobe and bilateral thalamus in the CSVD-NCI group were lower than those in the CN group,and the dif⁃ference was statistically significant(P<0.05).The CBF values of bilateral frontal lobes,bilateral parietal lobes,bi⁃lateral temporal lobes,bilateral semiovarian regions and bilateral thalamus in the CSVD-VCI group were lower than those in the CSVD-NCI group and CN group,and the difference was statistically significant(P<0.05).In the CSVD-VCI group,bilateral frontal lobes,bilateral parietal lobes,bilateral temporal lobes,bilateral occipital lobes,left thalamus and left semioval region were positively correlated with MMSE scores(P<0.05);Bilateral frontal lobe,bilateral parietal lobe,bilateral temporal lobe,left occipital lobe and bilateral semiovale were positively corre⁃lated with MoCA score(P<0.05).Conclusion 3D-ASL can sensitively monitor the abnormal cerebral blood per⁃fusion in patients with CSVD,and the cerebral blood perfusion further decreases with the emergence of cognitive impairment.MMSE combined with MoCA can be used as an effective tool for clinical screening of CSVD patients with cognitive dysfunction.