磁敏感加权成像在预测烟雾病患者血管重建术后复发的应用价值

Clinical value of susceptibility weighted imaging in prediction of recurrence after revascularization surgery in patients diagnosed with moyamoya

目的探讨术前磁敏感加权成像(susceptibility weighted imaging,SWI)检查中的刷子征与烟雾病(moyamoya diease,MMD)患者血管重建术后复发之间的联系。方法选取2016年8月至2017年8月上海交通大学医学院附属第九人民医院神经外科确诊为MMD并行颅内外血管重建手术的患者44例。患者术前均行数字减影血管造影(digital subtraction angiography,DSA)、MRI、磁共振血管造影(magnetic resonance angiography,MRA)、SWI检查及单光子发射计算机断层扫描(single photon emission computed tomography,SPECT)脑血流灌注显像,对各项检查结果进行相应的影像学分级和评分。术后对所有患者随访3年。结果44例患者中共有10例复发。与无复发患者比较,复发患者SPECT脑血流灌注显像评分构成及SWI图像(刷子征)分级构成,差异有统计学意义(P<0.05)。COX回归分析显示,SPECT脑血流灌注显像评分以及SWI图像(刷子征)分级是MMD血管重建术后复发的主要独立危险因素(HR=3.95,P=0.049;HR=8.26,P=0.048)。结论SWI图像中刷子征的出现以及SPECT脑血流灌注显像所见脑血流灌注严重不足是影响MMD患者复发的独立危险因素,二者同时出现时预示患者术后复发的风险较高。

Objective To evaluate the relationship between the brush sign of susceptibility weighted imaging(SWI)images and recurrence of patients with moyamoya disease(MMD)after surgical revascularization.Methods Forty-four MMD patients received surgical revascularization were enrolled in the study from August 2016 to August 2017.All the patients had undergone digital subtraction angiography(DSA),MRI,magnetic resonance angiography(MRA),SWI and single photon emission computed tomography(SPECT)cerebral blood flow scan before the surgery.The imaging grade of SWI and the score of SPECT were carried out.Each patient was followed up for three years.Results The clinical data of 44 MMD patients were analyzed.There were 10 patients had recurrence during the follow-up.Compared with the patients without recurrence,the composition of SPECT score and SWI(brush sign)grade in the patients with recurrence was statistically significant(P<0.05).COX proportional risk regression model showed that the independent risk factors of the recurrence of MMD were the score of SPECT cerebral blood flow scan and brush sign(HR=3.95,P=0.049;HR=8.26,P=0.048).Conclusions The presence of brush sign on SWI images and severe insufficiency of cerebral blood flow in SPECT imaging are independent risk factors for recurrence of MMD,and the combination of both predicts a higher risk of recurrence after surgery.