伪连续动脉自旋标记成像评估出血型烟雾病患者脑血流动力学研究

Study of pseudo-continuous arterial spin labeling perfusion MRI on the evaluation of cerebral hemodynamics in patients with hemorrhagic moyamoya disease

目的基于伪连续动脉自旋标记成像(pseudo-continuous arterial spin labeling,pCASL)技术探讨成人烟雾病出血后脑血流动力学改变。材料与方法将首都医科大学附属宣武医院2016年12月至2019年4月收治的32例出血型或缺血型成人烟雾病患者共计38个阳性征象半球作为研究对象,其中出血半球21个、缺血半球17个,均在发病3个月内进行pCASL检查,在半卵圆中心层面及阳性征象层面选取病变周围区域、同侧额叶、颞叶进行感兴趣区测算获得pCASL-脑血流量(cerebral blood flow,CBF)、pCASL-动脉脑血容量(arterial cerebral blood volume,aCBV)、pCASL-动脉通过时间(arterial transit time,ATT)数值,出血组和缺血组组间比较,采用两独立样本t检验和Mann-Whitney U检验。结果(1)出血型大脑半球共计21个,病变周围测算aCBV、ATT及CBF分别为(1.01±0.22)mL/100g、(1.53±0.98)s和(37.88±6.19)mL/(100 g·min),额叶测算aCBV、ATT及CBF分别为(1.23±0.31)mL/100g、(1.55±0.15)s和(47.03±13.78)mL/(100 g·min),颞叶测算aCBV、ATT及CBF分别为(1.28±0.30)mL/100g、(1.54±0.12)s和(51.91±13.96)mL/(100 g·min);缺血型大脑半球共计17个,病变周围测算aCBV、ATT及CBF分别为(1.11±0.24)mL/100g、(1.46±0.35)s和(49.27±14.13)mL/(100 g·min),额叶测算aCBV、ATT及CBF分别为(1.17±0.30)mL/100g、(1.51±0.37)s和(43.17±14.63)mL/(100 g·min),颞叶测算aCBV、ATT及CBF分别为(1.21±0.35)mL/100g、(1.50±0.40)s和(49.25±20.85)mL/(100 g·min)。(2)出血型与缺血型相比,病变周围区CBF值显著减低,差异有统计学意义(P<0.05),aCBV及ATT差异无统计学意义,额叶及颞叶pCASL灌注差异无统计学意义。结论出血型烟雾病患者pCASL上脑灌注较缺血型烟雾病更低,pCASL可以检测成人出血型烟雾病患者的血流衰竭程度,监测周围额颞叶细微的缺血变化,为进一步通过监测血流动力学情况预警再出血发生提供研究基础。

Objective:To investigate hemodynamic changes in adult patients with hemorrhagic moyamoya disease based on pseudo-continuous artery spin labeling(pCASL)imaging.Materials and Methods:A total of 32 patients(38 hemispheres)with hemorrhagic or ischemic moyamoya diasease in Xuanwu Hospital were enrolled from December 2016 to April 2019,including 21 hemorrhagic hemispheres and 17 ischemic hemispheres.All patients underwent pCASL exams within 3 months after the onset.Mean perfusion parameters of cerebral blood flow(CBF),pCASL-arterial cerebral blood volume(aCBV)and pCASL-arterial transit time(ATT)derived using pCASL were measured within peripheral region of the lesion,ipsilateral frontal lobe and temporal lobe on the semi-oval layer and positive lesion layer.Inter-group comparison between hemorrhage and infarction was carried out through t-test of two independent samples and Mann-Whitney U test of two independent samples.Results:A total of 21 hemorrhagic hemispheres were involved.In the peripheral region of the lesion,mean aCBV,ATT and CBF values were(1.01±0.22)mL/100g,(1.53±0.98)s and(37.88±6.19)mL/(100 g·min),respectively.In the frontal lobe,mean aCBV,ATT and CBF values were(1.23±0.31)mL/100g,(1.55±0.15)s and(47.03±13.78)mL/(100 g·min),respectively.In the temporal lobe,mean aCBV,ATT and CBF values were(1.28±0.30)mL/100g,(1.54±0.12)s and(51.91±13.96)mL/(100 g·min),respectively.For the 17 ischemic cerebral hemispheres,mean aCBV,ATT and CBF values were(1.11±0.24)mL/100g,(1.46±0.35)s and(49.27±14.13)mL/(100 g·min)in the lesion peripheral region,(1.17±0.30)mL/100g,(1.51±0.37)s and(43.17±14.63)mL/(100 g·min)in the frontal lobe,and(1.21±0.35)mL/100g,(1.50±0.40)s and(49.25±20.85)mL/(100 g·min)in the temporal lobe.Compared with ischemic hemispheres,the hemorrhagic hemispheres showed significantly lower CBF in the peripheral region of the lesion(P<0.05).However,there's no statistical difference between two groups in term of aCBV and ATT.No evident statistical difference was seen in statistics of perfusion parameters of the frontal lobe and temporal lobe.Conclusions:Hemorrhagic moyamoya disease has the lower perfusion than ischemic moyamoya.pCASL can detect the grade of blood flow failure in adults with hemorrhagic moyamoya disease,monitor tiny ischemic changes in peripheral frontal and temporal lobes,which can provide a basis for further research on early detection of rebleeding by monitoring hemodynamics.