单侧大脑中动脉M1段慢性闭塞后突出血管征与脑灌注对照研究

A comparative study of cerebral perfusion and prominent vessel sign after unilateral middle cerebral artery M1 segment chronic occlusion

目的探讨单侧大脑中动脉(MCA)M1段慢性闭塞后,突出血管征(PVS)在脑灌注状态及临床预后评估方面的应用价值。方法收集2018年1月至2021年5月南京中医药大学连云港附属医院单侧MCAM1段慢性闭塞患者42例,男性24例、女性18例,年龄(53.2±8.9)岁。依据T2*加权血管成像(SWAN)序列PVS显示差异分为PVS阳性组(17例)和PVS阴性组(25例),于三维动脉自旋标记(3D arterialspinlabeling,3D ASL)序列脑血流量(CBF)伪彩图选择闭塞侧MCA供血区额叶、顶叶、颞叶及脑室旁白质区感兴趣区[ROI=(200±20)mm2],比较两组患者CBF值差异,并随访两组患者6个月内缺血性脑血管病发生率。计量资料采用独立样本t检验,等级资料采用秩和检验。结果PVS阳性组额叶CBF值为(33.54±6.40)ml/min×100 g,顶叶CBF值为(32.68±7.13)ml/min×100 g,颞叶CBF值为(33.79±6.87)ml/min×100 g,侧脑室旁白质区CBF值为(29.81±5.94)ml/min×100 g,均低于PVS阴性组,差异均有统计学意义(均P<0.05)。PVS阳性组6个月内缺血性脑血管病事件发生率为70.59%(12/17),明显高于PVS阴性组,差异有统计学意义(P<0.05)。结论单侧MCAM1段闭塞后,PVS与脑血流灌注状态密切相关,在临床预后评估方面亦具有重要价值。

Objective To investigate the value of prominent vessel sign(PVS)in the evaluation of cerebral perfusion and clinical prognosis after unilateral middle cerebellar artery(MCA)M1 segment chronic occlusion.Methods A total of 42 patients with unilateral MCA M1 segment chronic occlusion in Nanjing University of Chinese Medicine Affiliated Lianyungang Hospital from January 2018 to May 2021 were collected,including 24 males and 18 females,aged(53.2±8.9)years.They were divided into a PVS positive group(17 cases)and a PVS negative group(25 cases)according to the PVS display difference of T2 star weighted anatomy(SWAN)sequence.The frontal lobe,parietal lobe,temporal lobe,and paraventricular white matter region of interest[ROI=(200±20)mm2]of occlusive MCA were selected by the cerebral blood flow(CBF)pseudo-color images of 3D arterial spin labeling(3D ASL)sequence.The CBF values of the two groups were compared,and the incidences of ischemic cerebrovascular diseases in the two groups were followed up within 6 months.Independent sample t test was used for measurement data,and rank sum test was used for ranked data.Results The CBF values of frontal lobe,parietal lobe,temporal lobe,and paraventricular white matter region of interest in the PVS positive group were(33.54±6.40)ml/min×100 g,(32.68±7.13)ml/min×100 g,(33.79±6.87)ml/min×100 g,and(29.81±5.94)ml/min×100 g,which were lower than those in the PVS negative group,with statistically significant differences(all P<0.05).The incidence of ischemic cerebrovascular diseases in the PVS positive group within 6 months was 70.59%(12/17),which was higher than that in the PVS negative group,with a statistically significant difference(P<0.05).Conclusion After M1 segment occlusion of unilateral MCA,PVS is closely related to cerebral blood flow perfusion,which has an important value in clinical prognosis evaluation.