应用三维动脉自旋标记成像分析脑白质病变患者脑血流量的研究

Analysis of cerebral blood flow in patients with white matter lesions by 3D arterial spin labeling imaging

目的探讨脑白质病变(white matter lesion,WML)患者是否存在低灌注。方法选取2018年5月至2019年3月首都医科大学电力教学医院的50~85岁的体检者进行头颅MRI检查,根据影像结果分为WML组(轻度组、中重度组)及正常体检组。所有纳入的受试者均应用三维动脉自旋标记(3D arterial spin labeling,3D ASL)成像技术测定侧脑室旁及半卵圆中心(深部白质)的局部脑血流量(regional cerebral blood flow,rCBF)。比较3组间各部位的rCBF,并分析rCBF与WML严重程度之间的相关性。结果共纳入62例受试者,其中WML组42例(轻度WML21例,中重度21例),正常体检组20例。3组间年龄及高血压病史占比的比较,差异均有统计学意义(P=0.000),性别、糖尿病、高脂血症、吸烟史、饮酒史的差异无统计学意义(P>0.05)。单因素分析显示,3组左侧侧脑室前角旁、左侧侧脑室后角旁、右侧侧脑室前角旁、右侧侧脑室后角旁、双侧侧脑室旁、左侧半卵圆中心、右侧半卵圆中心、双侧半卵圆中心的rCBF比较,差异均有统计学意义(P<0.05)。多元有序logistic回归分析显示,双侧侧脑室旁rCBF是影响脑室旁白质病变(periventricular lesions,PVL)评分的保护因素(OR=0.914,P=0.000),侧脑室旁rCBF越低,PVL评分越高;双侧半卵圆中心rCBF是影响深部脑白质病变(deep white matter lesion,DWML)评分的保护因素(OR=0.936,P=0.041),半卵圆中心rCBF越低,DWML评分越高。高血压是PVL及DWML评分的独立危险因素(OR=6.309,P=0.003;OR=7.933,P=0.001)。年龄对PVL及DWML无影响(P>0.05)。结论WML患者脑白质区域存在低灌注。

Objective To investigate a low perfusion exist or not in the patients with cerebral white matter lesions(WML).Methods The subjects aged 50-85 years old,who underwent physical examination in Beijing Electric Power Teaching Hospital,Capital Medical University,were divided into WML group and normal control group by MRI from May2018 to March 2019.3 D arterial spin labeling(3 D ASL)was used to measure the regional cerebral blood flow(rCBF)in all subjects’paraventricular and centrum semiovale(deep white matter).The rCBF in different parts of different groups was compared,and the correlation between rCBF and WML severity was analyzed.Results There were 62 subjects were enrolled in the study,42 cases in WML group(21 cases in mild subgroup,moderate and severe group,respectively),20 cases in nomal control group.There was significant differences in age and proportion of hypertension among the three groups(P=0.000).There were no significant differences in gender,diabetes mellitus,hyperlipidemia,smoking and drinking cases among the three groups(P>0.05).Univariate analysis showed that the rCBF around the left lateral ventricle anterior horn,the left lateral ventricle posterior horn,the right lateral ventricle anterior horn,the right lateral ventricle posterior horn,bilateral paraventricular,the left centrum semiovale,the right centrum semiovale and the bilateral centrum semiovales were all significantly different among the three groups(P<0.05).Multiple logistic regression analysis showed that the rCBF in bilateral paraventricular was the protective factor of periventricular lesion(PVL)score(OR=0.914,P=0.000),the lower the rCBF in paraventricular,the higher the PVL score.The rCBF in bilateral centrum semiovales was the protective factor of deep white matter lesion(DWML)score(OR=0.936,P=0.041),the lower the rCBF in centrum semiovales,the higher the DWML score.Hypertension was an independent risk factor for PVL and DWML(OR=6.309,P=0.003;OR=7.933,P=0.001).Age had no effect on PVL and DWML(P>0.05).Conclusions Patients with WML have low perfusion in the white matter area.