ASL技术对2型糖尿病患者脑皮层血流的初步研究

A preliminary study of cerebral cortical blood flow in patients with type 2 diabetes mellitus by ASL

目的探讨应用ASL(arterial spin labeling,ASL)技术探测2型糖尿病患者脑皮质脑血流(cerebral blood flow,CBF)的改变。方法选取临床确诊的2型糖尿病患者(Type 2 diabetes mellitus,T2DM)21例为T2DM组及相匹配的对照组(healthy controls,HCs)21例。T2DM组及对照组均由神经专科医师行简易精神状态量表(mini mMental state examination,MMSE)评分。MRI扫描前,均进行空腹血糖及糖化血红蛋白实验室检查;MRI检查序列:常规MRI序列检查(T 1-FLAIR、T 2WI、T 2-FLAIR、DWI、ASL),以除外脑血管病、肿瘤等器质性病变。MRI检查结束后,应用GE-ADW4.6工作站将原始ASL序列进行后处理,得到相应脑皮质脑血流图(cerebral blood flow,CBF);应用基于Matlab的SPM、Dpabi软件对CBF图进行标准化、归一化、平滑化处理,之后应用脑皮层MASK模板提取脑皮质CBF值;应用SSPS17.0对T2DM、HCs组CBF数据进行统计学分析,并对T2DM组CBF与血糖值(blood glucose,Glu)、糖化血红蛋白值(glycated hHemoglobin,HbA1c)行Spearman相关性分析。结果T2DM组、对照组脑皮质CBF值差异有统计学意义(P<0.001);T2DM组CBF值与病史时间(P=0.885,r=0.03)、Glu值(P=0.081,r=0.389)、HbA1c值(P=0.261,r=0.26)无相关性。结论ASL技术可客观评价T2DM患者脑皮质脑CBF改变,为临床早期制定干预措施提供参考资料。

Objective To explore the changes of cortical cerebral blood flow in type 2 diabetic patients by using three-dimension arterial spin labeling(ASL)technique.Methods 21 patients with type 2 diabetes mellitus(T2DM)and 21 healthy controls(HCs)matched by age and sex were included.Mini mental state examination(MMSE)was scored by neurologists in both the patient group and the control group.Before MRI examination,fasting blood glucose and glycosylated hemoglobin were examined in laboratory.MR sequences included ASL,conventional MR sequence(T 1-FLAIR,T 2WI,T 2-FLAIR,DWI,excluding cerebrovascular diseases,tumors and other organic lesions).After MR examination,the ASL sequence was processed by GE-ADW4.6 workstation,and the corresponding cortical cerebral blood flow(CBF)map was obtained.The SPM and Dpabi software based on MATLAB were used to standardize,normalize and smooth CBF maps,and then the whole brain MASK template was used to extract brain CBF values.The CBF data of T2DM and HCs groups were analyzed by SSPS 17.0 with independent sample T test.The correlation between CBF and blood glucose(Glu),glycosylated hemoglobin(HbA1c)and medical history was analyzed by Spearman.Results There were significant differences in CBF values of whole brain between T2DM and HCs groups(P<0.001).There was no correlation between CBF values of T2DM group and history time(P=0.885,r=0.03),Glu values(P=0.081,r=0.39),HbA1c values(P=0.261,r=0.26).Conclusion 3D-pCASL technology can objectively evaluate CBF changes in patients with T2DM,and provide reference information for early clinical intervention.