DTI及ASL在亚急性期脑出血后交叉性小脑神经机能障碍的应用

Application of DTI and ASL in Crossed Cerebellar Diaschisis after Subacute Cerebral Hemorrhage

目的 探讨3.0 T磁共振扩散张量成像(DTI)与动脉自旋标记(ASL)脑灌注成像技术在单侧幕上亚急性期脑出血后交叉性小脑神经机能障碍(CCD)的诊断价值.方法 回顾性分析30例单侧幕上亚急性期脑出血后CCD的患者,测量双侧小脑半球的平均扩散系数(DCavg)、脑血流量(CBF)及双侧小脑中脚,各向异性分数(FA)值,计算小脑半球CBF的不对称指数(AI),分析CCD现象的对侧小脑中脚FA值、对侧小脑半球DCavg值和CBF值的变化及其相关性.结果30例CCD患者病变对侧小脑半球CBF值为(29.139±9.359)ml·100 g^(-1)·min^(-1),同侧小脑的 CBF 值为(36.269±11.168)ml·100 g^(-1)·min^(-1),AI 值(22.096±11.512)%,两侧小脑半球的CBF值差异有统计学意义(t=6.79,P<0.001);同侧小脑中脚FA值为0.596±0.032,对侧小脑中脚FA值为0.470±0.081,差异有统计学意义(t=9.770,P<0.001);对侧小脑半球 DCavg 值为(0.759±0.004)×10^(-3)mm^(2)/s,同侧小脑半球DCavg值为(0.785±0.049)×10^(-3)mm^(2)/s,差异具有统计学意义(t=4.292,P<0.001).对侧小脑半球的CBF值与DCavg值呈高度相关(r=0.743,P<0.001);对侧小脑半球的CBF值与小脑中脚FA值呈中度相关性(r=0.475,P<0.05).幕上脑出血合并CCD的患者对侧小脑中脚FA值及对侧小脑半球DCavg值的降低表示神经纤维束的完整性被破坏,这表明了 CCD的发生与皮质-脑桥-小脑(CPC)的纤维束通路受阻有关.结论 单侧幕上亚急性期脑出血后发生CCD现象,FA值、DCavg值和CBF值可有效评估小脑半球纤维束的破坏程度及小脑低灌注程度,DCavg值与CBF值呈明显相关.

Objective To investigate the value of Diffusion Tensor Imaging(DTI)and Arterial Spin Labeling(ASL)imaging in the diagnosis of the crossed cerebellar diaschisis(CCD)after unilateral supratentorial subacute cerebral hemorrhage in 3.0 T MRI.Methods 30 cases of unilateral supratentorial subacute cerebral hemorrhage complicated with CCD were retrospectively analyzed.Average diffusion coefficient(DCavg)and Cerebral blood flow(CBF)value of bilateral cerebellum and Fractional Anisotropy(FA)value of bilateral cerebellum were measured,the asymmetry index of cerebral blood flow in cerebellum was calculated.The change and correlation of foot FA value,DCavg value and CBF value in contralateral cerebellum were analyzed.Results The average CBF of contralateral cerebellar in 30 patients with CCD was(29.139±9.359)ml·100 g^(-1)·min^(-1),and the average CBF of ipsilateral cerebellar hemispheres was(36.269±11.168)ml·100 g^(-1)·min^(-1),the AI value was(22.096±11.512)%.There was significant difference in CBF between ipsilateral cerebellar hemispheres and contralateral cerebellar hemispheres(t=6.79,P<0.001).The average FA of ipsilateral medipeduncle was 0.596±0.032,and the average FA of contralateral medipeduncle was 0.470±0.081.There was significant difference(t=9.770,P<0.001).The average DCavg of contralateral cerebellar hemisphere was(0.759±0.004)×10^(-3)mm^(2)/s,and the mean DCavg of ipsilateral cerebellar hemisphere was(0.785±0.049)10^(-3)mm^(2)/s,the difference was statistically significant(t=4.292,P<0.001).There was a significant correlation between CBF and DCavg values in the contralateral cerebellar hemisphere(r=0.743,P<0.001),and a moderate correlation between CBF of contralateral cerebellar hemispheres and FA of contralateral medipeduncle(r=0.475,P<0.05).The decrease of FA in medipeduncle and DCavg in cerebellar hemisphere of the Patients with supratentorial intracerebral hemorrhage complicated with CCD indicates the destruction of the integrity of fiber bundles,indicating that the occurrence of CCD was related to the obstruction of the fiber bundle pathway of cortex-pons-cerebellum(CPC).Conclusion CCD can occur after supratentorial subacute cerebral hemorrhage.FA,DCavg and CBF values can evaluate the degree of cerebellar hemispheric fiber bundle destruction and cerebellar hypoperfusion,and DCavg values are significantly correlated with CBF values.