高分辨率MRI技术与动态对比增强MRI技术用于中枢神经系统血管炎诊断及预后评价中的价值

Value of high-resolution MRI technology and dynamic contrast-enhanced MRI technology in diagnosis and prognosis evaluation of central nervous system vasculitis

目的 分析高分辨率(HR)MRI技术与动态对比增强(DCE)MRI技术用于中枢神经系统血管炎(central nervous system vasculitis, CNSV)诊断及预后评价中的价值。方法 选择2021年5月至2022年4月在焦作市第二人民医院就诊的43例单侧大脑中动脉(middle cerebral artery, MCA)M1段狭窄且疑似存在CNSV的病例,先通过HR-MRI检查判断病例是否存在CNSV,并了解其管腔狭窄情况。然后开展DCE-MRI检查,并利用专业软件对DCE-MRI图像进行处理,得到容量转移常数(Ktrans),比较不同类型组间病灶区和对侧镜像区Ktrans及组内治疗前后病灶区Ktrans。结果 43例就诊病例中,28例被证实存在CNSV,其中9例无脑梗死,13例急性或亚急性期脑梗死,6例慢性期脑梗死。三类患者管腔狭窄程度及范围比较差异无统计学意义(P>0.05);三类患者病灶区Ktrans比较有显著差异,其中急性-亚急性期脑梗死患者病灶区Ktrans明显高于其他两类患者(P<0.05),慢性期脑梗死患者Ktrans明显高于无脑梗死患者(P<0.05);急性-亚急性期、慢性期脑梗死患者病灶区Ktrans均明显高于对侧镜像区(P<0.05),治疗6个月后病灶区Ktrans明显低于治疗前(P<0.05)。结论 通过HR-MRI检查可对管腔狭窄情况进行了解,并可对伴MCA M1段狭窄的CNSV起到一定诊断作用;DCE-MRI中的定量参数Ktrans对CNSV患者预后具有一定评价作用。

Objective To analyze the value of high-resolution(HR) MRI technology and dynamic contrast-enhanced(DCE) MRI technology in the diagnosis and prognosis evaluation of central nervous system vasculitis(CNSV). Methods Forty-three patients with unilateral middle cerebral artery(MCA) M1 segment stenosis and suspected CNSV who were treated in our hospital from May 2021 to April 2022 were taken. Firstly, the presence of CNSV in the case was determined by HR-MRI examination, and the stenosis of the lumen was understood. Then DCE-MRI examination was carried out, and professional software was used to process DCE-MRI images to obtain the volume transfer constant(Ktrans), the Ktrans of the lesion area and the contralateral mirror area between different types of groups and the Ktrans of the lesion area before and after treatment within the group were compared. Results Among the 43 cases, 28 were confirmed to have CNSV, of which 9 had no cerebral infarction, 13 had acute or subacute cerebral infarction, and 6 had chronic cerebral infarction. There was no obvious difference in the degree and extent of lumen stenosis among the three types of patients(P>0.05);There were obvious differences in the Ktrans of the lesions in the three types of patients, among them, the Ktrans in the focal area of patients with acute-subacute cerebral infarction was obviously higher than that of the other two types of patients(P<0.05), Ktrans in patients with chronic cerebral infarction was obviously higher than that in patients without cerebral infarction(P<0.05);The Ktrans in the lesion area of patients with acute-subacute and chronic cerebral infarction were obviously higher than those in the contralateral mirror area(P<0.05), after 6 months of treatment, Ktrans in the lesion area was obviously lower than that before treatment(P<0.05). Conclusion HR-MRI examination can understand the lumen stenosis, and can play a certain role in the diagnosis of CNSV with MCA M1 stenosis;the quantitative parameter Ktrans in DCE-MRI has a certain role in evaluating the prognosis of CNSV patients.