无明显术后认知功能障碍的乳腺癌患者脑血流变化

Cerebral Blood Flow Changes in Breast Cancer Patients without Significant Postoperative Cognitive Dysfunction

目的采用磁共振伪连续动脉自旋标记(PCASL)技术探索乳腺癌患者术后脑血流量(CBF)改变,同时采用神经心理学量表研究乳腺癌患者术后认知功能改变。方法选取接受外科手术的乳腺浸润性导管癌患者27例,以及年龄、受教育程度相匹配的健康志愿者33例,对所有受试者进行神经心理学量表评估以及全脑CBF和T1高分辨率结构像数据采集。一般资料、神经心理学量表评分以及相关性分析均采用SPSS19.0软件进行分析,磁共振数据采用SPM 8软件进行统计分析。结果乳腺癌术后患者与健康志愿者相比,年龄、受教育年限以及神经心理学量表评分均无显著性差异,但是左侧海马旁回、左侧岛叶、双侧额上回以及右后内侧额叶皮质CBF减低,并且术后天数与右后内侧额叶皮质、双侧额上回的CBF呈正相关。结论尽管乳腺癌患者术后没有出现认知功能的降低,但麻醉手术仍会导致多发脑区血流量减低。而右后内侧额叶皮质、双侧额上回的异常脑血流灌注随术后时间进展可以出现改善。

Objective To explore the changes of cerebral blood flow(CBF)in breast cancer patients after surgery by using pseudo continuous artery spin labeling(PCASL)technique,and to study the changes of cognitive function in breast cancer patients after surgery by using Neuropsychology scale.Methods Twenty-seven patients with invasive ductal carcinoma of the breast who underwent surgery and 33 healthy volunteers matched for age and education were selected.All subjects were assessed with the Neuropsychology scale and the whole brain CBF and T1 high-resolution structural image data were collected.General data,Neuropsychology scale scores and correlation analysis were analyzed by SPSS 19.0 software,and magnetic resonance data were analyzed by SPM-8 software.Results Compared with the healthy control group,the patients with breast cancer after surgery had no significant difference in age,education years and Neuropsychology scale scores,but the CBF in the left parahippocampal gyrus,left insular lobe,bilateral superior frontal gyrus and right posterior-medial frontal cortex decreased,and the course of disease after surgery was positively correlated with the CBF in the right posterior-medial frontal cortex and bilateral superior frontal gyrus.Conclusion Although the cognitive function of breast cancer patients does not decrease after surgery,anesthesia surgery still leads to multiple brain blood flow reduction.The abnormal cerebral blood flow perfusion in the right posterior-medial frontal cortex and bilateral superior frontal gyrus improved with time,suggesting that the pathological process is reversible.