中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2014年
5期
381-385
,共5页
王斌%朱凤萍%周茜%何光武%朱勇%姚振威%毛颖
王斌%硃鳳萍%週茜%何光武%硃勇%姚振威%毛穎
왕빈%주봉평%주천%하광무%주용%요진위%모영
脑底异常血管网病%磁共振成像%脑血管重建术
腦底異常血管網病%磁共振成像%腦血管重建術
뇌저이상혈관망병%자공진성상%뇌혈관중건술
Moyamoya disease%Magnetic resonance imaging%Cerebral revascularization
目的：探讨MRA评价烟雾病责任血管及术后重建血管价值，以及灌注加权成像（PWI）评价血管重建术前后脑血流动力学变化的价值。方法搜集经DSA证实并行单侧血管重建术的24例烟雾病患者，均在术前及术后行MRA及PWI检查，其中9例患者术后行DSA检查。由3名经验丰富的放射科医师对MRA图像与DSA图像进行比较。测量患者手术侧及对侧大脑中动脉（MCA）分布区、小脑对照区的灌注参数，包括脑血流量（ CBF）、脑血容量（ CBV）、平均通过时间（ MTT）及延迟时间（ DT），计算术侧MCA分布区/对侧MCA分布区及术侧MCA分布区/小脑对照区的灌注参数相对比值（ rCBF、rCBV、rMTT及rDT值）。采用配对t检验比较手术前后正态分布的PWI灌注参数相对值的差异。结果 MRA在显示颈内动脉及其大分支血管狭窄、烟雾血管及重建血管方面与DSA相仿，DSA显示侧支血管优于MRA，MRA原始图像可以提供颅脑解剖及病变信息。烟雾病患者术后手术侧MCA分布区与对侧镜像区的rCBF（1.30±0.27）及rCBV（1.26±0.21）明显高于术前rCBF（0.73±0.15）及 rCBV（0.98±0.12）（t 值分别为-7.91、-6.64，P 值均＜0.05）；rMTT （1.06±0.20）及rDT（1.07±0.18）明显低于术前rMTT（1.53±0.34）及rDT（1.40±0.26）（t值分别为5.62、5.40，P值均＜0.05）。术后手术侧MCA分布区与小脑对照区的rCBF（1.93±0.34）及rCBV （2.25±0.35）明显高于术前的rCBF（0.88±0.18）及rCBV（1.16±0.22）（t值分别为-3.04、-3.06， P值均＜0.05）；术后rMTT（1.13±0.29）及rDT（1.29±0.12）明显低于术前的rMTT（1.88±0.19）及rDT（3.29±0.47）（t值分别为4.01、4.72，P值均＜0.05）。结论 MRA可以作为一种评估烟雾病责任血管及术后重建血管的安全可靠方法。 PWI能检测烟雾病患者脑缺血部位及程度，可作为血管重建术的疗效评价的重要方法。
目的：探討MRA評價煙霧病責任血管及術後重建血管價值，以及灌註加權成像（PWI）評價血管重建術前後腦血流動力學變化的價值。方法搜集經DSA證實併行單側血管重建術的24例煙霧病患者，均在術前及術後行MRA及PWI檢查，其中9例患者術後行DSA檢查。由3名經驗豐富的放射科醫師對MRA圖像與DSA圖像進行比較。測量患者手術側及對側大腦中動脈（MCA）分佈區、小腦對照區的灌註參數，包括腦血流量（ CBF）、腦血容量（ CBV）、平均通過時間（ MTT）及延遲時間（ DT），計算術側MCA分佈區/對側MCA分佈區及術側MCA分佈區/小腦對照區的灌註參數相對比值（ rCBF、rCBV、rMTT及rDT值）。採用配對t檢驗比較手術前後正態分佈的PWI灌註參數相對值的差異。結果 MRA在顯示頸內動脈及其大分支血管狹窄、煙霧血管及重建血管方麵與DSA相倣，DSA顯示側支血管優于MRA，MRA原始圖像可以提供顱腦解剖及病變信息。煙霧病患者術後手術側MCA分佈區與對側鏡像區的rCBF（1.30±0.27）及rCBV（1.26±0.21）明顯高于術前rCBF（0.73±0.15）及 rCBV（0.98±0.12）（t 值分彆為-7.91、-6.64，P 值均＜0.05）；rMTT （1.06±0.20）及rDT（1.07±0.18）明顯低于術前rMTT（1.53±0.34）及rDT（1.40±0.26）（t值分彆為5.62、5.40，P值均＜0.05）。術後手術側MCA分佈區與小腦對照區的rCBF（1.93±0.34）及rCBV （2.25±0.35）明顯高于術前的rCBF（0.88±0.18）及rCBV（1.16±0.22）（t值分彆為-3.04、-3.06， P值均＜0.05）；術後rMTT（1.13±0.29）及rDT（1.29±0.12）明顯低于術前的rMTT（1.88±0.19）及rDT（3.29±0.47）（t值分彆為4.01、4.72，P值均＜0.05）。結論 MRA可以作為一種評估煙霧病責任血管及術後重建血管的安全可靠方法。 PWI能檢測煙霧病患者腦缺血部位及程度，可作為血管重建術的療效評價的重要方法。
목적：탐토MRA평개연무병책임혈관급술후중건혈관개치，이급관주가권성상（PWI）평개혈관중건술전후뇌혈류동역학변화적개치。방법수집경DSA증실병행단측혈관중건술적24례연무병환자，균재술전급술후행MRA급PWI검사，기중9례환자술후행DSA검사。유3명경험봉부적방사과의사대MRA도상여DSA도상진행비교。측량환자수술측급대측대뇌중동맥（MCA）분포구、소뇌대조구적관주삼수，포괄뇌혈류량（ CBF）、뇌혈용량（ CBV）、평균통과시간（ MTT）급연지시간（ DT），계산술측MCA분포구/대측MCA분포구급술측MCA분포구/소뇌대조구적관주삼수상대비치（ rCBF、rCBV、rMTT급rDT치）。채용배대t검험비교수술전후정태분포적PWI관주삼수상대치적차이。결과 MRA재현시경내동맥급기대분지혈관협착、연무혈관급중건혈관방면여DSA상방，DSA현시측지혈관우우MRA，MRA원시도상가이제공로뇌해부급병변신식。연무병환자술후수술측MCA분포구여대측경상구적rCBF（1.30±0.27）급rCBV（1.26±0.21）명현고우술전rCBF（0.73±0.15）급 rCBV（0.98±0.12）（t 치분별위-7.91、-6.64，P 치균＜0.05）；rMTT （1.06±0.20）급rDT（1.07±0.18）명현저우술전rMTT（1.53±0.34）급rDT（1.40±0.26）（t치분별위5.62、5.40，P치균＜0.05）。술후수술측MCA분포구여소뇌대조구적rCBF（1.93±0.34）급rCBV （2.25±0.35）명현고우술전적rCBF（0.88±0.18）급rCBV（1.16±0.22）（t치분별위-3.04、-3.06， P치균＜0.05）；술후rMTT（1.13±0.29）급rDT（1.29±0.12）명현저우술전적rMTT（1.88±0.19）급rDT（3.29±0.47）（t치분별위4.01、4.72，P치균＜0.05）。결론 MRA가이작위일충평고연무병책임혈관급술후중건혈관적안전가고방법。 PWI능검측연무병환자뇌결혈부위급정도，가작위혈관중건술적료효평개적중요방법。
Objective To evaluate the clinical value of MRA on the abnormal vessels in Moyamoya and cerebral revascularization , and to evaluate PWI in the observation of cerebral hemodynamics before and after cerebral revascularization.Methods Twenty-four patients with Moyamoya disease ascertained by DSA received cerebral revascularization on one side.MRA and PWI were performed for all patients before and after the operation , while DSA was performed after operation in nine patients to compare the images of MRA and DSA by three experienced radiologists.Perfusion parameters in terminal branches of middle cerebral artery ( MCA) on the operative side were compared with those on the contralateral sides and the cerebellum , including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and delay time ( DT) , as well as relative ratio ( values on the operative side/values on the contralateral side , and values on the operative side/values on the cerebellar region ) of perfusion parameters (rCBF, rCBV, rMTT and rDT) were calculated.Comparisons of the data between different groups were performed using paired Student′s t test.Results MRA was similar to DSA in displaying the internal carotid artery , main branches stenosis, Moyamoya vessels, and cerebral revascularization.DSA was better in displaying collateral vessels than MRA, but primary images of MRA provided anatomic and pathologic information of cerebral parenchyma.After the operations , rCBF (1.30 ±0.27) and rCBV (1.26 ±0.21) of MCA perfusion regions on the operative and the contralateral sides were higher than rCBF (0.73 ±0.15) and rCBV (0.98 ±0.12) before the operation significantly (t=-7.19,-6.64,P<0.05).rMTT (1.06 ±0.20) and rDT (1.07 ± 0.18) after the operation were lower than rMTT(1.53 ±0.34)and rDT (1.40 ±0.26) before the operation (t=5.62,5.40,P<0.05) .In MCA perfusion regions on the operative and cerebellar sides , rCBF(1.93 ± 0.34)and rCBV(2.25 ±0.35)were higher than rCBF(0.88 ±0.18)and rCBV(1.16 ±0.22)(t=-3.04,-3.06,P<0.05) before the operation.rMTT (1.13 ±0.29) and rDT (1.29 ±0.12) were lower than rMTT (1.88 ±0.19 ) and rDT ( 3.29 ±0.47 ) before the operation ( t =4.01, 4.72, P <0.05 ).Conclusions MRA is a safe , reliable method to evaluate abnormal vessels and cerebral revascularization after the operation in moyamoya disease.PWI can detect poor cerebral perfusion , and can be used for assessment of the effect of cerebral revascularization.
