CAJ | 학술논문

目的：比较经颅多普勒超声（transcranial Doppler，TCD）与血管编码动脉自旋标记（vessel-encoded arterial spin-labeling, VE-ASL）技术在评价单侧颈内动脉系统狭窄患者侧支循环情况中的作用。方法对TCD及颈部血管彩超检查诊断为单侧颈内动脉或大脑中动脉中度以上狭窄或闭塞的患者30例，行MRA及VE-ASL MRI检查。①记录TCD检测到的狭窄侧狭窄远端及非狭窄侧同一深度大脑中动脉收缩期峰值血流速度以及VE-ASL测量的狭窄侧和非狭窄侧大脑中动脉供血区的脑血流量。②比较TCD和VE-ASL MRI两种方法检测到的脑动脉侧支循环情况差异。结果①TCD检测的狭窄侧狭窄远端及非狭窄侧同一深度大脑中动脉收缩期峰值血流速度平均分别为(31.6±10.5) cm/s,(83.1±9.2) cm/s。VE-ASL测量的大脑中动脉供血区CBF值平均为狭窄侧(22.5±9.8) mL·min-1·100g-1，非狭窄侧(31.7±8.3) mL·min-1·100g-1。狭窄侧/非狭窄侧收缩期峰值血流速度比值明显低于狭窄侧/非狭窄侧大脑中动脉供血区CBF比值（0.37±0.173 vs.0.66±0.141, P=0.001）。②TCD侧支循环检出率明显低于VE-ASL，分别为前循环侧支检出率26.7%vs.70%（P=0.001），后循环侧支检出率16.7%vs.60%（P<0.001），总的脑侧支循环检出率36.7%vs.86.7%（P<0.001）。结论 TCD评价脑动脉侧支循环情况不如无创的VE-ASL，主要受限于Willis环解剖变异以及软脑膜动脉侧支循环的形成。
목적：비교경로다보륵초성（transcranial Doppler，TCD）여혈관편마동맥자선표기（vessel-encoded arterial spin-labeling, VE-ASL）기술재평개단측경내동맥계통협착환자측지순배정황중적작용。방법대TCD급경부혈관채초검사진단위단측경내동맥혹대뇌중동맥중도이상협착혹폐새적환자30례，행MRA급VE-ASL MRI검사。①기록TCD검측도적협착측협착원단급비협착측동일심도대뇌중동맥수축기봉치혈류속도이급VE-ASL측량적협착측화비협착측대뇌중동맥공혈구적뇌혈류량。②비교TCD화VE-ASL MRI량충방법검측도적뇌동맥측지순배정황차이。결과①TCD검측적협착측협착원단급비협착측동일심도대뇌중동맥수축기봉치혈류속도평균분별위(31.6±10.5) cm/s,(83.1±9.2) cm/s。VE-ASL측량적대뇌중동맥공혈구CBF치평균위협착측(22.5±9.8) mL·min-1·100g-1，비협착측(31.7±8.3) mL·min-1·100g-1。협착측/비협착측수축기봉치혈류속도비치명현저우협착측/비협착측대뇌중동맥공혈구CBF비치（0.37±0.173 vs.0.66±0.141, P=0.001）。②TCD측지순배검출솔명현저우VE-ASL，분별위전순배측지검출솔26.7%vs.70%（P=0.001），후순배측지검출솔16.7%vs.60%（P<0.001），총적뇌측지순배검출솔36.7%vs.86.7%（P<0.001）。결론 TCD평개뇌동맥측지순배정황불여무창적VE-ASL，주요수한우Willis배해부변이이급연뇌막동맥측지순배적형성。
Objectives To evaluate the performances of transcranial Doppler (TCD) and vessel-encoded arterial spin labeling MRI perfusion imaging (VE-ASL) in the evaluation of collateral circulation of cerebral arteries. Methods Thirty patients with unilateral ICA or MCA stenosis diagnosed by TCD and carotid duplex ultrasound and confirmed by MRA underwent VE-ASL. Peak systolic velocity (PSV) of bilateral MCA in the same depth, distal to the stenosis site, was recorded. Cerebral blood flow (CBF) in bilateral MCA territories was measured by VE-ASL. The detection rates of collater-al flow using TCD and VE-ASL were compared. Results TCD revealed that PSV in the ipsilateral and contralateral MCA were (31.6 ± 10.5) cm/s and (83.1 ± 9.2) cm/s, respectively. VE_ASL revealed that CBF in the ipsilateral and contralateral MCA territory were (22.5±9.8) mL·min-1·100g-1 and (31.7±8.3) mL·min-1·100g-1, respectively. The PSV ratio of the ipsi-lateral/contralateral MCA was significantly lower than the CBF ratio of the ipsilateral/contralateral MCA(0.37 ± 0.173 vs. 0.66±0.141, P=0.001). The detection rates of collateral flow using TCD were lower than those using VE-ASL. The detec-tion rate was 26.7% vs. 70% on TCD vs. VE-ASL in anterior collateral circulation (P=0.001), was 16.7% vs. 60% (P<0.001) on TCD vs. VE-ASL in posterior collateral circulation. The total display rate of collateral flow was 36.7%vs. 86.7%on TCD vs. VE-ASL (P<0.001). Conclusions TCD is inferior to VE-ASL in evaluating the collateral circulation because of the limitations including the anatomical variations of the circle of Willis and formation of leptomenigeal anastomoses.