CAJ | 학술논문

目的：利用3T磁共振的三维动脉自旋标记灌注加权成像（3D ASL）方法，通过观察全脑脑血流灌注情况，评价3D ASL在诊断交叉性小脑神经机能联系不能（CCD）的作用，并了解原发脑组织病变与CCD的关系。方法收集幕上单侧大脑中动脉供血区脑组织病变合并对侧小脑半球低灌注患者58例，利用3D ASL可定量测量脑组织的脑血流量（CBF）方法，测量双侧小脑半球脑组织的CBF的灌注情况，计算小脑不对称指数（AI），依据AI大于10％时诊断为CCD，并分析幕上病变与CCD之间的相关性。结果58例幕上单侧大脑中动脉供血区脑组织病变导致幕下对侧小脑半球低灌注区，以小脑半球下部明显；幕上单侧脑组织病变中55例均为脑梗死，脑外伤3例，脑梗死病变占绝大部分。幕上病灶均累及皮质－桥脑－小脑束的放射冠及以上的白质纤维走行通道；其中幕上脑组织的CBF值越低、其对侧小脑半球CBF测值越低，呈明显正相关性；幕上脑组织低灌注面积与CCD的发生无明显相关性。4例患者做了2次ASL检查，2例患者做了3次3D ASL检查，其CCD病变区小脑半球的血流量变化不明显。发出CCD的病程最短为1d，最长为1年2个月CCD小脑半球低灌注区以小脑下部明显，其CCD产生与幕上脑组织病变发生部位呈明显相关，与发病时间及病程无明显相关性。结论3D ASL作为一种新的灌注方法，能够无创的评价CCD的发生，其具有很好的诊断价值及能定量评估小脑半球低灌注程度，3D ASL为进一步研究CCD的发生机制提供广泛发展空间。
목적：이용3T자공진적삼유동맥자선표기관주가권성상（3D ASL）방법，통과관찰전뇌뇌혈류관주정황，평개3D ASL재진단교차성소뇌신경궤능련계불능（CCD）적작용，병료해원발뇌조직병변여CCD적관계。방법수집막상단측대뇌중동맥공혈구뇌조직병변합병대측소뇌반구저관주환자58례，이용3D ASL가정량측량뇌조직적뇌혈류량（CBF）방법，측량쌍측소뇌반구뇌조직적CBF적관주정황，계산소뇌불대칭지수（AI），의거AI대우10％시진단위CCD，병분석막상병변여CCD지간적상관성。결과58례막상단측대뇌중동맥공혈구뇌조직병변도치막하대측소뇌반구저관주구，이소뇌반구하부명현；막상단측뇌조직병변중55례균위뇌경사，뇌외상3례，뇌경사병변점절대부분。막상병조균루급피질－교뇌－소뇌속적방사관급이상적백질섬유주행통도；기중막상뇌조직적CBF치월저、기대측소뇌반구CBF측치월저，정명현정상관성；막상뇌조직저관주면적여CCD적발생무명현상관성。4례환자주료2차ASL검사，2례환자주료3차3D ASL검사，기CCD병변구소뇌반구적혈류량변화불명현。발출CCD적병정최단위1d，최장위1년2개월CCD소뇌반구저관주구이소뇌하부명현，기CCD산생여막상뇌조직병변발생부위정명현상관，여발병시간급병정무명현상관성。결론3D ASL작위일충신적관주방법，능구무창적평개CCD적발생，기구유흔호적진단개치급능정량평고소뇌반구저관주정도，3D ASL위진일보연구CCD적발생궤제제공엄범발전공간。
Objective To evaluate the use of three-dimensional arterial spin labeling perfusion weighted imaging (3D ASL) in the diagnosis of crossed cerebellar diaschisis (CCD) role by observing the whole brain perfusion of cerebral blood flow,. and to investigate the relationship between the primary brain lesions with CCD. Methods Tha data of 58 cases with supratentorial lesions associated with unilateral middle cerebral artery blood supply combined with contralateral cerebellar hemisphere hypoperfusion were collected..The cerebral blood flow of bilateral cerebellar hemisphere cerebellar was measured using 3D ASL and the asymmetry index (AI) was calculated. CCD was diagnosed if the AI was greater than 10%..The correlations between supratentorial lesion and CCD was analyzed..Results In 58 cases with unilateral supratentorial lesions supplied by middle cerebral artery resulted in contralateral hypoperfusion in infratentorial cerebellar hemisphere, especially in the lower part of cerebellar hemisphere. 55 of the unilateral supratentorial lesions were cerebral infarction, 3 were brain injury. All the supratentorial lesions involved the white matter along the cortex-pons-cerebellar tract..The lower CBF valued in the supratentorial brain tissue and the lower CBF valued in the contralateral cerebellar hemisphere,.which showed a positive correlation..There was no correlation between the occurrence of CCD and the size of low perfusion in supratentorial brain tissue..ASL was done twice in 4 patients and 3 times in 2 patients,.and there was no obvious changes of the CBF in the cerebellum CCD lesion hemisphere..CCD occurred during 1 day and 1 years 2 months after the disease..The occurrence of CCD was related to the location of supratentorial cerebral lesions and not related to the time of onset and duration..Conclusion As a new perfusion method,.3D ASL,.is capable of noninvasive evaluating the occurrence of CCD,.which has a good diagnostic value and can quantitatively assess the degree of cerebellar hemisphere low perfusion. .3D ASL provides more information for further study the mechanism of CCD.