多模态磁共振灌注成像技术在颅内动脉粥样硬化性狭窄中的对比研究

发布时间：2018-02-09 11:01

本文关键词： 短暂性脑缺血发作动脉自旋标记动态磁敏感加权灌注成像假连续式动脉自旋标记灌注成像颅内动脉粥样硬化自旋标记动脉到达时间动态磁敏感成像　出处：《中国人民解放军医学院》2016年硕士论文　论文类型：学位论文

【摘要】：第一部分：多参数准连续式动脉自旋标记与动态磁敏感增强灌注成像在短暂性脑缺血发作中的对比研究目的：本研究采用多参数三维假连续式动脉自旋标记灌注成像(three-dimensional pseudo-continuous arterial spin labeling,3D pCASL)与动态磁敏感增强灌注成像(dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC PWI)对短暂性脑缺血发作(transient ischemic attack, TIA)患者进行成像,比较两者对责任病灶的检出率。方法：连续纳入39例临床诊断TIA患者，并在首次发作24小时内进行磁共振检查。扫描序列包括常规头颅MR成像、MRA (magnetic resonance angiography, MRA), DW1、3D pCASL(选取两个标记延迟时间post-labeling time, PLD, PLD=1.5s及PLD=2.5s),DSC PWI。后处理获取3D pCASL的脑血流(cerebral blood flow, CBF)图像和DSC PWI的Tmax图像。比较不同灌注方法与MRA及DWI结合法对于缺血病灶检出率和缺血面积。结果：就TIA患者的缺血病灶检出率而言,3D pCASL (PLD 1.5s及PLD2.5s)的CBF图像与DSC PWI Tmax对比无差异;3D pCASL (PLD1.5s)的CBF图像对于缺血的检出率高于MRA结合DWI法;DSC PWI Tmax、3D pCASL (PLD2.5s)CBF与MRA结合DWI法无差异。就显示低灌注面积而言,3D pCASL(PLD1.5s)的CBF图像显示的面积最大,其次是DSC PWI Tmax,而3D pCASL (PLD2.5s)的CBF图像显示的低灌注面积最小。结论：3D pCASL脑灌注成像技术无创、快速、可重复性强,推荐作为临床可疑TIA患者的影像筛查手段,不同PLD的3D pCASL序列对于病灶的检出及缺血面积的显示有差异,选择较短PLD有可能提高病灶的检出率。第二部分：增强型准连续动脉自旋标记灌注成像技术对于重度颅内粥样硬化性狭窄低灌注定量测量的研究目的：本研究采用多参数增强型准连续式动脉自旋标记动脉成像(enhance pseudo-continuous arterial spin labeling, e-pCASL)获取颅内动脉粥样硬化性狭窄患者脑血流量(cerebral blood flow, CBF)图,并与传统的动态磁敏感增强灌注成像(dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC PWI)及准连续式动脉自旋标记灌注成像(pseudo-continuous arterial spin labeling, pCASL)进行比较，，使用DSC PWI为金标准,对比研究三种灌注方式测量CBF比值的差异性与相关性。方法：纳入重度颅内动脉粥样硬化性狭窄患者39例，同时行e-pCASL、pCASL和DSC PWI成像,根据狭窄动脉责任供血区域,经验性手工勾勒感兴趣区(ROI)进行测量,获得CBF值,使用镜像法获得对侧CBF比值,对三种灌注方式的CBF比值进行SNK方差分析。同时基于e-pCASL获取动脉通过时间(arterial transit time,ATT)，基于DSC PWI获取最大达峰时间(time to peak TTP)。使用ATT和TTP进行分层分析,对于e-pCASL CBF比值、pCASL CBF比值与DSC PWI rCBF比值进行析因方差分析和相关性分析。结果e-pCASL CBF比值与DSC PWI rCBF比值相关性(r=0.871)高于pCASL CBF比值与DSC PWI rCBF比值相关性(r=0.642)。使用TTP分层数据显示，TTP及灌注方法的选择在重度动脉狭窄患者患侧与健侧的CBF比值中无明显差异。根据ATT分组显示，e-pCASL CBF与DSC PWI rCBF比值的相关性在不同ATT时间均较高。结论：e-pCASL在重度动脉狭窄患者中与DSC PWI在CBF定量测量中一致性和相关性较好,且不受ATT因素的影响,具有准确、简便、无刨、可重复性好的特点。
[Abstract]:The first part: the comparison of multi parameter quasi continuous arterial spin labeling and dynamic susceptibility contrast perfusion imaging in transient ischemic attack: This study adopts multi parameter three-dimensional pseudo continuous arterial spin labeling (three-dimensional pseudo-continuous arterial spin labeling, 3D pCASL) and dynamic susceptibility contrast perfusion imaging (dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC PWI) for transient ischemic attack (transient ischemic attack, TIA) for imaging patients, compared to the detection rate of lesions responsible. Methods: a total of 39 consecutive patients with a clinical diagnosis of TIA patients, and magnetic resonance imaging in the first attack within 24 hours. The scanning sequences included conventional MR imaging MRA (magnetic resonance, angiography, MRA), DW1,3D pCASL (select two mark delay time post-label Ing time, PLD, PLD=1.5s and PLD=2.5s), DSC PWI. postprocessing of cerebral blood flow to obtain 3D pCASL (cerebral blood flow, CBF Tmax and DSC PWI) image. Comparison of different perfusion methods with MRA and DWI combined method for ischemic lesion detection rate and ischemic area. Results: the detection of TIA in patients with ischemic lesions the rate of 3D, pCASL (PLD 1.5s and PLD2.5s CBF) and DSC PWI Tmax image contrast has no difference; 3D pCASL (PLD1.5s) CBF image for ischemia detection rate is higher than that of MRA combined with DWI DSC PWI Tmax, 3D; pCASL (PLD2.5s) CBF and MRA combined with DWI method. No difference showed low perfusion area 3D, pCASL (PLD1.5s) CBF image display area is the largest, followed by DSC PWI Tmax, and 3D pCASL (PLD2.5s) CBF images showed the low perfusion area minimum. Conclusion: 3D pCASL brain perfusion imaging is non-invasive, rapid, reproducible, recommended as clinically suspected TIA Image screening method for patients with 3D, pCASL PLD are different for different sequence detection and display area of ischemic lesions, choose shorter PLD may improve the detection rate of lesions. The second part: enhanced quasi continuous arterial spin labeling for the purpose of severe intracranial atherosclerotic stenosis: quantitative measurement of low perfusion this research adopts multi parameter enhanced quasi continuous arterial spin labeling (enhance pseudo-continuous arterial spin artery imaging labeling, e-pCASL) for intracranial atherosclerotic stenosis in patients with cerebral blood flow (cerebral blood, flow, CBF), and the traditional dynamic magnetic susceptibility enhancement perfusion imaging (dynamic susceptibility contrast enhanced perfusion-weight imaging, DSC and PWI) quasi continuous arterial spin labeling (pseudo-continuous arterial spin labeling, pCASL). For comparison, the use of DSC PWI as the gold standard, the difference comparison of three kinds of perfusion measurements of CBF ratio and correlation. Methods: in patients with severe intracranial atherosclerotic stenosis in 39 cases, while e-pCASL, pCASL and DSC PWI imaging, according to arterial stenosis of feeding area, empirical hand sketched a region of interest (ROI) measure the CBF value, the ratio of CBF side using mirror method, the ratio of CBF to three kinds of perfusion SNK variance analysis. At the same time, based on the e-pCASL obtained through time (arterial transit artery time, ATT, DSC) based on PWI to obtain the peak time (time to peak TTP) using ATT and TTP. Stratified analyses were performed for the e-pCASL pCASL CBF ratio, CBF ratio and DSC PWI ratio of rCBF factorial variance analysis and correlation analysis. The results of e-pCASL CBF and DSC PWI rCBF ratio Ratio correlation (R =0.871) was higher than that of pCASL CBF The value of DSC PWI rCBF and the ratio of correlation (r=0.642). Using the TTP hierarchical data show that no significant difference between the CBF ratio and TTP perfusion method in patients with severe arterial stenosis and the contralateral side of the ATT packet. According to the correlation between e-pCASL and DSC showed that CBF PWI rCBF ratio of ATT at different time were higher. Conclusion: e-pCASL in severe artery stenosis in patients with DSC and PWI CBF in the quantitative measurement of consistency and correlation, and is not affected by the factors of ATT, accurate, simple, noninvasive, reproducible characteristics.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.2;R743

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