磁共振动脉自旋标记技术在缺血性脑血管病的应用研究

发布时间：2018-02-24 22:25

本文关键词： 磁共振成像动脉自旋标记技术缺血性脑血管病脑梗死短暂性脑缺血发作脑血流量　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用3.0T磁共振动脉自旋标记灌注技术(magnetic resonance perfusion imaging arterial spin labeling,MRI-ASL)对缺血性脑血管病进行扫描,对原始图像采用Functool处理,将重建图像与多种磁共振技术成像进行对照,探讨磁共振动脉自旋标记灌注成像技术在缺血性脑血管病中的应用价值。材料与方法:128例2015年7月至2016年6月在本院接受磁共振检查的脑血管病(ischemic cerebrovascular disease,ICVD)患者,其中脑梗死(cerebral infarction,CI)患者50例、短暂性脑缺血发作(transient ischemic attack,TIA)患者78例。所有患者均行磁共振常规扫描((T1WI、T2WI、T2-FLAIR)、磁共振弥散加权成像(diffusion weighted imaging,DWI))、磁共振血管成像(magnetic resonance angiography,MRA)和三维动脉自旋标记灌注成像(3D-ASL)。脑梗死患者组:测量ASL灌注异常面积和DWI信号异常面积,根据ASL灌注异常面积与DWI信号异常面积将患者分为ASLDWI组、ASL≈DWI组、ASLDWI组,研究分析患者ASL及DWI图像;TIA患者组:对检查结果分为MRA阳性+ASL阳性组、MRA阳性+ASL阴性组、MRA阴性+ASL阳性组、MRA阴性+ASL阴性组,统计分析各种检查技术及联合应用的临床价值。结果:脑梗死组:ASL灌注异常面积与DWI信号异常面积经配对t检验,差异有统计学意义(P0.01)。其中 ASLDWI 患者 47 例(47/50,94.0%),ASL≈DWI 患者 1 例(1/50,2.0%),ASLDWI 患者 2 例(2/50,4.0%)。TIA患者组:常规扫描及DWI显示信号异常的0例(0%);MRA显示血管异常的41例(52.6%);ASL显示灌注异常的患者47例(60.2%);两者联合应用显示异常患者60例(76.9%)。其中MRA阳性+ASL阳性的患者29例;MRA阳性+ASL阴性的患者12例;MRA阴性+ASL阳性的患者19例;MRA阴性+ASL阴性的患者18例。结论:结合患者临床症状和随访结果,ASL在缺血性脑血管病的临床诊断中有重要的意义,优于磁共振常规序列且方便易行。结合DWI扫描,能够确定脑梗死中半暗带的范围;可以提供短暂性脑缺血发作患者的血流灌注情况,与MRA、DWI联合应用能显著提高诊断准确率。应作为缺血性脑血管疾病的常规扫描序列。
[Abstract]:Objective: application of 3.0T arterial spin labeling magnetic resonance perfusion technique (magnetic resonance perfusion imaging arterial spin labeling, MRI-ASL) to scan the ischemic cerebrovascular disease, the original image is processed by Functool. The reconstructed image with various imaging magnetic resonance techniques were compared, to explore the application value of magnetic resonance perfusion imaging of arterial spin labeling in ischemic cerebrovascular disease. Materials and methods: 128 cases from July 2015 to June 2016 in cerebrovascular disease in our hospital for MRI (ischemic cerebrovascular disease ICVD (cerebral) in patients with cerebral infarction, including infarction, CI) in 50 patients with transient ischemic attack (transient ischemic, attack, TIA) 78 patients. All patients were underwent conventional MRI ((T1WI, T2WI, T2-FLAIR), diffusion weighted magnetic resonance imaging (diffusion weighted, imaging, DWI)), magnetic resonance angiography (magnetic resonance angiography, MRA) and 3D arterial spin labeling (3D-ASL) perfusion imaging in patients with cerebral infarction group. ASL: measurement of abnormal perfusion area and DWI abnormal signal area, according to the abnormal ASL perfusion area and DWI abnormal signal area were divided into ASLDWI group, ASL = DWI group, ASLDWI group, ASL and DWI were analyzed image; TIA group: the patients were divided into MRA positive +ASL positive group, MRA positive +ASL negative group, MRA negative and +ASL positive group, MRA negative and +ASL negative group, the clinical value of statistical analysis of various imaging techniques and combined application. Results: the cerebral infarction group: ASL perfusion area and DWI abnormal signal area by paired t test, the difference was statistically significant (P0.01). Among 47 cases of ASLDWI (47/50,94.0%), 1 cases of ASL patients (1/50,2.0% = DWI), 2 cases of patients with ASLDWI (2/50,4.0%).TIA group: conventional scan and DWI showed abnormal signal 0 Cases (0%); MRA showed 41 cases of vascular anomalies (52.6%); ASL showed 47 cases of abnormal perfusion of patients (60.2%); combination showed 60 cases with abnormal (76.9%). Among the 29 cases of MRA positive +ASL positive patients; 12 cases of MRA positive +ASL negative patients; 19 cases of MRA negative +ASL positive patients; 18 cases of patients with MRA +ASL negative. Conclusion: the combination of clinical symptoms and follow-up results of patients with ASL has important significance in clinical diagnosis of ischemic cerebrovascular disease, is better than conventional MR sequences and convenient. Combined with DWI scan, to determine the scope of the penumbra of cerebral infarction can provide; transient cerebral perfusion in patients with ischemic stroke, and MRA, DWI combined application can significantly improve the accuracy of diagnosis. As a routine scan sequence of ischemic cerebrovascular disease.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R743

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