磁共振3D ASL全脑灌注成像在动脉瘤性蛛网膜下腔出血后延迟性脑缺血中的应用研究

发布时间：2018-03-17 12:00

本文选题：动脉瘤性蛛网膜下腔出血　切入点：3D　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨磁共振三维动脉自旋标记(three-dimension arterial spin labeling,3D ASL)在动脉瘤破裂引发蛛网膜下腔出血后迟发性脑缺血中的早期临床预测价值。方法:1、回顾性分析2015年11月~2016年6月我院收治的动脉瘤性蛛网膜下腔出血(aneurismal subarachnoid hemorrhage,a SAH)患者的临床资料,所有患者均在动脉瘤破裂蛛网膜下腔出血后的3~14 d内行磁共振3D ASL检查,术后随访3个月,将所有aSAH患者自然分为DCI组和非DCI组,另外选取同期收治的10例动脉瘤未破裂出血患者作为对照组。2、将全部病例原始数据导入GE MR ADW4.6工作站进行移动校正及降噪处理后,利用Functool软件进行图像后处理,依据脑血管供血区,同时结合伪彩图显示的脑血流灌注异常区定义感兴趣区(region-of-interest,ROI),测定相应区域的灌注参数值。3、采用SPSS 19.0统计软件对数据进行分析。结果:1、30例a SAH患者中,11例发生了DCI,19例未发生DCI,aSAH后DCI的发生率为36.7%,DCI患者早期临床危重状态(Fisher3~4级)所占比例明显高于非DCI组。2、DCI组、非DCI组和对照组患者的脑血流灌注异常程度存在差异,且差异有统计学意义(Chi-Square统计量为17.540,P=0.000)。aSAH患者脑血流灌注减低程度与改良Rankin评分(Modified Rankin Scale,mRS)评分呈显著正相关(r=0.955,P=0.000)。aSAH后早期脑血流灌注(early cerebral blood flow perfusion,CBF)明显减低的患者,发生DCI的风险会明显增加。3、Logistic回归分析显示脑血流灌注减低程度(OR,0.453;95%CI,0.236~0.866;P 0.017)、改良Fisher分级(OR,0.127;95%CI,0.028~0.567;P 0.007)与DCI的发生显著相关,是DCI的危险因素。4、受试者工作曲线(receptor operation,ROC)曲线说明CBF值对DCI的预测价值尚不能确定,而CBF比值和AI值的ROC曲线下面积为0.9070.9,P值0.05,有统计学意义,说明二者对DCI早期诊断价值较高。结论:磁共振3D ASL作为一种有效的检测工具,是目前常规脑灌注技术的有效补充,对DCI患者的早期诊断和aSAH患者的早期预后评估有重要价值。
[Abstract]:Objective: to investigate the early clinical predictive value of three-dimensional arterial spin labeling 3D ASL in delayed cerebral ischemia after subarachnoid hemorrhage caused by aneurysm rupture. Methods: 1, retrospective analysis was made from November 2015 to June 2016. Clinical data of patients with aneurysm subarachnoid hemorrhage (SAH) treated in our hospital. MRI 3D ASL was performed in all patients within 14 days after aneurysm rupture. All patients with aSAH were followed up for 3 months. All patients with aSAH were naturally divided into DCI group and non-#en3# group. In addition, 10 patients with unruptured aneurysm bleeding were selected as control group. The original data of all cases were imported into GE Mr ADW4.6 workstation for movement correction and noise reduction. The image was processed by Functool software. According to the blood supply area of cerebral vessels, At the same time, combined with the definition of abnormal area of cerebral blood flow perfusion shown by pseudo-color map, region-of-interest ROI was used to determine the perfusion parameter value of the corresponding area. The data were analyzed by SPSS 19.0 software. Results among the 30 patients with a SAH, 11 cases had DCII and 19 cases had DCI. The incidence of DCI in patients without DCI aSAH was 36.7%. The incidence of DCI was significantly higher than that of non-DCI group (36.7%), and the incidence of DCI was significantly higher than that of non-DCI group (36.7%), and the incidence of DCI was significantly higher than that of non-DCI group (36.7%). The degree of abnormal cerebral blood flow perfusion was different between non-#en0# group and control group. There was a significant positive correlation between the degree of cerebral blood flow perfusion reduction and the modified Rankin score modified Rankin scale mRSs in patients with cerebral blood flow perfusion of 17.540 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000 ~ 0.000, respectively. Logistic regression analysis showed that the degree of cerebral blood flow perfusion decrease was 0.45395% (P 0.017), and the risk of DCI was 0.127 ~ 95% (P 0.017). There was a significant correlation between the degree of cerebral blood perfusion reduction and the incidence of DCI. It is the risk factor of DCI. The operating curve indicates that the predictive value of CBF value to DCI is uncertain, while the area under ROC curve of CBF ratio and AI value is 0.9070.9 (P = 0.05), which has statistical significance. Conclusion: Mr 3D ASL, as an effective detection tool, is an effective supplement of conventional cerebral perfusion technique, and has important value in early diagnosis of DCI patients and early prognosis evaluation of aSAH patients.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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