动脉自旋标记与动态磁敏感对比增强MRI在脑卒中缺血半暗带的对照研究

发布时间：2018-05-26 21:55

本文选题：磁共振成像 + 动脉自旋标记　；参考：《苏州大学》2014年硕士论文

【摘要】：1目的对照研究动脉质子自旋标记（arterial spin labeling，ASL）与动态磁敏感对比增强MRI (dynamic susceptibility contrast-enhanced MRI，DSC-MRI)在评价脑卒中缺血半暗带中的应用价值。 2材料与方法对34例发病12h内的急性脑卒中患者行常规MRI、扩散加权成像（DWI）、ASL和DSC检查。ASL检查方法采用单、多相位技术进行扫描，单相位ASL反转时间TI=1800ms；多相位ASL，相位数为8，每个相位之间相差300ms（TI=300ms，600ms，900ms，1200ms，1500ms，1800ms，2100ms，2400ms）。DSC采用平面回波-自由衰减（EPI-FID）序列，采集40次，，在第4次扫描时利用高压注射器快速团注钆喷酸葡胺Gd-DTPA0.2mmol/kg，流率为5mL/s。观察2种技术的灌注特点，包括低灌注、高灌注、正常灌注、是否伴有局部高灌注。采用SPSS17.0软件进行统计学分析。分别将2种灌注技术与DWI结合来评价缺血半暗带（ischemic penumbra，IP），2种灌注技术评价结果采用Mann-Whitney(曼-惠特尼)U检验做定性分析；以DWI显示的最大病变为标准层面，分别测量2种技术异常灌注范围大小，结果采用独立样本t检验做定量分析。 3结果定性分析，34例患者中32例2种灌注方法判断结果一致（低灌注30例，其中存在IP17例，不存在IP13例；高灌注2例），两者间差异无统计学意义（Z=-0.054，P0.05）。定量分析，34例患者2种灌注技术显示的最大病变层面异常灌注区面积大小，SDSC=27.1714.07cm2，SASL=29.1012.72cm2，两者间差异无统计学意义（t=-0.499，P0.05）。 2例2种技术灌注结果不一致（2例ASL均表现为高灌注，DSC均为正常灌注）；6例患者ASL图显示低灌注区伴局部高灌注，占整个低灌注患者的20%（6/30），而DSC不存在此表现。 4结论 4.1无创性ASL技术与DSC技术对评价脑卒中IP具有较好的一致性。 4.2ASL对显示脑卒中高灌注、低灌注区伴局部高灌注（提示侧枝循环存在）可能比DSC更敏感。
[Abstract]:1 purpose To evaluate the value of proton spin-labeled arterial spin labeling (ASL) and dynamic susceptibility contrast-enhanced MRII-DSC-MRI in evaluating ischemic penumbra in stroke. 2 Materials and methods Thirty-four patients with acute stroke within 12 hours after onset were examined by conventional MRI, diffusion weighted imaging (DWI) ASL and DSC. The inversion time of single phase ASL was 1800ms, the phase number of multi-phase ASL was 8, and the difference between each phase was 300ms / t 600ms / 600ms / 100ms / 100ms / 1500ms / 1 500ms / 1. DSCA was collected 40 times by plane echo / free attenuation EPI-FID.Gd-DTPA 0.2mmolkgkg was injected with a high pressure injector at the fourth scanning time, and the flow rate was 5mLrs / kg. The flow rate was 5mLrs-1 / kgGd-DTPA 0.2mmolkg-1 路kgGd-DTPA 0.2mmol / kg, and the flow rate was 5mLrs-1 / kg, using planar echo / free attenuating EPI-FIDS sequence. The perfusion characteristics of the two techniques were observed, including low perfusion, high perfusion, normal perfusion and local hyperperfusion. SPSS17.0 software was used for statistical analysis. Two perfusion techniques were combined with DWI to evaluate the results of two perfusion techniques in ischemic penumbra. Mann-Whitney (Mann-Whitney U test) was used for qualitative analysis, and the maximum lesion displayed by DWI was taken as the standard level. The range of abnormal perfusion of the two techniques was measured, and the results were quantitatively analyzed by independent t-test. 3 results The qualitative analysis showed that 32 cases of 34 patients had the same results by two perfusion methods (30 cases of low perfusion, including 30 cases of IP17, no case of IP13, and 2 cases of hyperperfusion, the difference was not statistically significant (P 0.05). Quantitative analysis showed that the area of abnormal perfusion area at the maximum lesion level was 27.1714.07cm ~ (2) and (29.1012.72) cm ~ (2). There was no significant difference between the two methods. There was no significant difference between the two groups (P _ (0.05). The results of two different perfusion techniques were inconsistent in 2 cases. All of the 2 cases of ASL showed that the hyperperfusion was normal in 6 cases. The ASL of 6 cases showed low perfusion area with local hyperperfusion, accounting for 20% 30% of the total hypoperfusion patients, but DSC did not. 4 conclusion 4.1 Non-invasive ASL and DSC techniques are consistent in assessing stroke IP. 4.2ASL may be more sensitive than DSC in showing stroke hyperperfusion, low perfusion with local hyperperfusion (indicating the presence of collateral circulation).
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R743.3

【参考文献】