磁共振脑灌注成像在烟雾病患者中的应用价值

发布时间：2019-05-19 19:37

【摘要】：目的：研究烟雾病患者病损区域局部血流动力学情况，探讨磁共振脑灌注成像对烟雾病患者的临床应用价值。方法：收集5例我科近1年收治的，均经DSA检查明确诊断为MMD的患者且全部为单侧MMD患者。所有患者入院后经头CTA初步检查后进一步行PWI检查，最终经DSA检查明确诊断。磁共振PWI的检查使用的是自由衰减EPI序列，检查具体部位和范围与T2加权相同，需不断扫描五十次，当进行第六次扫描时静脉推注顺磁性对比剂（通常为Gd-DTPA），注射须使用高压注射器，成人使用剂量约为0.2mmol/kg，推药速率控制在3-5ml/s之内，注射完毕后以相同的剂量和速率推注生理盐水。将所有扫描结果发送到专门的计算机进行分析，得出时间-强度相关关系，最后可得到各个脑血流灌注参数图。选择一个能最大显示病变区域的层面，并在图中标记出灌注异常区域，以对侧为相对正常参考，测量出双侧大脑半球的灌注参数值。获得的全部脑灌注参数值需经过标准化，该研究采用小脑作为参照。全部数据经SPSS11.0软件处理，对患侧与健侧大脑对应供血区rTTP、rMTT、rCBF、rCBV值进行配对t检验，P 0.05为差异有显著性意义。结果：5例MMD患者的磁共振脑灌注成像均不正常，，患侧各项脑灌注参数出现异常,结果显示其最大峰值时间、平均通过时间延迟显著,而局部脑血流量出现了明显下降。所有患者病变侧rCBV平均值为1.13±0.28，与健侧（1.25±0.36）比较有显著性差异(P 0.01)；病变侧rCBF为1.11±0.36，与健侧（1.32±0.40）比较有显著性差异(P 0.01)。结论：磁共振脑灌注成像能够准确显示MMD患者脑血流动力学情况，从而显示其脑缺血程度及范围；对MMD围手术期患者血管条件及灌注区域进行术前评估、术后预测有重要意义。
[Abstract]:Objective: to study the regional hemodynamics of patients with moyamoya disease and to evaluate the clinical value of magnetic resonance cerebral perfusion imaging in patients with moyamoya disease. Methods: five patients with MMD diagnosed by DSA were collected and all of them were unilateral MMD patients. After admission, all patients were examined by PWI after initial CTA examination, and finally diagnosed by DSA. Magnetic resonance PWI (MRI) uses a free attenuated EPI sequence, which is the same location and range as T2 weighted and requires continuous scanning 50 times. Paramagnetism contrast agent (usually Gd-DTPA) is injected intravenously on the sixth scan. High pressure syringe should be used for injection. the dose of adult injection is about 0.2 mmol 路kg ~ (- 1), and the injection rate is controlled within 3-5ml/s. Normal saline is injected at the same dose and rate after injection. All the scanning results were sent to a special computer for analysis, and the time-intensity correlation was obtained. finally, the perfusion parameters of each cerebral blood flow were obtained. A plane with maximum display of lesion area was selected, and the abnormal perfusion area was marked in the diagram, and the perfusion parameters of bilateral cerebral hemispheres were measured with the contralateral side as a relatively normal reference. All the parameters of cerebral perfusion need to be standardized, and cerebellum is used as a reference in this study. All the data were processed by SPSS11.0 software, and the rTTP,rMTT,rCBF, rCBV values of the corresponding blood supply area between the affected side and the healthy side were tested by pairing t test, and there was significant difference between the two sides. Results: magnetic resonance cerebral perfusion imaging was abnormal in 5 patients with MMD. The parameters of cerebral perfusion on the affected side were abnormal. The results showed that the maximum peak time, the average transit time and the local cerebral blood flow were significantly delayed, while the regional cerebral blood flow was significantly decreased. The average rCBV of the lesion side was 1.13 卤0.28, which was significantly different from that of the healthy side (1.25 卤0.36). The rCBF of the lesion side was 1.11 卤0.36, which was significantly different from that of the healthy side (1.32 卤0.40). Conclusion: magnetic resonance cerebral perfusion imaging can accurately display the cerebral hemodynamics of patients with MMD, thus showing the degree and extent of cerebral ischemia, and it is of great significance to evaluate the vascular conditions and perfusion area of patients in perioperative period of MMD before operation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743;R445.2

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