动脉自旋标记技术在PAOD患者小腿肌灌注方面的可重复性测量
发布时间：2018-11-19 11:26
【摘要】：目的:这项研究假设动脉自旋标记核磁共振成像技术在3.0T扫描仪上测量健康志愿者和周围血管病患者小腿肌结扎前后血流灌注方面将是一种可靠无创的技术,并且将对这两个组群进行区分。以往的研究工作证实了钆对比剂的首过效应在周围血管病患者小腿肌灌注测量的实用性。然而,患有周围血管病的患者通常会有进展性的肾疾病,所以不能接受钆对比剂。应用动脉自旋标记测量小腿肌灌注的一大优势就是不用钆对比剂。方法:周围血管病患者的特征有跛行,踝肱指数0.4-0.9。正常对照组年龄要匹配,并且没有周围血管病的任何风险因素。收集周围血管病患者15名,健康对照者30名。所有受试者都采取仰卧位,并以套袖止血带进行结扎以达到缺血后反应性充血,在3.0T扫描仪上对受试者进行扫描。扫描后获得61幅ASL原始图像,通过运动矫正后再进行信号平均得到动脉自旋标记血流量图。灌注峰值是在ASL血流量图上最大信号强度处取ROI测得,本次研究选取的是比目鱼肌的最大血流值。灌注测量研究是在周围血管病患者与正常对照组之间进行,而可重复性研究通过12个受试者(5个正常对照,7个周围血管病患者)重复测量来完成。结果:通过对磁共振成像结果分析得出30名健康对照者(年龄,52±10岁)的肌灌注峰值(peak perfusion,PP)为61±13ml/min-100g,15名周围血管病患者(年龄:63±9岁,踝肱指数:0.68±0.11)的PP值为37±9ml/min-100g,健康对照组明显高于周围血管病患者。两独立样本T检验结果显示95%的可信区间不跨0,我们可以认为两组数据均值差异具有统计学意义,作为可重复性测量设计的研究结果显示,12名受试者测量前后结果的组内相关系数(intraclass correlation coefficient ICC)为0.94,(95%的可信区间95%confidence interval[CI]:0.80-0.98),对45名受试者两位观察者间的组内相关系数为0.98%,(95%的可信区间[CI]:0.96-0.99)。结论:动脉自旋标记技术是一种可重复性非创伤性的技术在测量小腿肌灌注方面。动脉自旋标记技术可以对正常人群与周围血管病患者进行辨别。这项科技会证实它在提高肌灌注临床治疗方案上的作用,特别是对于那些不能接受钆对比剂的患者。
[Abstract]:Objective: this study hypothesized that arterial spin-labeled magnetic resonance imaging would be a reliable and noninvasive technique for measuring blood perfusion in healthy volunteers and patients with peripheral vascular disease before and after ligation of the leg muscles on a 3.0T scanner. And the two groups will be distinguished. Previous studies have confirmed the usefulness of the first-pass effect of gadolinium contrast agents in the measurement of leg muscle perfusion in patients with peripheral angiopathy. However, patients with peripheral vascular disease usually have progressive kidney disease, so gadolinium contrast agents are not acceptable. One advantage of using arterial spin labeling to measure leg muscle perfusion is the use of gadolinium contrast agents. Methods: the features of peripheral vascular disease were claudication, ankle brachial index (malleolus index) 0.4-0.9. Normal controls are age-matched and have no risk factors for peripheral vascular disease. Fifteen patients with peripheral vascular disease and 30 healthy controls were collected. All subjects were supine and ligated with cuff tourniquet to achieve reactive hyperemia after ischemia. The subjects were scanned on 3.0T scanner. After scanning, 61 original ASL images were obtained. The peak value of perfusion was obtained from ROI at the maximum signal intensity on ASL blood flow chart, and the maximum blood flow value of soleus muscle was selected in this study. Perfusion measurements were performed between peripheral vascular disease patients and normal controls, while repetitive studies were performed by repeated measurements in 12 subjects (5 normal controls and 7 peripheral vascular disease patients). Results: the peak muscle perfusion (peak perfusion,PP) of 30 healthy controls (age, 52 卤10 years) was 61 卤13 ml / min -100 g / g of peripheral vascular disease (age: 63 卤9 years). The malleolus brachial index (PP) was 37 卤9 ml / min ~ (-100 g), which was significantly higher in the healthy control group than in the peripheral vascular disease patients. The results of T test of two independent samples show that 95% confidence interval is not over 0. We can think that the difference of mean value between two groups of data is statistically significant, as a result of repeatable measurement design, The intragroup correlation coefficient (intraclass correlation coefficient ICC) of 12 subjects before and after measurement was 0.94 (95% confidence interval 95%confidence interval [CI]: 0.80-0.98). The correlation coefficient between two observers in 45 subjects was 0.98 (95% confidence interval [CI]: 0.96-0.99). Conclusion: arterial spin labeling is a reproducible non-traumatic technique for measuring leg muscle perfusion. Arterial spin labeling can distinguish normal people from patients with peripheral vascular disease. The technology will confirm its role in improving clinical treatment of muscle perfusion, especially in patients who cannot accept gadolinium contrast.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.5
[Abstract]:Objective: this study hypothesized that arterial spin-labeled magnetic resonance imaging would be a reliable and noninvasive technique for measuring blood perfusion in healthy volunteers and patients with peripheral vascular disease before and after ligation of the leg muscles on a 3.0T scanner. And the two groups will be distinguished. Previous studies have confirmed the usefulness of the first-pass effect of gadolinium contrast agents in the measurement of leg muscle perfusion in patients with peripheral angiopathy. However, patients with peripheral vascular disease usually have progressive kidney disease, so gadolinium contrast agents are not acceptable. One advantage of using arterial spin labeling to measure leg muscle perfusion is the use of gadolinium contrast agents. Methods: the features of peripheral vascular disease were claudication, ankle brachial index (malleolus index) 0.4-0.9. Normal controls are age-matched and have no risk factors for peripheral vascular disease. Fifteen patients with peripheral vascular disease and 30 healthy controls were collected. All subjects were supine and ligated with cuff tourniquet to achieve reactive hyperemia after ischemia. The subjects were scanned on 3.0T scanner. After scanning, 61 original ASL images were obtained. The peak value of perfusion was obtained from ROI at the maximum signal intensity on ASL blood flow chart, and the maximum blood flow value of soleus muscle was selected in this study. Perfusion measurements were performed between peripheral vascular disease patients and normal controls, while repetitive studies were performed by repeated measurements in 12 subjects (5 normal controls and 7 peripheral vascular disease patients). Results: the peak muscle perfusion (peak perfusion,PP) of 30 healthy controls (age, 52 卤10 years) was 61 卤13 ml / min -100 g / g of peripheral vascular disease (age: 63 卤9 years). The malleolus brachial index (PP) was 37 卤9 ml / min ~ (-100 g), which was significantly higher in the healthy control group than in the peripheral vascular disease patients. The results of T test of two independent samples show that 95% confidence interval is not over 0. We can think that the difference of mean value between two groups of data is statistically significant, as a result of repeatable measurement design, The intragroup correlation coefficient (intraclass correlation coefficient ICC) of 12 subjects before and after measurement was 0.94 (95% confidence interval 95%confidence interval [CI]: 0.80-0.98). The correlation coefficient between two observers in 45 subjects was 0.98 (95% confidence interval [CI]: 0.96-0.99). Conclusion: arterial spin labeling is a reproducible non-traumatic technique for measuring leg muscle perfusion. Arterial spin labeling can distinguish normal people from patients with peripheral vascular disease. The technology will confirm its role in improving clinical treatment of muscle perfusion, especially in patients who cannot accept gadolinium contrast.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.5
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