磁敏感加权成像评估皮层软脑膜支临床应用研究
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摘要
目的脑梗死急性期,二级侧支循环尤其是皮层软脑膜支开放程度,对于保护缺血半暗带、防止梗死范围进一步扩大、促进血管再通、改善患者临床预后等方面具有十分重要的作用,磁敏感加权成像(Susceptibility weighted imaging,SWI)作为一项无创的影像学技术,在评估皮层软脑膜支的临床应用可能具有广阔的前景。方法本次研究对18名前循环脑梗死急性期患者,在发病3天内完善磁共振灌注加权成像(Perfusion Weighted Imaging,PWI)、弥散加权成像(Difused Weighted Imaging,DWI)、SWI和磁共振血管成像(Magnetic Resonance Angiography,MRA)等相关影像学检查,利用阿尔伯特早期CT评分(Alberta Stroke Program Early CT Score,ASPECTS),分别对平均通过时间(Mean Transit Time,MTT)、SWI、脑血容量(Cerebral Blood Volume,CBV)进行评分,进而研究SWI对皮层软脑膜支开放程度的临床意义。结果 SWI-ASPECTS与MTT-ASPECTS存在正相关,且具有统计学意义(r=0.662,P=0.001),此外,我们发现SWIASPECTS与CBV-ASPECTS存在正相关,且具有统计学意义(r=0.793,P<0.001)。结论 SWI可以评估急性脑梗死患者二级侧枝循环,尤其是皮层软脑膜支开放情况,对于临床医师制定和选择治疗方案,判断患者血管再通和临床预后可能提供重要的影像学信息。
Objective During the acute period of cerebral infarction,secondary collateral circulation,especially in leptomeningeal collateralization,play an important role in the protection of penumbra,further expanding of infarction scope and promote recanalization,improving the prognosis of patients.Susceptibility weighted imaging(SWI) as a noninvasive imaging technique,its application in evaluating the leptomeningeal collateralization,may have broad prospects.Methods This study enrolled 18 patients suffered acute cerebral infarction.They adopted Magnetic Resonance Perfusion Weighted Imaging(PWI) and Diffusion Weighted Imaging(DWI),SWI and Magnetic Resonance Angiography(MRA) and other relevant examination within 3 days after onset.Alberta Stroke Program Early CT Score(ASPECTS) method was used to evaluate Mean Transit Time(MTT),SWI,Cerebral Blood Volume(CBV),and then study the clinical significance of SWI in evaluating leptomeningeal collateralization open degree.Results SWI-ASPECTS and MTT-ASPECTS has a positive correlation and statistically significant(r = 0.662,P = 0.001),in addition,we found that the SWI-ASPECTS and CBV-ASPECTS has a positive correlation and statistically significant(r = 0.793,P < 0.001).Conclusions SWI can evaluate the secondary collateral circulation in patients with acute cerebral infarction,especially the open degree of cortical pial ligaments.It may provide important imaging information for clinicians to formulate and select a treatment plan to judge the revascularization and clinical prognosis of patients.
Objective During the acute period of cerebral infarction,secondary collateral circulation,especially in leptomeningeal collateralization,play an important role in the protection of penumbra,further expanding of infarction scope and promote recanalization,improving the prognosis of patients.Susceptibility weighted imaging(SWI) as a noninvasive imaging technique,its application in evaluating the leptomeningeal collateralization,may have broad prospects.Methods This study enrolled 18 patients suffered acute cerebral infarction.They adopted Magnetic Resonance Perfusion Weighted Imaging(PWI) and Diffusion Weighted Imaging(DWI),SWI and Magnetic Resonance Angiography(MRA) and other relevant examination within 3 days after onset.Alberta Stroke Program Early CT Score(ASPECTS) method was used to evaluate Mean Transit Time(MTT),SWI,Cerebral Blood Volume(CBV),and then study the clinical significance of SWI in evaluating leptomeningeal collateralization open degree.Results SWI-ASPECTS and MTT-ASPECTS has a positive correlation and statistically significant(r = 0.662,P = 0.001),in addition,we found that the SWI-ASPECTS and CBV-ASPECTS has a positive correlation and statistically significant(r = 0.793,P < 0.001).Conclusions SWI can evaluate the secondary collateral circulation in patients with acute cerebral infarction,especially the open degree of cortical pial ligaments.It may provide important imaging information for clinicians to formulate and select a treatment plan to judge the revascularization and clinical prognosis of patients.
引文
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[15]Hendrikse J,van Raamt A F,Van d G Y,et al.Distribution of cerebral blood flow in the circle of Willis[J].Radiology,2005,235(1):184-189.
[16]Brozici M,Van d Z A,Hillen B.Anatomy and functionality of leptomeningeal anastomoses:a review.[J].Stroke,2003,34(11):2750-2762.
[17]Liebeskind D S.Collateral circulation[J].Stroke;a journal of cerebral circulation,2003,34(9):2279-2284.
[18]Morita Y,Fukuuchi Y,Koto A,et al.Rapid changes in pial arterial diameter and cerebral blood flow caused by ipsilateral carotid artery occlusion in rats.[J].Keio Journal of Medicine,1997,46(3):120-127.
[19]Zhang H,Prabhakar P,Sealock R,et al.Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke[J].J Cereb Blood Flow Metab,2010,30(5):923-934.
[20]Bang O Y,Saver J L,Buck B H,et al.Impact of collateral flow on tissue fate in acute ischaemic stroke[J].Journal of Neurology Neurosurgery&Psychiatry,2008,79(6):625-629.
[21]Hussein H M,Georgiadis A L,Vazquez G,et al.Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke:A Multicenter Study[J].Ajnr American Journal of Neuroradiology,2010,31(3):454-458.
[22]Lazzaro M A,Chen M,Christoforidis G A,et al.The impact of diabetes on the extent of pial collaterals in acute ischemic stroke patients[J].Journal of Neurointerventional Surgery,2011,3(3):242-245.
[23]Lee S Y,Cha J K,Kang M J.Regional Cerebral Blood Volume Ratio on Perfusion MRI on the Growth of Infarct Size in Acute Ischemic Stroke[J].European Neurology,2009,62(5):281-286.
[24]Cortijo E,Calleja A I,García-Bermejo P,et al.Relative cerebral blood volume as a marker of durable tissue-at-risk viability in hyperacute ischemic stroke[J].Stroke,2014,45(1):113-118.
[25]Tamura H,Hatazawa J,Toyoshima H,et al.Detection of deoxygenation-related signal change in acute ischemic stroke patients by T2*-weighted magnetic resonance imaging[J].Stroke,2002,33(4):967-971.
[26]Santhosh K,Kesavadas C,Thomas B,et al.Susceptibility weighted imaging:a new tool in magnetic resonance imaging of stroke[J].Clinical Radiology,2009,64(1):74-83.
[27]Huang P,Chen C H,Lin W C,et al.Clinical applications of susceptibility weighted imaging in patients with major stroke[J].Journal of Neurology,2012,259(7):1426-1432.
[28]Ribo M,Molina C,Montaner J,et al.Acute Hyperglycemia State Is Associated With Lower t PA-Induced Recanalization Rates in Stroke Patients[J].Stroke,2005,36(8):1705-1709.
[29]Saqqur M,Uchino K,Demchuk A M,et al.Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke.[J].Stroke,2007,38(3):948-954.
[30]Liebeskind D S,Tomsick T A,Foster L D,et al.Collaterals at angiography and outcomes in the Interventional Management of Stroke(IMS)III trial.[J].Stroke,2014,45(3):759-964.
[31]Nambiar V,Sohn S I,Almekhlafi M A,et al.CTA collateral status and response to recanalization in patients with acute ischemic stroke.[J].Ajnr American Journal of Neuroradiology,2014,35(5):884-890.
[2]Lansberg M G,Bluhmki E,Thijs V N.Efficacy and safety of tissue plasminogen activator 3 to 4.5 hours after acute ischemic stroke:a meta-analysis[J].Stroke;a journal of cerebral circulation,2009,40(7):2438-2441.
[3]Lum C,Ahmed M E,Patro S,et al.Computed tomographic angiography and cerebral blood volume can predict final infarct volume and outcome after recanalization[J].Stroke,2014,45(9):2683-2688.
[4]Hussein H M,Georgiadis A L,Vazquez G,et al.Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke:A Multicenter Study[J].Ajnr American Journal of Neuroradiology,2010,31(3):454-458.
[5]Liebeskind D S.Of mice and men:essential considerations in the translation of collateral therapeutics[J].Stroke;a journal of cerebral circulation,2008,39(12):e187-189.
[6]Cho Z H,Ro Y M,Lim T H.NMR venography using the susceptibility effect produced by deoxyhemoglobin.[J].Magnetic Resonance in Medicine Official Journal of the Society of Magnetic Resonance in Medicine,1992,28(1):25-38.
[7]Lee BC;Vo KD;Kido DK;Mukherjee P;Reichenbach J;Lin W;Yoon MS;Haacke M.MR high-resolution blood oxygenation level-dependent venography of occult(low-flow)vascular lesions.[J].Ajnr American Journal of Neuroradiology,1999,20(7):1239-1242.
[8]Tsui Y K,Tsai F Y,Hasso A N,et al.Susceptibility-weighted imaging for differential diagnosis of cerebral vascular pathology:A pictorial review[J].Journal of the Neurological Sciences,2009,287(1-2):7-16.
[9]Mcverry F,Liebeskind D S,Muir K W.Systematic review of methods for assessing leptomeningeal collateral flow[J].Ajnr Am J Neuroradiol,2012,33(3):576-582.
[10]Park H,Cha J K,Kang M J,et al.Reduced r CBV Ratio in Perfusion-Weighted MR Images Predicts Poor Outcome after Thrombolysis in Acute Ischemic Stroke[J].European Neurology,2011,65(5):257-263.
[11]Menon B K,Smith E E,Modi J,et al.Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions[J].Ajnr Am J Neuroradiol,2011,32(9):1640-1645.
[12]Barber PA,Demchuk A M,Zhang J,et al.Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy.ASPECTS Study Group.Alberta Stroke Programme Early CT Score[J].Lancet,2000,355(9216):1670-1674.
[13]Liu J,Wang Y,Akamatsu Y,et al.Vascular remodeling after ischemic stroke:Mechanisms and therapeutic potentials[J].Progress in Neurobiology,2014,115(2):138-156.
[14]Shuaib A,Butcher K,Mohammad A A,et al.Collateral blood vessels in acute ischaemic stroke:a potential therapeutic target[J].Lancet Neurology,2011,10(10):909-921.
[15]Hendrikse J,van Raamt A F,Van d G Y,et al.Distribution of cerebral blood flow in the circle of Willis[J].Radiology,2005,235(1):184-189.
[16]Brozici M,Van d Z A,Hillen B.Anatomy and functionality of leptomeningeal anastomoses:a review.[J].Stroke,2003,34(11):2750-2762.
[17]Liebeskind D S.Collateral circulation[J].Stroke;a journal of cerebral circulation,2003,34(9):2279-2284.
[18]Morita Y,Fukuuchi Y,Koto A,et al.Rapid changes in pial arterial diameter and cerebral blood flow caused by ipsilateral carotid artery occlusion in rats.[J].Keio Journal of Medicine,1997,46(3):120-127.
[19]Zhang H,Prabhakar P,Sealock R,et al.Wide Genetic Variation in the Native Pial Collateral Circulation is a Major Determinant of Variation in Severity of Stroke[J].J Cereb Blood Flow Metab,2010,30(5):923-934.
[20]Bang O Y,Saver J L,Buck B H,et al.Impact of collateral flow on tissue fate in acute ischaemic stroke[J].Journal of Neurology Neurosurgery&Psychiatry,2008,79(6):625-629.
[21]Hussein H M,Georgiadis A L,Vazquez G,et al.Occurrence and Predictors of Futile Recanalization following Endovascular Treatment among Patients with Acute Ischemic Stroke:A Multicenter Study[J].Ajnr American Journal of Neuroradiology,2010,31(3):454-458.
[22]Lazzaro M A,Chen M,Christoforidis G A,et al.The impact of diabetes on the extent of pial collaterals in acute ischemic stroke patients[J].Journal of Neurointerventional Surgery,2011,3(3):242-245.
[23]Lee S Y,Cha J K,Kang M J.Regional Cerebral Blood Volume Ratio on Perfusion MRI on the Growth of Infarct Size in Acute Ischemic Stroke[J].European Neurology,2009,62(5):281-286.
[24]Cortijo E,Calleja A I,García-Bermejo P,et al.Relative cerebral blood volume as a marker of durable tissue-at-risk viability in hyperacute ischemic stroke[J].Stroke,2014,45(1):113-118.
[25]Tamura H,Hatazawa J,Toyoshima H,et al.Detection of deoxygenation-related signal change in acute ischemic stroke patients by T2*-weighted magnetic resonance imaging[J].Stroke,2002,33(4):967-971.
[26]Santhosh K,Kesavadas C,Thomas B,et al.Susceptibility weighted imaging:a new tool in magnetic resonance imaging of stroke[J].Clinical Radiology,2009,64(1):74-83.
[27]Huang P,Chen C H,Lin W C,et al.Clinical applications of susceptibility weighted imaging in patients with major stroke[J].Journal of Neurology,2012,259(7):1426-1432.
[28]Ribo M,Molina C,Montaner J,et al.Acute Hyperglycemia State Is Associated With Lower t PA-Induced Recanalization Rates in Stroke Patients[J].Stroke,2005,36(8):1705-1709.
[29]Saqqur M,Uchino K,Demchuk A M,et al.Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke.[J].Stroke,2007,38(3):948-954.
[30]Liebeskind D S,Tomsick T A,Foster L D,et al.Collaterals at angiography and outcomes in the Interventional Management of Stroke(IMS)III trial.[J].Stroke,2014,45(3):759-964.
[31]Nambiar V,Sohn S I,Almekhlafi M A,et al.CTA collateral status and response to recanalization in patients with acute ischemic stroke.[J].Ajnr American Journal of Neuroradiology,2014,35(5):884-890.