三维准连续动脉自旋标记灌注成像对老年人后循环缺血病灶的诊断价值
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摘要
目的探究三维准连续动脉自旋标记灌注成像(3D-pCASL)对80岁以上老年人后循环缺血(PCI)的诊断价值,对老年人PCI的临床诊断提供影像学依据。方法对80岁以上临床诊断为PCI的老年男性患者20例以及正常老年男性33名分别进行磁共振常规扫描及3D-pCASL扫描,延迟标记时间(PLD)选取1525和2525 ms,利用SPM12软件分别测量其左侧枕叶、右侧枕叶、左侧小脑、右侧小脑脑血流量(CBF)。采用独立样本t检验及秩和检验比较在两个PLD时间病例组与对照组前后循环CBF的差异,病例组与对照组双侧枕叶、双侧小脑CBF的差异,以及病例组与对照组在两个PLD时间的时间间隔中双侧枕叶、双侧小脑CBF增量(△CBF)的差异。结果病例组在PLD时间为1525 ms及2525 ms时,前循环的CBF值均高于后循环CBF值,而对照组仅在1525 ms时前循环的CBF值均高于后循环CBF值,差异具有统计学意义(P=0.000,P=0.000,P=0.025);病例组在两个PLD时间时双侧枕叶、双侧小脑的CBF值均低于对照组,差异均具有统计学意义(P=0.003,P=0.002,P=0.000,P=0.001,P=0.000,P=0.001,P=0.002,P=0.014);与对照组相比,病例组在两个PLD时间的时间间隔中双侧枕叶、小脑△CBF均更小,差异均具有统计学意义(P=0.004,P=0.001,P=0.001,P=0.025)。结论高年龄段老年人因后循环血流慢,3D-pCASL技术需采用多个PLD时间判断PCI的有无;3D-pCASL技术对检测后循环CBF下降敏感,可作为老年人后循环卒中预警手段之一。
Objective To investigate the value of 3D pseudo-continuous arterial spin labeling( 3DpCASL) magnetic resonance perfusion technique in evaluating posterior circulation ischemia( PCI) of the elderly beyond 80 years old and to offer the evidence of PCI of the elderly for clinical diagnosis. Methods Totally 53 male subjects older than 80 years were recruited in this study,including 20 subjects with clinically diagnosedPCI and 33 normal subjects. All the subjects underwent routine brain magnetic resonance imaging and 3D-pCASL sequence on a 3. 0T magnetic resonance imaging system with 8 channel brain coil. Two post-labeling delay( PLD) time( PLD = 1525 ms and PLD = 2525 ms) of 3D-pCASL were used in this study to increase the accuracy of cerebral blood flow( CBF) change of posterior circulation region. We used SPM12 software to measure mean CBF values of bilateral occipital lobes and bilateral cerebellums. Independent sample t-test and rank-sum test were performed to evaluate the difference of CBF changes of anterior circulation and posterior circulation in two groups at two PLD time,the difference of CBF changes of bilateral occipital lobes and bilateral cerebellums in two groups of two PLD time, and the difference of increment of CBF between two PLD interval between two groups. Results In case group,the CBF value of the anterior circulation was significantly higher than that of posterior circulation at both two PLD time points( PLD = 1525 ms and PLD = 2525 ms)( P = 0. 000, P =0. 000); in control group,the CBF value of the anterior circulation was significantly higher than that of the posterior circulation only at PLD = 1525ms( P = 0. 025). The CBF values at bilateral occipital lobes and bilateral cerebellums at two PLD time points( PLD = 1525 ms and PLD = 2525 ms) were significantly higher in case group than in control group( P = 0. 003,P = 0. 002,P = 0. 000,P = 0. 001,P = 0. 000,P = 0. 001,P = 0. 002,P = 0. 014,respectively). Compared with the control group,the difference was statistically significant in bilateral occipital lobes and cerebellums with a smaller △CBF between two PLD interval in case group( P = 0. 004,P = 0. 001,P = 0. 001,P = 0. 025). Conclusions Multiple PLD time points need to be used in 3D-pCASL in diagnosing PCI of the elderly because the posterior circulation is slow in these patients. 3D-pCASL technique is sensitive in detecting decreased CBF in posterior circulation and therefore can be used to predict posterior circulation stroke in the elderly.
Objective To investigate the value of 3D pseudo-continuous arterial spin labeling( 3DpCASL) magnetic resonance perfusion technique in evaluating posterior circulation ischemia( PCI) of the elderly beyond 80 years old and to offer the evidence of PCI of the elderly for clinical diagnosis. Methods Totally 53 male subjects older than 80 years were recruited in this study,including 20 subjects with clinically diagnosedPCI and 33 normal subjects. All the subjects underwent routine brain magnetic resonance imaging and 3D-pCASL sequence on a 3. 0T magnetic resonance imaging system with 8 channel brain coil. Two post-labeling delay( PLD) time( PLD = 1525 ms and PLD = 2525 ms) of 3D-pCASL were used in this study to increase the accuracy of cerebral blood flow( CBF) change of posterior circulation region. We used SPM12 software to measure mean CBF values of bilateral occipital lobes and bilateral cerebellums. Independent sample t-test and rank-sum test were performed to evaluate the difference of CBF changes of anterior circulation and posterior circulation in two groups at two PLD time,the difference of CBF changes of bilateral occipital lobes and bilateral cerebellums in two groups of two PLD time, and the difference of increment of CBF between two PLD interval between two groups. Results In case group,the CBF value of the anterior circulation was significantly higher than that of posterior circulation at both two PLD time points( PLD = 1525 ms and PLD = 2525 ms)( P = 0. 000, P =0. 000); in control group,the CBF value of the anterior circulation was significantly higher than that of the posterior circulation only at PLD = 1525ms( P = 0. 025). The CBF values at bilateral occipital lobes and bilateral cerebellums at two PLD time points( PLD = 1525 ms and PLD = 2525 ms) were significantly higher in case group than in control group( P = 0. 003,P = 0. 002,P = 0. 000,P = 0. 001,P = 0. 000,P = 0. 001,P = 0. 002,P = 0. 014,respectively). Compared with the control group,the difference was statistically significant in bilateral occipital lobes and cerebellums with a smaller △CBF between two PLD interval in case group( P = 0. 004,P = 0. 001,P = 0. 001,P = 0. 025). Conclusions Multiple PLD time points need to be used in 3D-pCASL in diagnosing PCI of the elderly because the posterior circulation is slow in these patients. 3D-pCASL technique is sensitive in detecting decreased CBF in posterior circulation and therefore can be used to predict posterior circulation stroke in the elderly.
引文
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[10]Simonsen CZ,Madsen MH,Schmitz ML,et al.Sensitivity of diffusion-and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%[J].Stroke,2015,46(1):98-101.
[11]Cloud GC,Markus HS.Diagnosis and management of vertebral artery stenosis[J].QJM,2003,96(1):27-54.
[12]Schulz UG,Fischer U.Posterior circulation cerebrovascular syndromes:diagnosis and management[J].J Neurol Neurosurg Psychiatr,2017,88(1):45-53.
[13]Thierfelder KM,Baumann AB,Sommer WH,et al.Vertebral artery hypoplasia:frequency and effect on cerebellar blood flow characteristics[J].Stroke,2014,45(5):1363-1368.
[14]Hartkamp NS,De Cocker LJ,Helle M,et al.In vivo visualization of the PICA perfusion territory with super-selective pseudo-continuous arterial spin labeling MRI[J].Neuroimage,2013,83:58-65.
[15]高培毅,林燕.脑梗死前期脑局部低灌注的CT灌注成像表现及分期[J].中华放射学杂志,2003,37(10):18-22.
[16]Merwická,Werring D.Posterior circulation ischaemic stroke[J].BMJ,2014,348:g3175.
[2]李焰生.中国后循环缺血的专家共识[J].中华内科杂志,2006,45(9):786-787.
[3]Markus HS,van der Worp HB,Rothwell PM.Posterior circulation ischaemic stroke and transient ischaemic attack:diagnosis,investigation,and secondary prevention[J].Lancet Neurol,2013,12(10):989-998.
[4]Flossmann E.Prognosis of vertebrobasilar transient ischaemic attack and minor stroke[J].Brain,2003,126(9):1940-1954.
[5]Wu B,Lou X,Wu X,et al.Intra-and interscanner reliability and reproducibility of 3D whole-brain pseudo-continuous arterial spin-labeling MR perfusion at 3T[J].J Magn Reson Imaging,2014,39(2):402-409.
[6]Abaci O,Harmankaya O,Kocas B,et al.Long-term follow-up of patients at high risk for nephropathy after contrast exposure[J].Angiology,2015,66(6):514-518.
[7]Kohno N,Okada K,Yamagata S,et al.Distinctive patterns of three-dimensional arterial spin-labeled perfusion magnetic resonance imaging in subtypes of acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2016,25(7):1807-1812.
[8]Wintermark M,Sesay M,Barbier E,et al.Comparative overview of brain perfusion imaging techniques[J].Stroke,2005,32(5):294-314.
[9]庾建英,刘继新,朱沂,等.灌注加权成像和扩散加权成像对兔早期后循环缺血的对比分析[J].中国神经精神疾病杂志,2011,37(3):184-187.
[10]Simonsen CZ,Madsen MH,Schmitz ML,et al.Sensitivity of diffusion-and perfusion-weighted imaging for diagnosing acute ischemic stroke is 97.5%[J].Stroke,2015,46(1):98-101.
[11]Cloud GC,Markus HS.Diagnosis and management of vertebral artery stenosis[J].QJM,2003,96(1):27-54.
[12]Schulz UG,Fischer U.Posterior circulation cerebrovascular syndromes:diagnosis and management[J].J Neurol Neurosurg Psychiatr,2017,88(1):45-53.
[13]Thierfelder KM,Baumann AB,Sommer WH,et al.Vertebral artery hypoplasia:frequency and effect on cerebellar blood flow characteristics[J].Stroke,2014,45(5):1363-1368.
[14]Hartkamp NS,De Cocker LJ,Helle M,et al.In vivo visualization of the PICA perfusion territory with super-selective pseudo-continuous arterial spin labeling MRI[J].Neuroimage,2013,83:58-65.
[15]高培毅,林燕.脑梗死前期脑局部低灌注的CT灌注成像表现及分期[J].中华放射学杂志,2003,37(10):18-22.
[16]Merwická,Werring D.Posterior circulation ischaemic stroke[J].BMJ,2014,348:g3175.