MR-ASL联合DTI评价脑瘫患儿手术前后的脑功能
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摘要
目的应用3.0 T磁共振动脉自旋标记(ASL)与扩散张量成像(DTI)技术研究脑瘫患儿行颈总动脉外膜交感神经网剥脱术前后脑血流量(cerebral blood flow,CBF)及各向异性分数(fractionalanisotropy,FA)发生的变化情况。方法应用3.0 T磁共振仪对30例正常儿童与30例行颈总动脉外膜交感神经网剥脱术前1周内、术后14 d的单侧痉挛型脑性瘫痪患儿进行常规序列、DWI、ASL、DTI等序列扫描,应用Mri Cloud后处理工作站获得被检者大脑患侧额叶、颞叶、顶叶、中央前回、内囊区域、基底节、丘脑、小脑等区域的CBF值、FA值,使用配对t检验对数据进行统计学分析。结果正常儿童与脑瘫患儿进行对比,脑瘫患儿患侧大脑皮质区、中央前回、基底节、内囊、小脑区运动相关区域CBF较低,差异有统计学意义;行颈总动脉外膜交感神经网剥脱术后脑瘫患儿患侧上述区域脑血流量有改善。正常儿童与脑瘫患儿进行对比,患儿患侧基底节区、豆状核、丘脑、内囊后肢区FA值较低;手术后患儿患侧基底节区、丘脑、内囊后肢较正常组的FA值有增加,差异有统计学意义。结论经磁共振ASL及DTI技术评估颈总动脉外膜交感神经网剥脱术可有效提高患儿脑血流量,改善大脑缺血缺氧状态。
Objective To compare the changes of cerebral blood flow(CBF) and fractional anisotropy(FA) in children with cerebral palsy before and after carotid sympathetic nerve network denudation surgery by 3 T magnetic resonance(MR) arterial spin labeling(ASL) and diffusion tensor imaging(DTI) techniques. Methods Conventional MR imaging, diffusion-weighted imaging(DWI), ASL, and DTI were performed on 30 normal children as control and on 30 children with unilateral cerebral palsy within 1 week and 14 days after carotid sympathetic nerve network denudation using a 3 T MR system(Achieva/Intera, Philips). Mri Cloud postprocessing workstation was used to obtain the CBF and FA values of the frontal, temporal, and parietal cortex, precentral gyrus,internal capsule, basal ganglia, thalamus, and cerebellum of the affected side. Paired t test was used for statistical analysis. Results CBF of cerebral cortex, precentral gyrus, internal capsule, basal ganglia, and cerebellum was significantly lower in children with cerebral palsy than normal control. The CBF improved postoperatively. The FA values of the basal ganglia, putamen, thalamus and posterior limb of internal capsule in children with cerebral palsy were also lower than that of normal control. Postoperatively the FA values became significantly higher than that of normal control. Conclusion MR-ASL and DTI are useful techniques for monitoring effect of carotid sympathetic nerve network denudation surgery with improved brain function reflected by CBF and FA.
Objective To compare the changes of cerebral blood flow(CBF) and fractional anisotropy(FA) in children with cerebral palsy before and after carotid sympathetic nerve network denudation surgery by 3 T magnetic resonance(MR) arterial spin labeling(ASL) and diffusion tensor imaging(DTI) techniques. Methods Conventional MR imaging, diffusion-weighted imaging(DWI), ASL, and DTI were performed on 30 normal children as control and on 30 children with unilateral cerebral palsy within 1 week and 14 days after carotid sympathetic nerve network denudation using a 3 T MR system(Achieva/Intera, Philips). Mri Cloud postprocessing workstation was used to obtain the CBF and FA values of the frontal, temporal, and parietal cortex, precentral gyrus,internal capsule, basal ganglia, thalamus, and cerebellum of the affected side. Paired t test was used for statistical analysis. Results CBF of cerebral cortex, precentral gyrus, internal capsule, basal ganglia, and cerebellum was significantly lower in children with cerebral palsy than normal control. The CBF improved postoperatively. The FA values of the basal ganglia, putamen, thalamus and posterior limb of internal capsule in children with cerebral palsy were also lower than that of normal control. Postoperatively the FA values became significantly higher than that of normal control. Conclusion MR-ASL and DTI are useful techniques for monitoring effect of carotid sympathetic nerve network denudation surgery with improved brain function reflected by CBF and FA.
引文
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[3]Noguchi T,Kawashima M,Nishihara M,et al.Noninvasive method for mapping CVR in moyamoya disease using ASL-MRI.Eur J Radiol,2015,84:1137-1143.
[4]Koy A,Pauls KA,Flossdorf P,et al.Young adults with dyskinetic cerebral palsy improve subjectively on pallidal stimulation,but not in formal dystonia,gait,speech and swallowing testing.Eur Neurol,2014,72:340-348.
[5]李爱民,于炎冰,张黎.颈动脉外膜交感神经切除术在神经外科的应用.中华神经外科疾病研究杂志,2012,11:278-280.
[6]俞梦瑾,黄平兰,叶瑞雄,等.颈动脉交感神经网剥离术结合选择性脊神经后根切断术治疗脑性瘫痪肌痉挛:11例报道.中国康复理论与实践,2014,20:167-170.
[7]陈传亮,白岩,王梅云,等.三维伪连续性动脉自旋标记磁共振灌注成像联合扩散加权成像在脑胶质瘤分级中的价值.中国医学计算机成像杂志,2015,21:426-430.
[8]Yamamoto T,Takeuchi H,Kinoshita K,et al.Assessment of tumor blood flow and its correlation with histopathologic features in skull base meningiomas and schwannomas by using pseudocontinuous arterial spin labeling images.Eur J Radiol,2014,83:817-823.
[9]Maggipinto T,Bellotti R,Amoroso N,et al.DTI measurements for Alzheimer's classification.Phys Med Biol,2017,62:2361-2375.
[10]Englander ZA,Sun J,Laura Case,et al.Brain structural connectivity increases concurrent with functional improvement:evidence from diffusion tensor MRI in children with cerebral palsy during therapy.Neuroimage Clin,2015,7:315-324.
[11]郭慧敏,杨晓光,王泽峰.3.0 T场强磁共振应用MRA血管成像与3D-ASL脑灌注成像技术在诊断缺血性脑血管疾病中的应用.中国CT和MRI杂志,2016,14:35-36.
[12]刘超,李松柏.应用磁共振全脑动脉自旋标记灌注成像对颈动脉狭窄内膜剥脱术疗效的评价.影像诊断与介入放射学,2016,25:368-372.
[13]刘志刚,李华,李泽,等.颈总动脉周围交感神经网剥脱切除术联合Bobath法康复训练治疗3~6岁脑瘫患儿的临床效果观察.医学临床研究,2017,34:450-452.
[14]王文晶,付旷.新生儿缺氧缺血性脑病的MRI新技术研究进展.中国儿童保健杂志,2016,24:493-495.
[15]蒋昊翔,宋旸,齐乃新,等.MR扩散张量成像在痉挛型脑瘫诊断中的应用价值.实用放射学杂志,2014,30:283-287.