摘要
目的：
探讨MR灌注成像结合乙酰唑胺负荷试验评估脑血管储备功能的可行性，并评价其对脑梗死和高血压患者的临床意义。
材料和方法：
32例受检者在口服乙酰唑胺前后行2次MRI检查，按不同标准将其分为3组：脑梗死组(7例)，高血压组(13例)和对照组(12例)。采用1.5T GE Signa MR扫描仪进行常规扫描和灌注扫描。PWI图像使用Functool 2.0工作软件进行后处理，并根据公式CRC(％)=[(acetazolamide challenge rCBF-resting rCBF)／restingrCBF]100，计算以下各ROI的脑血管储备功能：脑梗死组选择患侧非梗死部位和健侧对称部位，高血压组与对照组选择额上回、颞上回、尾状核头部、豆状核、丘脑以及楔叶。SPSS13.0软件进行统计学分析。
结果：
1、脑梗死组患侧ROI与对侧对称部位的脑血管储备功能相比较，在统计学上无显著性差异(P＞0.05)。
2、高血压组各ROI的MTT、rCBV和rCBF在乙酰唑胺负荷前后相比较，在统计学上均无显著性差异(P＞0.05)。
3、对照组各ROI的MTT在乙酰唑胺负荷前后相比较，在统计学上有显著性差异(P＜0.05)，负荷后MTT缩短；rCBV和rCBF在乙酰唑胺负荷前后相比较，在统计学上有显著性差异(P＜0.05)，负荷后rCBV和rCBF增加。
4、高血压组各ROI的脑血管储备功能(5.5—27.8％)与对照组相应ROI的脑血管储备功能(34.0—56.1％)相比较，在统计学上有显著性差异(P＜0.05)，高血压组的脑血管储备功能降低。
结论：
1、通过对脑梗死灶周围灌注异常区域的观察，MR灌注成像可以对患者做出个体化的诊断，为临床治疗提供影像学依据。
2、本研究中，脑梗死组患侧大脑半球ROI与健侧ROI的脑血管储备功能之间没有差异，在评估脑梗死患者脑血管储备功能下降的程度时，不宜选择患侧与健侧脑血管储备功能的比值作为判断标准。
Object:
To research the feasibility of cerebrovascular reserve capability by combining the MRI perfusion with an acetazolamide challenge and evaluate the clinical meaning to patients with cerebral infarction and hypertension.
Materials and methods:
32 patients and volunteers were divided into three groups: cerebral infarction group, hypertension group, and control group. Two MRI examinations before and after oral administration of acetazolamide were performed to each group. MR and PWI examination were performed by 1.5 T GE Signa MR scanner. PWI imaging was processed by the Functool 2.0 work software. Then we counted the CRC of none stroke area in infarction group, and the CRC of super frontal gyrus, super tempo gyrus, caput nuclei caudate, lenticular, thalamus, and cuneus in hypertension group and control group. CRC was calculated by the formula: CRC (%)=[(acetazolamide challenge rCBF-resting rCBF)/resting rCBF] 100. Analysis was performed with SPSS13.0 soft ware.
Results:
1. Comparing CRC average value(14.94% and 15.97%) in the symmetry areas that away from the stroke lesions, we found that no statistical differences in both hemispheres
2. In view of MTT, rCBV and rCBF of ROI in hypertension group, there were no statistical differences before and after ACZ challenge.(p>0.05)
3. MTT of ROI were shortened after ACZ challenge in control group(p<0.05), rCBV and rCBF were increased after ACZ challenge in control group(p<0.05)
4. Comparing CRC of ROI in hypertension group (5.5-27.8%) with control group's (34-56.1%), we found that CRC in hypertension group was manifestly decreased (p<0.05).
Conclusions:
1 PWI can be used to observe the by pass circulation and reperfusion condition in
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