三维准连续式动脉自旋标记灌注成像在定量高血压患者脑血流动力学变化中的应用
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摘要
目的采用三维准连续式动脉自旋标记(3D p CASL)技术定量分析轻中度高血压患者脑血流动力学变化。方法 58例高血压患者和34例年龄相匹配的健康志愿者在3.0T MR扫描仪上行全脑3D p CASL扫描。基于3D p CASL序列获得脑血流(CBF)图,采用统计参数图8提取各脑区的CBF值,采用手绘法获取各脑白质区的CBF值。结果与健康对照组相比,高血压患者CBF在双侧半卵圆中心(P=0.000,P=0.000)、侧脑室旁白质(P=0.001,P=0.002)、胼胝体压部(P=0.003)、额叶(P=0.003)、顶叶(P=0.014)、枕叶(P=0.002)、颞叶(P=0.006)、延髓(P=0.012)、脑桥(P=0.016)、中脑(P=0.034)、小脑(P=0.000)及灰质(P=0.001)均明显降低,而在丘脑、苍白球、壳核及胼胝体膝部的CBF值差异均无统计学意义(P均>0.05)。结论 3D p CASL序列在高血压患者常规磁共振成像序列阴性时即可探测到血流动力学的变化,这些CBF下降的区域提示可能增加了高血压相关脑小血管病发生的风险。
Objective To investigate the cerebral hemodynamic changes in hypertensive patients using 3D pseudo-continuous arterial spin labeling(3D pCASL).Methods Fifty-eight hypertensive subjects and thirty-four age-matched healthy volunteers were recruited and scanned using the 3D whole-brain pCASL sequence.The regional cerebral blood flow(CBF) values were achieved based on 3D pCASL with SPM8 technique and were manually drawn.Results Compared with healthy volunteers,hypertensive patients had significantly lower CBF values in various regions,with statistical difference at the bilateral centrum semiovale(P=0.000,P=0.000),periventricular white matter(P=0.001,P=0.002),splenium of corpus callosum(P=0.003),frontal lobe(P=0.003),parietal lobe(P=0.014),occipital lobe(P=0.002),temporal lobe(P=0.006),medulla(P=0.012),pons(P=0.016),midbrain(P=0.034),cerebellum(P=0.000),and gray matter(P=0.001).Nevertheless,the CBF values in the thalami,globus pallidus,putamen,and genu of corpus callosum demonstrated no significant inter-group difference(all P>0.05).Conclusions 3DpCASL can be used to detect the subtle hemodynamic abnormalities even at the early stage of hypertension.The observed decrease in CBF in these regions may suggest an increased risk of cerebral small vessel diseases.
Objective To investigate the cerebral hemodynamic changes in hypertensive patients using 3D pseudo-continuous arterial spin labeling(3D pCASL).Methods Fifty-eight hypertensive subjects and thirty-four age-matched healthy volunteers were recruited and scanned using the 3D whole-brain pCASL sequence.The regional cerebral blood flow(CBF) values were achieved based on 3D pCASL with SPM8 technique and were manually drawn.Results Compared with healthy volunteers,hypertensive patients had significantly lower CBF values in various regions,with statistical difference at the bilateral centrum semiovale(P=0.000,P=0.000),periventricular white matter(P=0.001,P=0.002),splenium of corpus callosum(P=0.003),frontal lobe(P=0.003),parietal lobe(P=0.014),occipital lobe(P=0.002),temporal lobe(P=0.006),medulla(P=0.012),pons(P=0.016),midbrain(P=0.034),cerebellum(P=0.000),and gray matter(P=0.001).Nevertheless,the CBF values in the thalami,globus pallidus,putamen,and genu of corpus callosum demonstrated no significant inter-group difference(all P>0.05).Conclusions 3DpCASL can be used to detect the subtle hemodynamic abnormalities even at the early stage of hypertension.The observed decrease in CBF in these regions may suggest an increased risk of cerebral small vessel diseases.
引文
[1]吴兆苏,霍勇,王文,等.中国高血压患者教育指南[J].中华高血压杂志,2013,21(12):1123-1149.
[2]Birns J,Markus H,Kalra L.Blood pressure reduction for vascular risk:is there a price to be paid?[J].Stroke,2005,36(6):1308-1313.
[3]Dahl9f B.Prevention of stroke in patients with hypertension[J].Am J Cardiol,2007,100(3A):17J-24J.
[4]Wu WC,Lin SC,Wang DJ,et al.Measurement of cerebral white matter perfusion using pseudo-continuous arterial spin labeling 3T magnetic resonance imaging-an experimental and theoretical investigation of feasibility[J].PLos One,2013,8(12):e82679.
[5]Huang DD,Wu B,Shi KN,et al.Reliability of three-dimensional pseudo-continuous arterial spin labeling MR imaging for measuring visual cortex perfusion on two 3T scanners[J].PLos One,2013,8(11):e79471.
[6]Ma N,Lou X,Zhao TQ,et al.Intraobserver and interobserver variability for measuring the wall area of the basilar artery at the level of the trigeminal ganglion on high-resolution MR images[J].AJNR Am J Neuroradiol,2011,32(2):E29-E32.
[7]Nael K,Meshksar A,Liebeskind DS,et al.Quantitative analysis of hypoperfusion in acute stroke:arterial spin labeling versus dynamic susceptibility contrast[J].Stroke,2013,44(11):3090-3096.
[8]Harris AD,Coutts SB,Frayne R.Diffusion and perfusion MR imaging of acute ischemic stroke[J].Magn Reson Imaging Clin N Am,2009,17(2):291-313.
[9]Gevers S,Majoie CB,van den Tweel XW,et al.Acquisition time and reproducibility of continuous arterial spin-labeling perfusion imaging at 3T[J].AJNR Am J Neuroradiol,2009,30(5):968-971.
[10]Wu B,Lou X,Wu XH,et al.Intra-and inter-scanner reliability and reproducibility of 3D whole-brain pseudo-continuous arterial spin-labeling MR perfusion on 3T[J].J Magn Reson Imaging,2014,39(2):402-409.
[11]Wright SN,Kochunov P,Chiappelli J,et al.Accelerated white matter aging in schizophrenia:role of white matter blood perfusion[J].Neurobiol Aging,2014,35(10):2411-2418.
[12]Li X,Sarkar SN,Purdy DE,et al.Quantifying cerebellum grey matter and white matter perfusion using pulsed arterial spin labeling[J].Biomed Res Int,2014,2014(8):108691.
[13]Fernandez-Cadenas I,Mendioroz M,Domingues-Montanari S,et al.Leukoaraiosis is associated with genes regulating blood-brain barrier homeostasis in ischaemic stroke patients[J].Eur J Neurol,2011,18(6):826-835.
[14]Kennelly SP,Lawlor BA,Kenny RA.Blood pressure and the risk for dementia:a double edged sword[J].Ageing Res Rev,2009,8(2):61-70.
[15]Beason-Held LL,Moghekar A,Zonderman AB,et al.Longitudinal changes in cerebral blood flow in the older hypertensive brain[J].Stroke,2007,38(6):1766-1773.
[16]Lassen NA.Autoregulation of cerebral blood flow[J].Circ Res,1964,15:201-204.
[17]Fisher CM.Pathological observations in hypertensive cerebral hemorrhage[J].J Neuropathol Exp Neurol,1971,30(3):536-550.
[18]Tryambake D,He J,Firbank MJ,et al.Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension[J].Hypertension,2013,61(6):1309-1315.
[19]Toyoda K,Fujii K,Ibayashi S,et al.Changes in arterioles,arteries,and local perfusion of the brain stem during hemorrhagic hypertension[J].Am J Physio,1996,270(4Pt2):H1350-H1354.
[2]Birns J,Markus H,Kalra L.Blood pressure reduction for vascular risk:is there a price to be paid?[J].Stroke,2005,36(6):1308-1313.
[3]Dahl9f B.Prevention of stroke in patients with hypertension[J].Am J Cardiol,2007,100(3A):17J-24J.
[4]Wu WC,Lin SC,Wang DJ,et al.Measurement of cerebral white matter perfusion using pseudo-continuous arterial spin labeling 3T magnetic resonance imaging-an experimental and theoretical investigation of feasibility[J].PLos One,2013,8(12):e82679.
[5]Huang DD,Wu B,Shi KN,et al.Reliability of three-dimensional pseudo-continuous arterial spin labeling MR imaging for measuring visual cortex perfusion on two 3T scanners[J].PLos One,2013,8(11):e79471.
[6]Ma N,Lou X,Zhao TQ,et al.Intraobserver and interobserver variability for measuring the wall area of the basilar artery at the level of the trigeminal ganglion on high-resolution MR images[J].AJNR Am J Neuroradiol,2011,32(2):E29-E32.
[7]Nael K,Meshksar A,Liebeskind DS,et al.Quantitative analysis of hypoperfusion in acute stroke:arterial spin labeling versus dynamic susceptibility contrast[J].Stroke,2013,44(11):3090-3096.
[8]Harris AD,Coutts SB,Frayne R.Diffusion and perfusion MR imaging of acute ischemic stroke[J].Magn Reson Imaging Clin N Am,2009,17(2):291-313.
[9]Gevers S,Majoie CB,van den Tweel XW,et al.Acquisition time and reproducibility of continuous arterial spin-labeling perfusion imaging at 3T[J].AJNR Am J Neuroradiol,2009,30(5):968-971.
[10]Wu B,Lou X,Wu XH,et al.Intra-and inter-scanner reliability and reproducibility of 3D whole-brain pseudo-continuous arterial spin-labeling MR perfusion on 3T[J].J Magn Reson Imaging,2014,39(2):402-409.
[11]Wright SN,Kochunov P,Chiappelli J,et al.Accelerated white matter aging in schizophrenia:role of white matter blood perfusion[J].Neurobiol Aging,2014,35(10):2411-2418.
[12]Li X,Sarkar SN,Purdy DE,et al.Quantifying cerebellum grey matter and white matter perfusion using pulsed arterial spin labeling[J].Biomed Res Int,2014,2014(8):108691.
[13]Fernandez-Cadenas I,Mendioroz M,Domingues-Montanari S,et al.Leukoaraiosis is associated with genes regulating blood-brain barrier homeostasis in ischaemic stroke patients[J].Eur J Neurol,2011,18(6):826-835.
[14]Kennelly SP,Lawlor BA,Kenny RA.Blood pressure and the risk for dementia:a double edged sword[J].Ageing Res Rev,2009,8(2):61-70.
[15]Beason-Held LL,Moghekar A,Zonderman AB,et al.Longitudinal changes in cerebral blood flow in the older hypertensive brain[J].Stroke,2007,38(6):1766-1773.
[16]Lassen NA.Autoregulation of cerebral blood flow[J].Circ Res,1964,15:201-204.
[17]Fisher CM.Pathological observations in hypertensive cerebral hemorrhage[J].J Neuropathol Exp Neurol,1971,30(3):536-550.
[18]Tryambake D,He J,Firbank MJ,et al.Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension[J].Hypertension,2013,61(6):1309-1315.
[19]Toyoda K,Fujii K,Ibayashi S,et al.Changes in arterioles,arteries,and local perfusion of the brain stem during hemorrhagic hypertension[J].Am J Physio,1996,270(4Pt2):H1350-H1354.