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目的探讨磁共振灌注成像在动脉瘤性蛛网膜下腔出血后脑血管痉挛中的诊断价值,并探讨脑血流动力学与脑血管痉挛之间的关系。方法采用磁共振灌注加权成像和全脑血管造影的方法,对38例动脉瘤性蛛网膜下腔出血后(7±2)d的患者进行检查并动态观察。通过磁共振灌注成像检查采集大脑全动脉供血区,大脑中动脉供血区和基底节区所选感兴趣区的各项参数,包括rCBF、rCBV、MTT和TTP。通过分析这些参数,研究它们与脑血管痉挛程度的相关性。结果在38例患者中至少1条血管痉挛28例(轻度痉挛9例,中度痉挛10例,重度痉挛9例),无痉挛10例。按血管痉挛程度分成无痉挛组、轻度痉挛组、中度痉挛组、重度痉挛组。将rCBF、rCBV、TTP和MTT等参数纳入统计学分析,采用Spearman等级相关检验。在所有区域,伴随脑血管痉挛程度的加重,rCBV及rCBF值有所下降(P<0.05),在轻中度痉挛组,各区域rCBF及rCBV参数有增加和减少现象存在,重度痉挛组较对照组rCBF明显减少(P<0.05)。MTT及TTP呈明显线性增加趋势,痉挛组TTP分别较对照组明显延迟,有明显等级相关性(P<0.01)。结论进行磁共振灌注成像检查可以定量地提供脑组织血流灌注的信息。综合运用磁共振灌注成像和全脑血管造影技术对于研究脑血管痉挛的发展过程中血流灌注变化,有重要的临床意义。
Objective To investigate the diagnostic value of magnetic resonance perfusion imaging in cerebral vasospasm after aneurysmal subarachnoid hemorrhage and to explore the relationship between cerebral hemodynamics and cerebral vasospasm. Methods Thirty-eight patients with aneurysmal subarachnoid hemorrhage (7 ± 2) d were examined by dynamic MR perfusion weighted imaging and whole brain angiography. All parameters of the selected region of interest, including rCBF, rCBV, MTT and TTP, were collected by magnetic resonance perfusion imaging in the areas of cerebral arterial blood supply, middle cerebral artery blood supply and basal ganglia. By analyzing these parameters, we investigated their association with the degree of cerebral vasospasm. Results Among the 38 patients, at least 1 vasospasm was found in 28 patients (9 with mild spasm, 10 with moderate spasm and 9 with severe spasm) and 10 without spasm. According to the degree of vascular spasm into no spasm group, mild spasm group, moderate spasm group, severe spastic group. Parameters such as rCBF, rCBV, TTP and MTT were included in the statistical analysis, and Spearman rank correlation test was used. In all regions, the values of rCBV and rCBF decreased with the severity of cerebral vasospasm (P <0.05). In the mild to moderate spastic group, the parameters of rCBF and rCBV increased and decreased in all regions, while in severe spastic group Group rCBF was significantly reduced (P <0.05). MTT and TTP showed a significant linear increase trend, spasm group TTP delayed significantly compared with the control group, a significant level of correlation (P <0.01). Conclusion Magnetic resonance perfusion imaging can quantitatively provide information on the perfusion of brain tissue. The combined use of MR perfusion imaging and whole brain angiography has important clinical significance for studying the changes of perfusion during the development of cerebral vasospasm.