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目的探讨活体质子磁共振波谱(1H-MRS)在蛛网膜下腔出血(SAH)性脑血管痉挛发生时的评价作用。方法采用两次注血法建立狗SAH模型,实验分为注射生理盐水组和注血组。于模型制作成功后3、7、14d分别进行1H-MRS检查扫描,记录胆碱(Cho)、N-乙酰基天冬氨酸(NAA)和肌酸(Cr)的变化。1H-MRS扫描后即刻进行脑血管造影检查,测定基底动脉血管痉挛发生情况,与1H-MRS扫描结果加以比较分析。结果脑血管造影结果提示在第3天基底动脉血管发生明显痉挛,到第7天各段血管痉挛最为显著,第14天血管痉挛明显改善;1H-MRS的检测指标显示注血组各项指标在第3、7天变化较大,其中NAA在第3天下降到低谷,之后逐渐回升,至第14天接近正常水平;Cho在第3天稍有下降,然后上升,至第7天上升至高峰,尔后下降;而Cr则一直表现为上升趋势,但第7天后上升趋势明显放缓,与第14天相对含量相比差异无显著性(P>0.05)。1H-MRS功能检测结果与脑血管造影结果具有一定的吻合性。结论1H-MRS可用来监测蛛网膜下腔出血性脑血管痉挛发生时病程进展,是一种较好的功能影像学评价手段。
Objective To evaluate the role of proton magnetic resonance spectroscopy (1H-MRS) in the diagnosis of cerebral vasospasm caused by subarachnoid hemorrhage (SAH). Methods The dog model of SAH was established by two times of injection. The experiment was divided into saline injection group and injection group. 1H-MRS scans were performed at 3, 7 and 14 days after successful model making. The changes of Cho, N-acetyl aspartate (NAA) and creatine (Cr) were recorded. 1H-MRS scan immediately after the angiography, determination of basilar artery spasm, and 1H-MRS scan results were analyzed. Results Cerebral angiography showed that basilar artery vasospasm was obvious on day 3, vasospasm was the most significant on the 7th day, and vasospasm was significantly improved on the 14th day. The indexes of 1H-MRS showed that the indexes of the injection group were On the 3rd and 7th day, the NAA decreased to the lowest level on the 3rd day and then rose back to the normal level on the 14th day. The Cho decreased slightly on the 3rd day and then rose to the peak on the 7th day , And then decreased; however, Cr showed an upward trend all the time, but the upward trend obviously slowed down after the 7th day, but no significant difference compared with the 14th day (P> 0.05). 1H-MRS test results and cerebral angiography results have some agreement. Conclusion 1H-MRS can be used to monitor the progress of subarachnoid hemorrhagic cerebral vasospasm and is a good functional imaging evaluation method.