Clinical application of 3D ASL in assessment of collateral circulation after unilateral internal carotid artery occlusion
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摘要:
目的探讨三维动脉自旋标记(3D ASL)技术在评估单侧颈内动脉闭塞后侧支循环建立状态方面的临床应用价值。 方法收集2018年1月~2020年2月经三维时间飞跃法磁共振血管成像提示单侧颈内动脉闭塞且无其他颅内动脉中重度狭窄患者22例,其中男13例,女9例,年龄35~76岁(52.2±15.5岁),均行3D ASL序列灌注成像检查,使用Functool软件将原始数据自动生成脑血流量(CBF)伪彩图,分别于闭塞侧颈内动脉供血区及镜像区额叶、顶叶、脑室旁白质区、基底节区选取感兴趣区(ROI=200±20 mm2),并对比责任颈内动脉供血区与镜像区不同标记后延迟(PLD)时间脑血流量值差异。 结果入组患者中,左侧颈内动脉闭塞12例,右侧颈内动脉闭塞10例,3D ASL(PLD:1 525 ms)时闭塞颈内动脉供血区脑血流量值明显低于镜像区,两组差异有统计学意义(P<0.05),当PLD为2 525 ms时,闭塞颈内动脉供血区脑血流量值略低于镜像区,但差异无明显统计学意义(P>0.05)。 结论3D ASL成像技术可用于评估单侧颈内动脉闭塞后侧支循环建立及灌注状态,对于患者治疗方案的选择及预测临床预后均具有重要价值。 Abstract:ObjectiveTo evaluate the clinical value of 3D ASL in the assessment of collateral circulation after unilateral internal carotid artery (ICA) occlusion. MethodsFrom January 2018 to February 2020, 22 patients with unilateral ICA occlusion and no other moderate or severe stenosis of intracranial artery were studied by 3D-TOF MRA In ASL sequence perfusion imaging, including 13 males and 9 females with the age from 35 to 76 (average 52.2±15.5). The functool software was used to automatically generate the pseudocolor image of cerebral blood flow (CBF) from the original data. The areas of interest (ROI=200±20 mm2) were selected from the blood supply area of ICA on the occluded side and the frontal lobe, parietal lobe, paraventricular white matter area and basal ganglia area of the mirror image area. The CBF values of the time delay (PLD) between the responsible ICA blood supply area and the mirror image area were compared. ResultsThere were 12 cases of ICA occlusion on the left side and 10 cases of ICA occlusion on the right side. The CBF value in the blood supply area of ICA occlusion was significantly lower than that in the mirror area in 3D ASL (PLD: 1 525 ms). The difference between the two groups was significant (P<0.05). When PLD was 2 525 ms, the CBF value in the blood supply area of ICA occlusion was slightly lower than that in the mirror area, but the difference was not significant (P>0.05). Conclusion3D ASL imaging technology can be used to evaluate the establishment of collateral circulation and perfusion state after unilateral ICA occlusion, which is of great value for the selection of treatment plan and the prediction of clinical prognosis. -
图 1 患者男,67岁,头晕1周,右侧颈内动脉闭塞后不同PLD CBF伪彩图
A: 3D-TOF MRA提示右侧ICA闭塞, ACA及右侧PCA开放, 右侧大脑后动脉偏侧优势; B-C: 3D ASL PLD:1 525 ms时提示右侧额顶叶低灌注; D: DWI序列未见异常信号; E-F: 3D ASL PLD:2 525 ms时提示双侧额顶叶脑血流量基本对称.
Figure 1. Patient, male ,67 years old, dizziness 1 week, different pseudo-color images after occlusion PLD CBF right internal carotid artery
表 1 不同PLD闭塞侧ICA供血区与镜像区CBF值 [mL/(min•100 g), Mean±SD]
Table 1. The CBF value of ICA blood supply area and mirror area in different occlusal side
部位 额叶CBF值 顶叶CBF值 侧脑室旁CBF值 基底节区CBF值 PLD:1 525 ms PLD:2 525 ms PLD:1 525 ms PLD:2 525 ms PLD:1 525 ms PLD:2 525 ms PLD:1 525 ms PLD:2 525 ms 责任供血区 22.562±8.316 50.462±5.847 21.265±7.836 49.554±4.763 19.741±6.972 40.841±5.225 19.863±7.254 40.872±5.652 镜像区 39.208±6.684 52.282±4.741 37.814±6.582 51.163±4.462 32.538±6.865 42.338±4.682 34.695±7.059 42.241±5.085 t −7.318 0 −1.134 0 −7.585 0 −1.156 3 −6.134 5 −1.000 8 −6.873 1 −0.844 6 P <0.001 0.263 2 <0.001 0.254 1 <0.001 0.322 6 <0.001 0.403 1 CBF: 脑血流量;ICA: 颈内动脉; PLD: 标记后延迟. -
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